13159 (RPL)r
P.O. BOX 1504 N o .
Building j'Q•• d '� Southern Hill: 78-105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
Owner .
Joe DiPonti
]BUILDING: TYPE CONST. OCC: GRP.:
Address 24974 Lorena Drive
City Zip Tel.
Calabasas, cA 91302 (818) 591a-9540 [Legal Descript
Contractor.
stetre bodson Construction, Inc.
Address
68-805 A Perez Road. 2-9
P. Number
City Zip Tela
Cathedral Cites, & 9.223+ 324--3232
State Lic. City
8 Classif.5741'27 A Lic. # 1044
Arch., Engr.,
Designer
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed ynder provisions of Chapter 9 (commencing with Section
effec of Divjsion 3of�the Businessand Professions Code, and my license is in fdull force effect. 3/rldlf/Y/ �1 ,
nd
.F 1
_ SIGNATURE' ti. - DATE
OWNER -BUILDER DECLARATION
I hereby affirm'_that I am exempt from the Contractor's License law for the following
reason: (Sec.' 7031.5, Business. and Professions Code: Any city or county which requires a
permit to construct, after, improve, demolish, or repair any structure,, prior to its issuance also
requires the applicant for such permit to file a signed statement that he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis
for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
❑ I, as owner of the property, or my employees with wages as their sole compensation, will
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Professions Code: The Contractor's License Law does not apply to an owner of property who
builds or improves thereon and who does such work himself or through his own employees,
provided that' such improvements are not intended or offered for sale. If, however, the building
or improvement is sold within one year of completion, the owner -builder will have the burden
of proving that he did not build or improve for the purpose of sale.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to, an owner of property who builds or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby, affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's C6mpensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy , o. Company
Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
or less.)
I certify that in the performance of thg work for which this permit is issued, I shall not
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California. -
Date Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I certify that I have read this application and state that the above information is correct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives -of this city to enter the above•.
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
Description Pool and Soa
Sq. Ft. No.
Size Stories
1:3159. .
No. Dw.
Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition .❑
tstimateo valuation $25,000.00
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
.S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
AMOUNT
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECT -OR,
Issued by: Date Permit
Validated by:
Validation:
i
R
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. @ $
UNITS
SLAB GRADE
r ^
BONDING
YARD SPKLR SYSTEM
2ND FL. SQ. FT. @
FORMS
SEWER OR SEPTIC. TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. @
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR. SQ. FT. @
TEMP. POLE
GROUT
DRAINAGE PIPING
CAR P. SO. FT. @
FINAL INSP.
WALL _ SO. Ff. @
WATER SYSTEM
DRINKING FOUNTAIN.
GRADING
cu. yd.
$ plus x$
=$
URINAL
SQ. FT @
FRAMING
OINAL INSI. "/-?—.l
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
REMARKS:
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
SPARK ARRESTOR
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SQ. FT. @ c
BATH TUB
INSULATION/SOUND
SO. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID @ 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR @ 3/ac
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEEPLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC. TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP f ?
FRAMING
OINAL INSI. "/-?—.l
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL
ARCHITECTURAL/LANDSCAPE VARIANCE APPLICATION
PGA WEST RESIDENTIAL ASSOCIATION, INC.
Please compl''ete and include this request form, along with four (4)
sets of your, proposed home improvement,plans to:
PGA WEST RESIDENTIAL ASSOCIATION, INC.
P.O. Box 1060
La.Quinta,.. CA 92253
0r,,55-940 PGA Boulevard
' La Quinta,-.CA'92253 ,
Attn: Property Manager
I , ;C� n
'
NAME:, `-'C �. 1.' [-� - DATE:
ADDRESS:_',; 42 So -: •Yh,r rn. 1 1 t l
L�P_ o, 4±C,--Ay 22.53
PHONE: 6 1 cj T1- 0 UNIT:
PROPOSED 'START ING DATE : • - I L,_ `j 3
APP XIMAT COIgP N DATE: "7 - 21,: - q •' '
' %�
0 own, 's Signature
The following appropriate information should accompany your
completed application:
1. Four (4) sits- of�` complete plans to include:
a. . Improvements and/demolitions
b. Plot plan
c. All dimensions proposed
d. Relationship to neighboring units
.e. Material and color scheme
f., Planned modifications of all external systems (land-
scape, sprinklers, gas lines, electrical, etc.)
2. Agreement and Covemant Running with -.the Land completed
and .notorized.. Two (2) original.
3.,. Conditions of Approval and Disclaimer. form (signed) '
4. Facing and Adjacent, Neighbor form. (if :ipplicable)
5.. Constructio Regulations form (signed); '
ELECTRICAL [ Approved[ ] D'sapproved
Signature Date
LANDSCAB 9�� [ ] Approved [ ].Dis roved
00t e. "ILE. � Au P �v� rcEss
Signat re Date
ARCHIT 0 ITTEE [-Approved Disapproved
Al6 3
Signature U`. Date- ,
ARM H/Rev 5/9 3' -1-
Architectural Committee Worksheet
6 1 3 �"os� P N 01 P6nT I S y-) 411 0 Ln w*.. f� t «s
Date Received Owners Name P.G.A. West Location
5. �2An12 FbOt-1SPA I3��N� - 3yo�
Received By Type of Request [] CompleteInccomplete
Checks Recieved onT_�P13
Riverside County Recorders Office: Check # Amount $
PGA West Residential Association Inc. (Non Refundable)
Check # Amount $ 2 Deposited on
PGA West Residential Association Inc.- (Refundable)
Check # 2 Amount $ OQ��eposited on Refunded
Approval Application# [] Complete [] Incomplete
t
Agreement & Covenant # [] Complete [] Incomplete
Notarized '[ ] Yes.' [ ] No -Number of Plans-' 6
?a3
Contractor Name �(� A Contractor License # • Proof of Ins.
Submitted to:
.Architectural'Cohnittee Member Ini ials .Date
Reviewed By: !4 ' (i/LC M3
k Architectural Commute Member. I itials Date
Approved
Denied [ ] Architectural qoAmittee Member. Initials Date ..
- P
ADDITIONAL APPMVALS REQUIRED,--
Reason
EQUIRED.Reason Date Name Signature '
Reason Date Name Signature
O
Sharon Franz,
REMARKS: Asst. On Site Manager
PGA West Residential #1
"PERSONALIZED"
Property Management Co.
55-940 PGA Blvd.
La Quinta, CA 92253 (619) 771-1234