9512-028 (SFD)LICENSED CONTRACTOR DECLARATION
I herety affirm that I am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and ProfessionalsCode, and my
License is in full force and effect. 435033 orw)
License # Lic. Class Exp. Date
Signatureof Contractor_ / it
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
following reason:
() 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, Business & Professionals Code).
O I, 'as'owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals Code).
( ) I am exempt under Section , B&P.C. for this reason '
Date Signature of Owner
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
( ) I have and will maintain a certificate of consent to self -insure for workers',
compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
( ) I have and will maintain workers' compensation insurance, as required by
Section 3700 of the Labor Code, for the performance of the work.for which this
permit is issued; My workers' compensation insurancecarrier & policy no. are:
Carrier INSINS. CO, iJA-ri'1,11;: Policy No, WE 7'143tki-0
(This section need not be completed if the permit valuation is for $100.00 or less).
( ) I certify that in the performance of the 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, and agree that if I should become
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those p;o tisions..,�7r
Date: ?- 2«y'f_Applicantr�
� 4
Warning: Failure to secure Workers' Compensation coverage is unlawful and shall
subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this application agrees to, & shall, indemnify
& hold harmless the City of Indian Wells, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the buildin
construction, and hereby authorize representatives of this City to enter upon the
above-mentioned
r
property for n
W;es�
Signature (Owner/Agent)Date
ALCM
ING PERMIT
� PERM IT�y;9t♦�, 4f$S
41IVIGAZ
�11CRUJ,
DATE
VALUATION ` ' " - LOT "" ` - TRACT
JOB SITE ADDRESS 57-5'7(i 1N Q ER,1,J% IJ%i IN
APN 761-480-049
OWNER
CONTRAC�T•O f ("ON 'NIX SNC.
SS pp p dd !� pp yy��yy
l��.d�i.+�L G & .&I L A,RS� I I
M1�7NA
?7,170 29 Rt1,1.�1Si 71.�"Y Y
1:3-625;ti-wy 1 i 1, s t r . •i^
MCCA VALLEY CA 912294
GA QUINTA CA 9225.3
(619)3,05-8091 MIA
(
DEslc t i� s I Y it Ca U 1' ii1C. S
fYQ`n'./`,l' 4".. s 9hT 'PT eKwv f1"Y i• 11 YO4
-
13-661 flWY111f#G
USE OFPERMIT`
PALM DESERT, CA (619)779-0405
t'crltlil: <1+>es Iio1. i.rtcltttle lytcaak vviJls e+r lt�,ol.
__ . _ FEE_DESCRIPTION. _
FEES
c.V,`. t nv `AJId Z1C.ULrt.1VW
GAP.AGE CARPORY 974.00 SF
ESTIMATE D COST € F CONSTRUCT
3+ 9,097X0
PERMffFEE KUit1':MARY
ALAN C' 1-WZk .TYrX3 1014)f,#t)-439-3113 $1,32t,49 .
CONS'r.R.LTM0'M FE13 101-000-418-000 31, 84.50
ll' ECTIANICAL !'1X 141-000-421-000 $-07.00
1711 Ct'R1C.AI 0313- `101 »000-4204)(9) $270.717
PLIJ1 MING F1 1: 101-000-419-000 $276,50
STr," NG A10TION 1: FE - RR5I.0 101,-000-241-000 $36.91
GRA UNG IMF, 1.01-000423-000 $20.00
:iN1+'RAS'1RUCTURllw FEE 225-000-443342 $6,6+30.00
ART TN.PUSL1C PLACFS-1aESIC 701-000••255-060 $672,74
k.i+.g:DEPOSIT
SLTB-TOTAL CONS'17RUCTIONI ND .PLAN CHECK
�10,63ytil
IX SS 13111. -PAID FEES
$0,00
ZA
D 1170 'AL PERKTr 7+ EEN SUE NOW
FEg 0 2 1996
$10,639,91
y
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKIWAI I APOR,OVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbdures or
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm) /
:ems_
COACHELLA VALLEY UNIFIED SCHOOL DISTRICT
CERTIFICATE OF COMPLIANCE
(Government Code 53080)
Project Name:
Project Address: 57-570 Interlachen, La Quinta PGA
Project Owner's Name: Stoker- Construction Phone No.: 770 0710
Project Description: one dwelling
Building Type (Check one): Residential XX' (Include No. of Dwellings)
Commercial Industrial
Tract No.: Lot No.:
(If tract, attach Schedule "A" of all lots by tract, square footage for each lot and total.)
Assessor's Parcel No.: 761 480 040
(If Schedule "A" is used show Assessor's Parcel No. for each lot if one exists or Assessor's Parcel No. for parcels before subdivided.)
Total square feet of Building Area: 4394 Sq.Ft.
Certification of Applicant/Owners. The person signing certifies that the above information is correct and makes
this statement under penalty of perjury and further represents that he/she is authorized to sign on behalf of the
owner/developer.
Dated: `-� 2 — z -- 9(o Signature:
City/County Certification:
(Signature) Optional
(Title)
SCHOOL DISTRICT REQUIREMENTS FOR THE ABOVE PROJECT HAVE BEEN OR WILL BE
SATISFIED IN ACCORDANCE WITH ONE OF THE FOLLOWING (CIRCLE ONE):
Gov. Code Gov. Code Project Agreement Existing Not subject to fee
53080/65995 65970 Approval prior to 1/1/87 requirement.
Note:
Total Number of Sq./Ft. 4194
Amount per Sq/Ft. $ 1.72
Amount Collected $ 7,557.68
School District Official : J2.rro.? Title: Asst. Superintendent, Administrative Serv.
Foch "Tut" Pensis
Date: Feb . 2. 1996 Phone: (619) 399-5137, Ext. 235
Note: AB 2926 and SB 201 fees are capped at $1.72 per square foot for all residential construction, and at $0.28
per square foot for commercial/industrial projects.
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MEMORANDUM
TO: MARK HAROLD, BUILDING AND SAFETY MANAGER
VIA: CHRISTINE DI IORIO, PLANNING MANAGER
FROM: GREG TROUSDELL, ASSOCIATE PLANNER
DATE: JANUARY 17, 1996
SUBJECT: PLAN CHECK REVIEW (57-570 INTERLACHEN)
According to your request, we have reviewed the proposed single family custom home at 57-570
Interlachen in the PGA West Resort. Our comments are as follows:
1. No mechanical equipment shall be located within any required building setback. The
proposed AC condensing unit on the south side of the home shall be relocated so that it is a
minimum distance of five feet from the property line.
2. The PGA West HOA should approve the plans before issuance of a building permit for this
home.
If you have any questions, please call me.
STRUCTURAL AND CIVIL ENGINEERING
DENISE R. POELTLER, INC.
73.661 Highway 111 • Suite G • Palm Desert, California 92260
9 January 1996
Mr. Mark Harold
CITY OF LA QUINTA
Building Department
78-495 Calle Tampico
La Quinta, CA 92253
RE: LARSON RESIDENCE
57-570 INTERLACHEN DRIVE, PGA WEST
Dear Mr. Harold:
I have reviewed the dead and live loads used for the design
of TJI roof trusses, provided by TRUS-JOIST MacMILLAN and
found them in substantial conformance with my original design
loads.
Respectfully submitted,
Denise R. Poeltler
R.C.E. '33446
DRP/lm
W.O. #95-188
CC:
(619) 779-0405 . 0 FAX (619) 779-1317
No, 33448 '
Exp6-30
\CIV��'
POA WEST 11 RESIDENTIAL ASSOCIATION, INC.
P.O. Sox 1232 • La Quinta, CA 92253
J•anVary 25, 1996
Earl & Madeline I arson
l(e: Custom Residf,ncr Architectural Application - .57-570 In orlachzm, La Qui nta.
3Dear Mr. & Mrs. Z arson:
Z am pleas -ed to report chat the revised plans, as submitted by -!oi.ir Architect lu ichaal
K.iner, havq been approved by the Board of Directors of PGAWest II Asspcia• ion. The
approval o these pian: are based upon the following condicic is, and subject tc receipt of
a -complete set ofmvis.:d plans from Mr. •Kiner:
1. Flat roof tih:s tc, be replaced with barrel type, minimum 2 olors, color choices to be -
approved in ads am a of installation by the PGA West 11 R ;sidential Associi.tion
Architectur,,1 C aLi aittee.
2 Elimination oft.ie' 2 inch tail copper facia.
3. Softening of ext-, - r surface colors, to blend better with Gall ries and neighboring
Custom Honies, to be submitted and approved by the Col imittee in advance of
application. .
4. Per the red-linec roof plan and elevations ::;ubmitted by :Ala . Kiner, and referenced in
his letter of January 23, 1995 (attached), the I30ard has ap: ,roved the following
revisions.
a. E ;da, gement of the existing tiled roof over Vie dining/great room
b. F ala, gement of the existing tiled roof over tr,e breakfast rootii
c. I✓n1a! gement of the existing tiled roof over t.►e clary
dl. Ccea: ioh•ofa tiled roof over bedroom #4
e. Chane or'roof pitch to 5: X2 over the master bedroom, and other:; as
marked on the redlined plans
f. C iat) ges of slope aid size markings as shave 1 Gin redlined roof plans
g• C;lai� e'o►F roof. pitch to 'l2/6 as shown or: rc Mined elevations
m,. rirch r:<rsa::hr,'>S.rc:>?•I�.;o:! �:�pr:��._ .,:c.• .,. .u.:•,,:,,:,:�.rr_ a,.;
I
"MR. & N[RS, l.'.AU LARSENT
ANCAR Y' 25. 1596
PAGE TWO
5. The Board and C"onimittee, wbile approvir:g these revised plans, would still like to see
some.form of pyramid. or hip over, that large flat garage area, even if only over the cart
barn, .to break up the flat appearance from the street side of the left side of the }souse,
If this is still a possibility acid is desired by you, we'd ceilainl' approve it.
t J'�s iji.dieated in Mr. Kine r's telephone conversation with of:r property manager John..
'I fandel on J<<nu 3ry 24, 1996, 'it is imperative that any fu. tb(;r change orders contemplated
1,y yourselves o: N:r. Kiner that affect the exteriors of your home must be submitted in
biting for apps oval -by the committeeprior to their implementation. please allow a t least.
i •vo weeks to o Main approval for such changJ; orders. TluA will ensure that we five
a iequate time le to your concerns; as well as ours. 1
7: hank you. for your patience and perseverancuin this in -Tc -cunt matter. As noted above,
we must rec( ivf a complete copy of the redrawn plans (per the guidelines, and including
s1ructural enin+tering flans and calculations), prior to commencement •of constructic!n. of
tl,e footings of } our home, Finally, we w 11 reed anew co'or Board with samplfs o 'roo '
tics (barrel type), stucco colors and paving sraterials.
,Triank you f(.r y )ur coc.peration, and we look forward to the addition of another fin(
cl Istom residcric : te: PGA West 11 Residential Association.'
S. !�cerely,
P 3TA WEST 11 PESIDENTIAJ ASSOCTATIc.)N
1-,
oo
4 �f
D )n Troy, Chair nasi
A ch4ectural Review Comirittee v
cc Board of tors
1< ices associates ;
fol n Handel, The Monarch G.-oup
en..;,
cmton!rch•us_rs iohnlp,.,yres' +Jerson approval lmer!urcu,tom,rcgi�itgca.dn�