9712-091 (AR)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
,"Chaptcf 9 (commencing with Section 7000) of Division 3 of the Business and
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
(,211505
.Date s Signature of Contractor ,✓ r �� _ ;
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury 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).
( ) 1, -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 &II 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 insurance carrier & policy no. are:
Cartier Policy No.
(This section need not be completed if the permit valuation is for,$100.00 or less).
(x�^ 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, j rovisions. �
.Date:�, _ .... - dr -Applicant
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 applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, 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 building
construction, and hereby authorize representatives of this City to enter upon
the,above-mentioned property for inspection purposes.
(Signature (Owner/Agent) Date A • "x •'
,,,/ r v-
BUILDING PERMIT PERMIT# °°NTR°`"
9712r01 . ..
DATE / VALUATION $24.928 00 LOT, TRACT 0
8 Q
JOB SITE { "
ADDRESS .57-719INtfERLACHEN'
APN
761.-4.18.04 '
OWNER -
CONTRACTOR/DESIGNER/ENGINEER
1. V.NK & 1.A1,11CF VPI.-:tt
57-719 titTl.'1;KLACHEN
3802 Art?M[;DA tdt,1M
LA `UINTA CA 9225:1
,.A (XJ brI'A CA 92253
(1uf?}Sf.�'-].271 f.F3i.fi :'1€kS
i OR or fiRIP'C`l};iv`
USE OF PERMIT
F\D.ON'74.3454
WAX :"s` E. 0
pp
r
Av�i.i�� 4:i< 10. CI D?vSTRUL<.i 10W 3,20.00 3F
Ulf,' :S`R'A3'.ED vO ':l~' OF CON.,1, giaOCTION
PLAN CHECK FEE. 101-000-439-3 1 K
C,E7vNV'itl3C'D f0N F IFIR 101-0100-419-000 S?5100
7
Awl
1.511
rl.:Ej:'FKtICM; D/ES— 10140.420,000 $24+.2C►�
,�
t'LiiiNl3i3ffv! €!? 101 -000 -419 -OW $46,50
'tis i�ilf, U3tti`I'lfa3� nit! -1W."Pi) 101-OW-2AIA00 52.49
'�
0)
.
CD
G�2
SUD A'.Ad, C'0NS1!�UC* 11QN ANT) PLAN CTtB;CX
$532.4,40
-P111,XR`A71jD E'.i":V
O� m A q g y� 3 l ■ pUSS
RECEIPT
DATE
BY/ W
DATE FINALED
INSPECTOR
,4
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
7
Underground Ducts
Forms & Footings
Ducts
Slab Grade
_
Return Air
Steel
Combustion Air
Roof Deck
— — r
Exhaust Fans
O.K. to Wrap
-t
F.A.U.
Framing .
Compressor
Insulation
4 —
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
-
Condensate. Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Finalo
—�2
Final
POOLS - SPAS
BLOCKWALL
APPROVALS
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
OX for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
&V .. p _
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
~
`
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
_Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures .
Main Service
Sub Panels
Exterior Receptacles
G.F.X1 z .
_ Smoke Detectors
Temp. Use of Power
t.
Final'
Utility Notice (Perm)
Coachella Valley Unified School District
P.O. Box 847, Thermal, CA 92274
(760) 399-5137, Ext. 235
This Baa For District Ilse Only
CERTIFICATE OF COMPLIANCE
(Government Code 53080)
Project Name: Date: February 13, 1998
Owner's Name: Ivar & Janice Szper. Phone No.
Address: 57-719 Interlachen, La Ouinta, CA 92253
Project Description: Room Addition
APN:
Lot #:
Type of Development• Residential XX Commercial Industrial
rare Feet'' � ilding Area: 320 Sq. Ft.
Certification of Appliean wners: The person signmg certifies that the above information is correct and s s statement
under penalty of perjury and further represents that he/she is autorhized to sign on beh of the owner/devel r'
Dated: • •Signature: 4X�
1
SCHOOL DISTRICT REQUIREMENTS FOR THE ABOVE PROJECT HAVE BEEN OR -WILL BE r
SATISFIED IN ACCORDANCE WITH ONE OF THE FOLLOWING (CIRCLE 0NE)-`.
Gov. Code Gov. Code Project Agreement Existing Not subject to fee,
53080/65995 65970 Approval ;...•prior to 1/1/87,- ,L requirement. ,
Notes. Pursuant to AB -181 any room additions
Number of Sq./Ft. 320 - , `� or enclosures a 500 sq_ ft_ or lecc, are
Amount per Sq/Ft. $ exempt from `developer fees.
Amount Collected $
By: Foch "Tut" Pensis; .Assistant Superintendent Administrative;Services
Administrator in Charge '
Certificate issued by: Marcela Valdez Si-Ma/Trdaz�dle,�&-
gnature:-,. / N
NOTICE: Section 66020 of the Government Code enacted as Assembly Bill 3081, set forttn as Chapter 549, Statutes of die State of California 1996 effective Jan. 1, 19.97, requires that this schoal d a written notice to
the project applicant at the time of payment of school fees, mitigation payment or otter exactians. Thu notice is to advise you drat any protest in regard to such amounts or die validity duueof in ac6ordance with Section 66020
of the Govenunennt Code and older applicable law, commences with such payment or performance of any other requirement as described in Section 6MO of the Government Code. Additionn0y,116 noticeiadvises 0mt the
protest dumf must occur within 90 calendar days thereafter.
Note: AB 292&'and SB 201 fees are capped at $1.84 per square foot for alLresidential construction, and at $0.30
per square foot for commercial/industrial projects.
f e Dev. Fees Disk: tvlisc\Cert-Com.Sam. (REV. 1/97) I l
28k
PGA WEST
February 24, 1998
PGA WEST II RESIDENTIAL ASSOCIATION, INC.
P.O. BOX 1282, LA QUINTA, CA 92253
(760) 776-5100 FAX(760)776-5111
Dr. Ivar Spzer
RE: Architectural Change Request for 57-719 Interlachen
Dear Dr. Spzer:
The Architectural Committee is pleased to inform you that it has approved your request
for a Casita addition at the above referenced home. Please be advised that this addition is
good for a period of six months will end on August 24, 1998. If the work is not begun by
that date a new application must be submitted.
The Association requests that you contact its Landscape Foreman Miguel Valenzuela at
(760) 399-1844 to coordinate any changes.
Please contact me at (760) 776-5100 to do a final inspection of the project when the work
is complete.
Sincerely,
John J. Monahan
Association Manager
CC: Architectural Committee Unit File
Board of Directors
to i Y ur LH UUMI I N
SUB -LIST
CONTRACTOR:Ii�� ADDRESS-
OWNER /%�L9 pYGs a � ' JOB ADDRESSS-> 7Aq aT {
This form shall be posted on the job with the Building Inspection Card at all times In a conspicuous per.
It is the responsibility of the General Contractor or the Owner/Builder to monitor the sub -contractors that
are on this list are the same persons performing the work. Any changes to this list must be approved the
City. of La Quinta Department of Building & Safety 2ELQE to work being performed by a changed sub-
contractor. Failure to comply will result.in a stoppage of work and/or the voidance of building permit.
°TRADE' '
SUB>CONTRACTOR'S .
:NAME
':TYPE'OF
LICENSE
STATE
CONTRACTOR'S
LICENSE
NUMBER- "
:WORKER'S
:COMP. NAME!
:NUMBER:ONFILE.
CITY
BUSINESS
LICENSE
NUMBER/
: EXP. DATE
GRADE/
:EXCAVATE
A/C -12
PIPELINES
C-34
CONCRETE/
FOUNDATIONS -
�
C-8
ASPHALT'
A
FRAMING
B
STEEL/
STRUCTURAL
C-51
MASONRY
C-29
PLUMBING
C-36
LATHING
C-26
DRYWALL
142
C-9
Grp C�/11�
aye
PLASTERING -
C-36
to
C-20
ELECTRICAL
(General)
C-10
Ejc
ROOFING
C-39
/
SHEET METAL -
C-43
-FLOORING;:-:
C-15
k
-
GLASS!
GLAZING
C-17
-]bor;I
C-2
D
I a� AT
6
SEWAGEIDISP.
C-42
!m
PAINTING/
DECORATING...,
s
C-33
TILE.
C-54
r
CABINETS/
INSTALLATION
C-6
FENCING ; ' :.
C-13
ANDSCAPING :
k/
C-27
POOLS
C-53
OTHER