0005-035 (AR)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
.Chapter 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. 845��J Date////��.��
6857 BTC 0413112(12(
Date � 5' Signature of Contractor L4 �'�-
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 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.
(ave 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:
Carrier CA IN.i: EAS WITY 11113 Policy No. )4903727113
(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,II s�hajI forthwith comply with'thos - ro`vislons.
Date: Applicant_*r ice+
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 property1or inspection purposes.
Signature (Owner/Agent), Date
BUILDING PERMIT PERMIT#
DATET GALUATION LOT TRACT
ffff $13,032.00
JOB SITE
ADDRESS
: fi=i95 WINGFDMOT
APN t
( f
OWNER
4 ,
CONTRACTOR/DESIGNER/EN (NEER
ST'AfiiUY TAK.."AKi
BOB MWARDS CO U` 7014
54-595 W11` ORD Q1'
79.9710 Y01111 A 7✓XWEr1
LAQ7,111-TTA CA 92253
LAQi�p, CA 92253
(760)775-7933 C:BL#, 3212
USE OF PERMIT
«'r` ) ),
99FRCISIr ROOA4 ADDITION 2,10 SQ. FT.
ADDITION 240.00 SF
X97DWFM) COV OF CON.TrRUC'1'JEON
13,03:.2.00
:PERMIT F 1M SUMMARY
PIAW CHECK nE 101-000-439-518 $99.45
Ca ISTRUC TIONI FEE 101.000-419-000 $133.00
MECHANICAL FU 101-=0-421.000 $19.50
ELECTRICAL FSK 101-000-420-000 $21.00
P.4
E
SUB-`1~WAL C✓" 0NMUC iON AND PLAN CHECK
LOS PRE -PAM .Y'tk W
$0.00
rs.
'Y0TAL 1?'r'1 .M_,.CY FEES DU -C, Ti0W
WV95
RECEIPT
DATE
BY -
D,AT FI ALE D
INSPEC R
1 ' .: •1 r N*4011
,
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
s�
Ducts
Slab Grade
�sv�
Return Air
Steel
Combustion Air
Roof Deck
/
Exhaust Fans
O.K. to Wrap
(�]'
F.A.U.
Framing
Compressor
Insulation
/s
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
G 1--3
Final
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
I I
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
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
�, ..Desert Sands Unified School District ,
47-950 Dune Palms Road
Notice: La Quinta, CA 92253
Document Cannot Be Duplicated 760-771-5515
CERTIFICATE OF COMPLIANCE
Date 5/5/00 APN # 769-450-04_`=
No. 20401 g Jurisdiction La Quinta ' • , '
Owner NameStanle4asaki Permit #0005-035 :
No 54 Street d�_V' Log #
:�,
City,La'Quinta Zip 92253 Study Area ,.
Tract # Lot # Square Footage 240
Type of Development Residential Addition No. of Units . I
Comments, 240 sq. ft. Exercise Room Addition.
At the present time, the Desert Sands Unified School District does not collect fees on, garages/carports, covered '
patios/walkways, residential additions under 500 square feet, detached accessory structures or replacement mobilehtanes. It
has been determined the above-named owner is exempt from paying school fees at this time due to the following reason:
itesidentiai Addition 500 Sq Feet or Less ,
EXEMPT -
This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of -
- 0.00 X 240 or $ 0.00 the property listed above and that building
permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued
~,Fees Paid By N/A - Bod Edwards
By Telephone., 760=775-7533
Name on the check
By Dr. Doris Wilsonn�
7
Superintendent Y ..
Fee collected /exempted by MaryAnn L. Borja Exempt + `�;:• $0.00 F
�� t ..t, -
Check No. N/A
Signature
f
OTICE: Pursuant of Assembly BIII 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 9"ay approval period In which you may protest the fees or other pa-ment identified
ovwill begin to run from the date on which the building or installation permit for this project is sssued or on which they are paid to the Districts) or to another public entity authorized to
llect them on the District('s)(s') behalf• whichever is earlier.
Collector: Attach a copy of county or city plan check application form to district copy for all waivers.
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy- Accounting
FROV9.: MONARCH-ACCOUNTING PHONE N0. 760 776 5112 Mar. 16 2000.04:36PM P3
PGA WEST II RESIDENTIAL ASSOCIATION, INC.
F P.O. BOX 1282, LA QUINTA,' CA 92253
1 ; ` (760)"776-5100 FAX. (760) 776-5111
March 16, 2000 .
Mr. Stan Takasaki "
54595 Winged Foot".
La Quints, CA-92253
Reference: Architectural Change Request for a Room Addition/Additional Landscaping
Dear Mr. Takasaki: -
�The Landscape Committee and the PUD Architectural Committee reviewed'your request for a room addition
and additional landscaping at their meetings on Mardi 8th and March 14th, respectively.
The PUD Architectural Committee wishes to advise that your application has been approved as
submitted. The Landscape Committee wishes to advise that when the Queen.Palm is relocated
. and if it dies, the tree will be replaced at the homeowner's expense.
Review. by the Committee is only for general conformance with the architectural guidelines. L is
the responsibility of the owner to fully understand and conform to the architectural guidelines
criteria whether or. not all deficiencies are noted during review. It is also the owner's full
} responsibility to field verify all existing conditions. The Committee's decision with regard to
project design will be final. Please refer to the PUD Architectural Guidelines and Application fir
R - Changefor all required submittals. -
Please contact Raphael Villareal, supervisor for Valley Gardening Service at 760/399=1844 and
Carol Fuller, the.ASsociation Manager, prior to any irrigation modifications essociated'with this
change. Upon completion of changes, please contact Carol Fuller. Damage to the landscaping;
i.e.,"shrubs, trees, flowers and turf is the responsibility'of the contractor. The landscaping most
' be brought back to its original condition when the project is completed. ,
Approvals given by the Architectural Committee are good for only six rnokhs from the date
on the approval letter: After that time a new application must be submitted.
If you have any additional questions or concerns, please do not hesitate to contact Carol Fuller,
Association Manager, at 760/776-5106, Ext-20. '
Sincerely,' f• .
PGA WEST II RESIDENTIAL ASSOCIATION
For the PUD Architectural Committee
t
Carol Fuller
Association Manager
cc: Board of Directors
Unit File +