0307-190 (AR)LICENSED CONTRACTOR DECLARATION
Ihereby 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 # Lie. Class Exp. Date
{.rte
X,
3 Date d Signature of Contractor' i''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 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 insurance carrier .& policy no. are:
Carrier Policy No.
0%'hT1: FUN l)
0_0435:
(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 1_ should become
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with`those provisions.
Date: Applicant1-
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
11
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 enterupon
the above-mentioned property for inspection purposes.
ignature (Owner/Agent); �J, i (1 • C. Date �?`� •'�' "
BUILDING PERMIT PERMIT#
DATE VALUATION. LOT (Y4;t`jr•J;?J�l TRACT
VA, RO
JOB srut
APN
ADDRESS
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OWNER
CONTRACTOR / DESIGNER / EN INEER
S.IC4 '4J.5.171 .(�d9 W.t.1..t...E� `I .. ..
:G'tJ.wl:?1 Xa'L� J $��:i d"i. .U'.,. 7�LJ..M1.iA;y� :N�� �. y3.;��l.LC.. ..
+ .t �4mf Tse C'A. 92253
: VInIIT-Alr s CA 192 37 _4
A CSW 49111
USE OF PERMIT
60.00 11;3e
QXRA;3-F CAVO;i T ' I114,8lt Sp ,
XTcOTJ:Y+?IAT.c1) `_)ffr"1` (31K w'WP'.i 111 r',',rXV;
21," .'OAA')
C"'CiNSI'MiCTION PER', 4 0 400041 O -WO an.,"o
M;t�11_N C H)WIt:
) O OP, �x:� A 9 W?1 ! 9 I M*
S'CRS,sIhPK , 9t OTIDIA PEfr RF—','K). )
01 -G0042-3 -000
.. • .*,vf ,� .t: `. ��i"it.'s��.dc.L�L.A.��Xti �.�'�'�u.'E��� �..r���CrofaM1
� • ��' jy'��r li��.
Al
c P 3 `2003
CI1aCEDE�?'.
RECEIPTDATE
BYDATE
FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings _
Ducts
Slab Grade F
Return Air
Steel
Combustion Air
Roof Deck ^-
Exhaust Fans
O.IC to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING PPROVALS
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
Encapsulation
Gas Piping
Gas Test
Appliances
Final
.-
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)
COMMENTS:
Coachella Valley Unified School District
837733 Avenue 55, Thermal, CA 92274
(760) 398-5909 — Fax (760) 398-1224 .
Project Name:
This Box For District Use Only
DEVELOPER FEES PAID
AREA:
AMOUNT ..
LEVEL ONE AMOUNT:
LEVEL TWO AMOUNT:
MITIGATION AMOUNT:
COMM/MD. AMOUNT:
DATE:
RECEIPT:
CHECK #:
r
INITIALS:
CERTIFICATE OF COMPLIANCE
(California Education Code 17620)
Date: 9/5/03
Owner's Name: La Quinta Villas Phony No. 714 403-6007
Project Address: 55-921 Winged Foot, La Quinta, PGA, 92253 ,
Project Description: Guest Casita Addition
APN: 775 330 001 Tract #: Lot #'s:
Type of Development:CResidentialRN Commercial
e Feet of Building Area: 315
Industrial
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/dev:loper.
} Dated
W
Signature:
SCHOOL DISTRICT'S REQUIREMENTS FOR THE ABOVE PROJECT HAVE BEEN OR WILL BE SATISFIED IN
ACCORDANCE WITH ONE OF THE FOLLOWING: (CIRCLE ONE)
Education Code
17620
Number of Sq.Ft.
Amount per Sq.Ft.
Amount Collected
315
$0.00
$0.00
Gov. Code
65995
Building Permit Application Completed: Yes/No
Project Agreement Existing Not Subject to Fee
Approval Prior to 1/l/87 Requirement
By: Carey M. Carlson, Asst. Supt., Business Services
Note:
Pursuant to AB 1C81=any room =addtttons or enc.lo u$ esoosf 0
squ.:are foot or less; are exempffrom de elo` eC r fees.,
Certificate issued by: Marcela Valdez; Facilities Clerk Signature:
NOTICE OF 90 DAY PERIOD FOR PROTEST OF FEES AND STATEMENT OF FEES
Section 66020 of the Government Code asserted by Assembly Bill 3081, effective January 1, 1997, requires that this `district provide (1) a w itt notice to the
project appellant, at the time of payment of school fees, mitigation payment or other exactions ("Fees"), of the 90 -day period to protest the imposition of these
Fees and (2) the amount of the fees. -Therefore, in accordance with section 66020 of the Government code and othe- applicable law, this Notice shall serve to
advise you that the 90 -day protest.period in regard to such Fees or the validity thereof, commences with the paymemt of the fees or performance of any other
requirements as descrifieWin section 66020 of the Government code. Additionally, the amount of the fees imposed is as herein set forth, whether payable at this
time or in whole or in part prior to issuance of a Certificate of Occupancy. As in the latter, the 90 days starts on the date hereof. This Certificate of
Compliance is valid for thirty (30) days from the date of issuance. Extension will be granted only for good cause, as determined by the School District, and up
to three (3) such extensions may be granted. At such time as this Certificate expires, if a building permit has not been issued for the project that is the subject
of this Certificate, the owner will be reimbursed all fees that were paid to obtain this Certificate of Compliance.
�'V:c:'m}doc5 drvlees/certii;cate o.[':omplitmce li?rm tlblesTO L1SEi.doc 1/16/03 T
PGA WEST II RESIDENTIAL ASSOCIATION, INC.
P.O. BOX 1282, LA QUINTA, CA 92255
(760) 776-5100. FAX (760) 776-5111.
September 29, 2003
Mr. Jack Rainaldi
1651 E. Fourth Street
Suite 228
Santa Ana, CA 92701.
Reference: 55-291 Winged Foot; La Quinta, CA
Architectural Change Request.='Addition ofCasita and cart garage -
Dear Mr. Rainaldi:
The Architectural Committee reviewed and approved your plans;for the addition of a casita and cart garage.
The cart garage door, will have no windows' or ornamental design, will match the existing garage door_ and
will be painted to match the trim color of your home:
Review by the Committee is only for general conformance with the architectural guidelines._ It 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 Committees decision"with regard to project.design.willbe final.._ Please refer to
the Architectural Rules for all required submittals.
Please contact Javier Contreras, supervisor, for Valley Gardening Service at 760/776-6667 and Carol Fuller,
the Association Manager, prior to anyirrigation modifications associated with this change. Damage- to the
landscaping, i.e'.-shrubs,- trees, flowers -'and turf is the responsibility of the contractor. The landscaping
must be brought back to .its ;original condition when the project is completed. This application, is approved
with the understanding that there .will be no additional landscaping. '
Approvals given by the Architectural Committee are good for bnly six months from the date on the
approval letter.. After that time a new -application must be submitted.
Upon,completion of your -.project, please complete and retuin The Notice of Completion of Architectural
Change. _
In the meantime if you have any additional questions or concerns, -please do not hesitate to contact Carol
Fuller, Association Manager, at 760/776-5.100, Ext. 20:
Sincerely,
"PGA WEST I1 RESIDENTIAL ASSOCIATION
For the.Architedural Committee
Carol Fuller, CCAM .
Association Manager. "
/cif
cc: Board of Directors
Unit File