0002-433 (RPL)LICENSED CONTRACTOR DECLARATION
reby affirm under penalty of perju y'that I am licensed under provisions of
n F Ch�pier 9. (commencing with Section 1000) of Division 3 of the Business and
}cam w Professionals Code, and my License .is in full force.and effect.
M 'License #' Lic. Class-,", xP. Date
LO
.� W r__, 397232 CIb3II201
M o Z r— Date Signature of Contract Y't
0 %
J U � OWNER-BUI R DECLARATION
W W I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ 10_ License Law for the following reason:
Z_ ( ) 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).
( ) I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
M () I am exempt under Section , B&P.C. for this reason
LO
N Date Signature of Owner
ON
Q WORKER'S COMPENSATION DECLARATION
CL
C) 2 Z I hereby affirm under penalty of perjury one of the following declarations:
Lo ~ O () 1 have and will maintain a certificate of consent to self -insure for workers'
Xw �= compensation, as provided for by Section 3700 of the Labor Code, for the
m_J Q peformance of the work for which this permit is issued.
Q O Qf I have and will maintain workers' compensation insurance, as required by
O (-) Q Section 3700 of the Labor Code, for the performance of the work for which this
L Z permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
O STATE; FUND n • 1 7316.4e)
4e)
J (This section need not be completed if the permit valuation is for $100.00 or less).
() I certify that in the performance of -the work for which this permit is issued,
I shall not employ any person in any manner so as to become subject to the
workers' compensation laws of C'aliforn'ia, ay�d ag/ee tl}a if I should become
subject to the workers' compensation/provi$%ns, Sectio 7fl0 of the Labor
�Code,,,l shall forthwith comply with tFi - pr6. Iv s o . r
l ate: 0 Applicant
Warning: Failure to secqre Workers' Compensation coverage is unlawful and
shall subject an employer°to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
�\ any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
• correct. I agree to comply w'lth'al11 City, and State laws relating to the building
construction, and hereby authorize represen fives of this City to enter upon
the above-mentioned property for inspection71,
os, S.
11 3
J
Signature (Owner/Agent Date3_?—
t
BUILDING PERMIT PERMIT#
DATEVALUATION 31511" LOT TRACT
JOB SITE!
APN
ADDRESS 5&2" GRMiil 1VAVU0r6
OWNER
CONTRACTOR/DESIGNER/ENGINEER
PAUL & VIROINIA MAIE TA
StJN.tiiR KY)L,"
50-360 GRAND TRAVERSE
P.O. ,BOX 835
LA Q*JINfA (.'A 92253
PALM DESERT t_'A 92261
(619)_'56$-4014 ('91'm 521)
USE OF PERMIT
Fi XJL ANLYOR SP k
1't x�i. Sc 'A C1A11 i-AL/iiZtLl lSAi<itltsltJ SkALL ifti iN PL&Ch AT ilkL
i'LA13't'H!t iNS,t+tvt: ftt iN
PCKiL ANU0R ;,'PA 1 +.300.00 LS
F-STIMATED C(JST• OF CONSTRUCTION
ts,3o�.sa
PERMIT FEE SUMMAR V
PLAN t'Hh0K FUi i01 -WO -439-3113 sill is
(YINS 1R 1 K 7101`4 PP'f± 10 t -(M-41 K-dl(1() %171 1 0
NIL(IIANICAL FFX � 1'00L 101-0(20-•121-000
i!Lia; i'R(CA1. H -- tax -)L itii-t}ii0 d2it-()GG US.+Ku
PLtR BIN1ti PM -- t►tKA, 101 -(K)(? -419 -Wu
w f:
C1 IR-Tin'A1.(T)WfiMT.)tTION ANI)PLAN CHFCW
fi179 1 S
IX.S-S PRF PATI )1l.E;�
Sn 00
T YM, PYRMTT 11PERS DUE NOW
S37N.1S
RECEIPT
DATE
BY '. /
DATE FINALED
INSPECTOR
i /
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
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 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 G(/
Gas Piping
Gas Test
Appliances
Final Q—
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Vottage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS
/S: _
� .
A. ,, � � o �� PLOT PLAN
GENERAL SPECIFICATIONS
�� W siva cod 3 v
a
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F�• � i. .'r' , rr: .r') -.. ''- tic ra
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tb• . :ter;• ,! e y �..
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A RE -INSPECTION FEE OF $30 ;" CITY OF LA OUINTA
��
WILL BE CHARGED IF APPROVED BUILDING SAFETY DEPT.
PLANS AND JOB CARD ARE NOT ON
rv�%g
THE SITE fOR A SCHEDULED Ir ;_ r
INSPECTION. M i . C' - . ,- ' t
.NO EXCEPTIONS! 00
BY
DATE
x
C-0
$ %4 JCP
C
r 0
oil,
oa..� 1_
D.an to 5 tD
TU* Cola G R fl TT -
Coping 12' Can wwwE S
Pod
d Capacity L 0 0 0 coals
Pump CapwHY j•— O.P.Y.
Filo► P1 0 Z Z SQ. Ft.
Pump iLo N Z p_ H.P.
Filler Raft 7 0 O.P.M.
vimo er r'n 5 Mrs.
Wmmm Lina a Skimmer I� •
Ratorn Lina
Main Drain . ' L •
8l*mwr
b
Awayplan Valva
Haabr j,,o,Sin 2 , a o 3 &T.U.
(�
t Osalins by 5(/AI A 6 JL Electric by
Ligm
T4na Clods
/
DockiiM
Board rJ Color T7
sue. • Cir
%
Nam. A,:4 L. -1/i re i �,'r �► m Pr I a tf- R
AM5 0_ Z(o :'� 61*04 eSe-
CRYY z4 u v Lao
__ ......
Cross Straats
PAona
Dab 2 -X— 0 J Drawn try:- ).V �L
"AIR
DEE►
3 END 5
!, SINCE 1574
am
1 SHALLOW END. am eon COk
R4LAt OESRC G 97�r
SCALE 1H" - IV* sm ucom C
PLEASE COMPLETE FORM AND RETURN TO:
LA QUINTA FAIRWAYS H.O.A.
AVAIL PROPERTY MANAGEMENT
P.O. BOX 1032
PALM DESERT, CA 92261-1032
(760) 568-2717
(760) 568-0324 (fax)
REQUEST FOR ARCHITECTURAL VARIANCE APPROVAL
Homeowner PAUL ¢ Y1 RGI/V/M l`'I/-� I � Date 77-Z�8-6G
Property Address S0 _';)'60 7R4 Lot Number
Contact Telephone Number(s) "771—,='28'(9Q
Description of Improvement (Please include size, color, location, materials, species, as applicable)
DIG A4,0 Z)4�' K"liUJ C
Z�d�4Gyi•�c� G
Drawings, plot plan, rendering, cross section attached? YES L-�— NO
NOTES:* /VEz
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
ARCHITECTURAL CONTROL COMMITTEE
APPROVED L DISAPPROVED
0'
Conditions for Approval H Reasons for Disapproval:
i
z.
4_. -•
Notice:
A.
Document Cannot Be Duplicated
Date 3/19/96
Desert Sands Unified School District
82-879 Highway 111
Indio, CA 92201
619-775-3500
CERTIFICATE OF COMPLIANCE
APN # 769-632-017
No. 14277 Jurisdiction La Quinta
Owner Name Fairways La Quinta Permit #
No 50260 Street Grand Traverse Log #
City La Quinta zip 92253
Tract # 25389-1 Lot # 16 Square Footage
Type of Development Single Family Residence
Comments
irandtathered 2014 sq. ft.
Study Area 125
1
No. of Units 1
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 mobilehomes. It has been determined the above-named owner is exempt from paying
school fees at this time due to the following reason:
Under Mitigation Agreement
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to Government Code 53080
in the amount of 628.00 X 1 or $ 628.00
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 La Quinta Fairways 'Telephone -
Name on the check`
By Dolores A. Ballesteros fl
Superintendent
Fee collected /exempted by Pauline Pearson Payment Received $628.00
Check No. 2472
Signature ;V , 1 AA ,(A AM_
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