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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. Date
732:241 13 2/281199-
0 .
Date r �f Signature of Contractor''
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).
( ) 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' f
compensation,. as provided for by Section. 3700 of -the Labor Code, for the
performance of the work for which this permit is issued.
vl) 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.
PAJi.r1.. NSiJ1tMC1's r. 1�Ut'C: .50Y.442
(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
ubject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those. provisions.
Date: " �j ' `� Applicant "s�^✓%/ �� r'r°«_
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
t .e above-mentioned property for inspection purposes.
t d f
Signature (Owner/Anent) c„ R Date ✓ �
BUILDING PERMIT PERM' 970"13 CONT
DATE 967
15 VALUATION VALUATION�.79ti� LOT R TRACT 281 h
JOB SITE W234 HERMITAGE l AGE
ADDRESS
APN
761-470-038
OWNER
CONTRACTOR / DESIGNER / ENGINEER
ImI'V1 RICI I)SI
N11"E :Ac E DESIGN MIC
902341-TEittvtiTA�T
X371 ;p(?t1C:t4 51' k
(.A QUfTN T A CA 92253
_9.1 D11.0 CA 92201
(760)7759"9 Cl3L4 4:W))7
USE OF PERMIT
:tWi{31.j;+.iYtMI:e1f.'. O.�.f�.�(ZVIIIT # 970-03. POWM"VI:SiC N AT LXiRCP§8
ltfi ONO AND Qi f63T (3.Cif7f 0(!?VL
CUST0,f. ; CONTI'iCTICC'NON 2100 SF
FSTIAIAT.E.D COST -OF CONSTRUCT ION
,','Lr'4Pd (',Fl;Cf�+;:,t%'Ef� 101-000-.439-3133 :�S:t.US,iJt)
C,tYtt+dSTRII(:'r'1:ON FTJ` 101-0011-448-000 $34.00
ELECTRICAL FRE. 101-1100420-000 Its' 91
itro,NCi tYINCi°t'.itlt�l.t i -`1cF'�i15 • 1.01.^tiQO-'11.1-Ii00 �d;5t�
A[t'J` 1Id PUJOLIC. PLACES -AV,8111, 101-0(i4}Y255-000
t
SU13=Ti r�1, t�r1NS'T`.t�41(,"tiCiv AND PIANC.;1- UCK
$207.r
..ESS PRETAt1)'%13
10
T'(Yf XL I'F;ltW4' FE, WS D13EN ONV
. $207179
WAY 13 1997
40 k
1z..C5 -`-
RlPT
DATE
BY
DATE FINALED
INSPECTOR
1 •w.
INSPECTION R8COR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
Set Backs
Forms & Footings
Slab Grade
Steel
Roof Deck
O.K to Wrap
Framing
Insulation
Fireplace P.L.
Fireplace T.O.
Party Wall Insulation
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
BLOCKWALL A PROV S
Set Backs
Footings
Bond Beam
Final
PLUMBING APPROVALS
Waste Lines
Water Piping
Plumbing Top Out
Shower Pans
Sewer Lateral
Sewer Connection
Gas Pioina
OPERATION DATE INSPECTOR
MECHANICAL APPROVALS
Underground Ducts
Ducts
Return Air
Combustion Air
Exhaust Fans
F.A.U.
Final
POOLS - SPAS
Steel -- —
Electric Bond
Main Drain
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Gas Piping
Gas Test
Electric Final
Heater Final
Plumbing Final
Equipment Enclosure
O.K. for Finish Plaster
Appliances,
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbdures,. .
Main Service.
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
No (As e-
L,ZJUA, 1`rv� Siiv
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'0/h Rf I. iaf s
El
Sr.vk
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quid Roc 500 MST SFY TWIN TIF'"67!
INfi'1'Al,l A'T ION
1 Drill to correct size and depth using rotary -hammer.
2 Remove dust and rubble from the hole with compressed
air, a brush and water. Excess water must be removed
although hole may be damp.
3 Cut static mixer tip to second notch making sure the open-
ing is obstruction free. Twist off cap on cartridge. Remove
divider plugs.
4 Place static mixer over cartridge opening. Slide mixer nut
over static mixer and tighten. Load into dispensing tool.
Dispense and discard a bead of material to display proper
mix (indicated by uniform color change) before use.
5 Dispense adhesive into hole.
6 Insert anchor rod into hole.
7 In cases where you are using a screen, first fill the screen
from the bottom up, then insert screen into the hole.
•w.eui. i" :L.rr.. ..I�
7521055
PNEUMATIC GUN
FOR 22 OZ.
(.111I)FIZ rl,r I /SII
AVAILABLE MATERIALS
■ Mercaptan base epoxy, non -sag consistency.
lill 1 to 1 ratio.
■ Square cut rods — A307 steel, zinc plated. Other sizes,
materials, and finishes available upon request.
A1) IfAf'4'rl1E;FS/1=FA'rur{FS
■ Extremely fast cure
and set time.
■ Mixes through motionless mixer.
■ Pre -measured adhesive.
■ Cartridge can be used and
saved for future use.
■ Excellent chemical resistance
when cured.
■ Non -shrink.
!) Ill 11l(;rl3IIIS
■ Must be dispensed
at 1 to 1 ratio.
■ Must be dispensed through
static mixing nozzle.
■ Do not use below 40°F.
■ Do not overDuriwr�
reate epoxy blowback.
Ar OVALS/I-IGTINCS
■ ICBO #4945
■ City of Los Angeles #25120
7521052
PNEUMATIC GUN
FOR 13 OZ.
(11 111 F TMW
Base Material
Temperature
10
3
4
1/2
J`
0
o ��o
o
-0 uU
59°F. to 771F.
o nQ�
u o
5 r�.
^
J o
6
7 f
INfi'1'Al,l A'T ION
1 Drill to correct size and depth using rotary -hammer.
2 Remove dust and rubble from the hole with compressed
air, a brush and water. Excess water must be removed
although hole may be damp.
3 Cut static mixer tip to second notch making sure the open-
ing is obstruction free. Twist off cap on cartridge. Remove
divider plugs.
4 Place static mixer over cartridge opening. Slide mixer nut
over static mixer and tighten. Load into dispensing tool.
Dispense and discard a bead of material to display proper
mix (indicated by uniform color change) before use.
5 Dispense adhesive into hole.
6 Insert anchor rod into hole.
7 In cases where you are using a screen, first fill the screen
from the bottom up, then insert screen into the hole.
•w.eui. i" :L.rr.. ..I�
7521055
PNEUMATIC GUN
FOR 22 OZ.
(.111I)FIZ rl,r I /SII
AVAILABLE MATERIALS
■ Mercaptan base epoxy, non -sag consistency.
lill 1 to 1 ratio.
■ Square cut rods — A307 steel, zinc plated. Other sizes,
materials, and finishes available upon request.
A1) IfAf'4'rl1E;FS/1=FA'rur{FS
■ Extremely fast cure
and set time.
■ Mixes through motionless mixer.
■ Pre -measured adhesive.
■ Cartridge can be used and
saved for future use.
■ Excellent chemical resistance
when cured.
■ Non -shrink.
!) Ill 11l(;rl3IIIS
■ Must be dispensed
at 1 to 1 ratio.
■ Must be dispensed through
static mixing nozzle.
■ Do not use below 40°F.
■ Do not overDuriwr�
reate epoxy blowback.
Ar OVALS/I-IGTINCS
■ ICBO #4945
■ City of Los Angeles #25120
7521052
PNEUMATIC GUN
FOR 13 OZ.
(11 111 F TMW
Base Material
Temperature
Time
Over 100*F.
20 min.
77°F. to 1000F.
30 min...
59°F. to 771F.
60 min
450F. to 591F
1.75 hrs.
WIRE MESH �t'f�FFid
Order
Code
Description
7706924
3/s x
6 Wire
Mesh
7706940
3/e x
10 Wire
Mesh
7708924
1/2 x
6 Wire
Mesh
7708940
1h x
10 Wire
Mesh -
7710924
% x
6 Wire
Mesh
7710940
% x
10 Wire
Mesh
7712924
3/4 x
6 Wire
Mesh_
7712940
3/4 x
10 Wire
Mesh
Order
Description
_Code
7521032
1/2"•18 Element Mixer
7521036_
_
11 8 22 oz. Mixer Nut
7521038
13 oz. Mixer Nut
f�Ft'�!!)trn'TIf)P.1 I�Ir
11
Ultimate Tensile & Shear Loads In Lbs.
Liquid Roc 500
Concrete StrenQlh P.$.1.
Rod
Rod
2000 PSI
4000 PSI
Fast Set Square Cut Rod
Minimum
Box
Master
Tension
Shear
Tension
Order Code_ Order Code
Size
Hole Diameter
Embedment
Quantity
Quantity
7800001 3106032
3/2 x 8
1/2"
31/2"
6200
7015
6486
10
40
1.7 it. oz. 3106048
% x 12
10/box 3108032
1/2 x 8
5/e"
4+/a"
10810
13500
10875
10
20
_ _3108048
1/2 x 12
7800KIT 3110032
1.7 fl. oz. 3110048
% x 8
% x 12
3/4"
5"
16050
11860
19469
10
40
Renovation Kit 3112032
3/4 x 8
7
/9"
3
63/4
28888
17520
28160
10
20
3112048
3/4 x 12
7800004 1/e" 8 1"
_
1"
71h"
33103
31450
37076
10
40
22 II. oz. Special
11/s"
81h"
35500
34765
37938
10
20
10/Box Made To Order
—
f�Ft'�!!)trn'TIf)P.1 I�Ir
11
Summit Structural Engineering
2283 Fifth Street
La Verne, CA 91750
(909) 596-0842
April 8, 1997
Mark Reynolds
MENAGE
83-711 Peach Street
Indio, CA 92201
Subject: Richard's Residence at PGA West
Lot 8, Plan 3BR, Masters Collection
Dear Mark,
Per your request, we are providing an alternate detail "C" which may be used in lieu of detail "C" in the
calculation package dated March 18, 1997.
Also, during our telephone conversation yesterday you mentioned that the foundation and slab for the addition
have already been poured, and that the dowels were not inspected. To verify placement of dowels, a metal
detector may be used. It is not critical that the dowels were not grouted into the drilled holes in the existing
footing, as the soil at the subject project is not expansive in nature.
If you have any questions, please call me.
Sincerely,
Benjamin Herbst, P.E.
Attachments: Alternate detail C
c:\ben\j obfiles\MR 17\field 1. doc
FESSjO
IN
Cr Na 0054 t 93 m
Or N ExR 12/31/99 #
4 CIVIL
SOF CAI�FCP
fi
Residential, Commercial, Industrial, Land Development
April 8, 1997
T,&f 4 4a Qu&Z
78-495 CALLE TAMPICO — LA QUINTA, CALIFORNIA 92253 - (619) 777-7000
FAX (619) 777-7101
Mr. Tom Richards
80-234 Hermitage
La Quinta, Ca. 92253
Re:.Temporary Certificate of Occupancy
Dear Mr. Richards:
This letter will serve as the agreement between you and The City of La Quinta Building and
Safety Division for the temporary occupation of 80-234 Hermitage, permit number 9704-005.
Section 109.4 of the 1994 Uniform Building Code allows the Building Official to issue a
Temporary Certificate of Occupancy provided " no substantial hazard will result from occupying
the structure prior to completion of the entire building."
It is understood that the Certificate of Occupancy is Temporary, pending the completion of the
following items:
Provide anti -siphon devices at all exterior hose bibs.
Expose the floor outlet in the master bedroom.
Seal all'toilets at floor.
Complete master bath tub installation.
The Temporary Certificate of Occupancy is for the main portion of the residence only, it does not
include the Guest Bedroom. It is understood that the Guest Bedroom is not to be occupied. The
Temporary Certificate of Occupancy is to be considered valid for no more than 45 days from the
date of this agreement. The revisions for the attached Guest Bedroom will be reviewed,
completed, inspected, and accepted by The City of La Quinta Building and Safety Division within
45 days of this agreement. It is agreed that this Temporary Certificate of Occupancy will not be
extended for any reason should you not comply with any of the plan review or inspection items
necessary for approval by the City of the project.
It is also agreed that should this Temporary Certificate of Occupancy expire for any reason you
will not occupy the residence at your own expense until any remaining items are completed.
MAILING ADDRESS - P.O. BOX 1504 - LA QUINTA, CALIFORNIA 92253
The requested corrections for the barbeque/sink/fireplace at the pool are considered to be separate
as they are applicable to the pool permit. Those items will need to be addressed prior to the final
inspection of the pool.
Sincerely,
. 4W�v A&&
Mark Harold
Building and Safety Manager
c: Tom Hartung, Director of Building and Safety
Accepted: Date:
Tom Richards, Property Owner
80-234 Hermitage'
La Quinta, Ca. 922.53
SENT BY:MEN06E 04-07-97 04:31PM 6197759966-j' is 2
APR- 7-97 BION 9: Ol Pef 11 ':, t. GROUP
April 7, 1997
The Lud Trull Aveemedt datW Octobet 22, 1996
,Ju Ruberr C. Burke
28059 U.S. Highway 19 North, #100
Clhnuater FL 34631-,2698
FAX NO. -619 776 61111 P.
PGA WEST 11 RESIDENTIALASSOMT10N, INC.
Re: Architectural Variances - 80-234 Hermitage, La Quinta CA 92253
Dear Mt ftrke:
P.O. BOX 1282, LA QUINTA, CA 92253
(619)176-5100 PAX(619)776-5111
Certified Mail
Retum Recelpt #
This letter will serve as notice to the owner of the abovereferenced property that a number of architectural
sarimes have been commenced without due notice and approval by PGA WEST 11 Residential Amoclation,
including:
1) Change of exterior surfooe paint color
2) .Interior structural changes, including connection of exercise room to casita
3) Landscape impro%==ts
It is a utnditian of the A v&ialinn's rmanant¢,f Anditions And Rautininns (CCBtB'c) that any change to the
Ault—Auk •l+v*iwal i41bstu4V a+9"+ •A1g4iW iuJdieViut.rVLuJ&wgw ruwA bu uopm'ed by dw Aawtiudlitt, rwlut
to the work done. Enclosed please find an Architectural Variance Application wbich must be completed,
notarized and remitted pith a refundable Construction Deposit of $2,500.00 (see P. 6 under Section 9 ("Room
Additions/Atrium Enclosures). A $25.00 non-retitndable application fee is due as well. Both checks should
be made plyable to "PGA NEST II Ruidenliol Assooiation, P. O. Box 1382, La Quinta CA 93263".
I., X441 &A etc A vj6istivu iv apytuvr. the abuvv-rw&mntxd changes to your house, complete landKW,
irrigation and Sighting plans must be submitted, as well as structural plans signed by a licensed civil engineer
for chances made to the exerciaa room. Please famed the planR and fees to The Mnnsrch Gt+oup, attn- john
Handsh AwaiAtinn MAntttlm A?. -(m ramlinn f i . Str innim Tlranrl r 9?? 11
Cinally, in tudet to alluw Tuut lticicutls io obtain u Cerdl mu- of Occupancy, IT to n9ee9Fa1y shalt ha, as unit
o%imr Walt power of attoruey for Tim Laud l,ubt A jteee tout ,lases w- %A*,, 22, t9y6, wrap( lull rr4punstututy
for, and indemnify the Association from any liability as a result of the structural changes =do at 80.234
Hermitage, La Quinta CA. Please have Mr. Richards sign and date the attached "STATEMENT OF
i�I1)F1INIFICATTON belmv, and provide a copy of the Cettffieate of Occupancy from the City of La Quinta for
the Association's ales_
Sincerely.
PGA WEST R RESIDENTIAL ASSOCIATION, INC.
Por the Architectural Committee
By
JOHN HANDEL, ASSOC. NfGR.
CC: Don Troy, Chairman
Archkecturat Committee
Board of Directors
James D. Baker, Pres., Menage Design Inc.
Unit Fite
&Njol,n•.pgwvj2\W 8 tr. 28118 to erA .w 4.7.97.doc