11-0247 (AR)t — ,:
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application. Number: 11-00000247
Property Address: 80266 HERMITAGE
`APN: 762-230-025- - -
Application description; ADDITION - RESIDENTIAL
Property Zoning: . LOW DENSITY RESIDENTIAL
Application valuation: 100000
Applicant:
Td!t 4 4 4"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Architect or Engi" n er:
Z.Ai y &J. q'
$ (J
567
LICENSED CONTRACTOR'S 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.
icense Class: 748605 . ' License No.: B
f
date: !klil ✓Contractor: f a/fs/ 01, &f
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($5001::
(_ 1 1, 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 and Professions Code: The '
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
and who does the work himself or herself through his or her own employees, provided that the
improvements are not intended or offered for sale. If, however, the building or improvement is sold within
one year of completion, the owner -builder will have the burden of proving that he or she did not build or
improve for the purpose of sale.).
(_ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
property who builds or improves thereon, and who contracts foi the projects with a contractor(sl licensed
pursuant to the Contractors' State License Law.).
I ) I am exempt under Sec. , B.&P.C. for this reason
Date: Owner:
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the
work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name: _
Lender's Address:
LQPERMIT
Owner:
C D J CONLEY
3625 PERKINS LN SW STE 101
LAKEWOOD, WA -98499
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 5/13/11
Contractor:
LANG CONSTRUCTION MAY .�. 1011
80590 CAMINO SAN GREGERI
BERMUDA DUNES", CA 92203
(760) 834-9020 CITY OFLA5UINTA
LIC. No .: B FINra9V1:>E DEPT.
--------------------------------------------
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 and policy number are:
Carrier STATE FUND Policy Number 1889409-2010
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 provisions.
Date: �� to Aofpplicant: MQ/j& W-
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL'FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($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.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
conditions and restrictions set forth on this 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 application,
the owner, and the applicant, each agrees to, and shall defend, indemnity and hold harmless the City
of La Quinta, its officers, agents and employees for any act or omission related to the work being
performed under or following issuance of this permit.
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 county ordinances and state laws relating to building construction, and hereby authorize representatives
oythis county to enter upon the above-mentioned property for inspection purposes.
WI- 1 1 s
'Date: iignature (Applicant or Agent):XAM
Application Number . . . . . 11-00000247
Structure Information
Construction Type . .
. . . TYPE V, UNPROTECTED
Occupancy Type . .
. . . DWELLG/LODGING/CONG <=10
Other struct info". .
. . . CODE EDITION 2010
FLOOD ZONE no
PATIO SQ FTG
224.00
----------------------------------------------------------------------------
IST FLOOR SQUARE FOOTAGE
702.00,
Permit . . . BUILDING PERMIT
Additional desc .
Permit Fee . . . .
639.50 Plan Check Fee
415.68
Issue Date . . . .
Valuation
100000
Expiration Date
11/09/11.
Qty Unit Charge
Per
Extension
BASE FEE
414.50
50.00 4.5000
---------------=------------------------------------------------------------
THOU BLDG 50,001-100,000
225.00
Permit . . . ELECT - ADD/ALT/REM
Additional desc .
Permit Fee . . . .
50.05 Plan Check Fee
12.51
Issue Date . . . .
Valuation-
0
Expiration Date
11/09/11
Qty Unit Charge
Per
Extension
BASE FEE
15.00
702.00 .0350
ELEC NEW RES - 1 OR 2 FAMILY
24.57
224.00 .0200
ELEC GARAGE OR NON-RESIDENTIAL
4.48
8.00 .7500
--------------------------------
PER ELEC DEVICE/FIXTURE 1ST 20
-------------------------------------------
6.00
Permit . . . MECHANICAL
Additional desc .
Permit Fee
44.00 Plan Check Fee
11.00
Issue Date . . . .
Valuation
0 -----�
Expiration.Date
11/09/11
Qty Unit Charge
Per
Extension
BASE FEE
15.00
5.00 4.5000
EA" MECH VENT INST/ DUCT.ALT
22.50
1.00 6.5000
----------------------------------------------------------------------------
EA MECH OTHER VENT SYSTEM
6.5G
Permit . . . PLUMBING
Additional desc . .
LQPERMIT
Application Number . . . . 11-00000247
Permit . . . . PLUMBING
Permit Fee . . . . 75.00 Plan Check Fee
18.75
Issue Date Valuation . . .
. 0
Expiration Date 11/09/11
Qty Unit Charge Per
Extension
BASE FEE
15.00
10.00 6.0000 EA PLB FIXTURE
60.00
- ----------------------------------------------------------------=-----------
Special Notes and Comments
702 SF ADDITION TO EXIST. SFD. INCLUDES
EXERCISE RM, CLOSET AND BATH. 224 SF
COV. PATIO ADDITION REMODEL TO CASITA
BEDROOM. 2010 CODES.
----------------------------------------------------------------------------
Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473)
4.00
ENERGY REVIEW FEE
41.57
STRONG MOTION (SMI) - RES
10.00
Fee summary Charged Paid Credited
Due
---------------------------------------------------------
Permit Fee Total 808.55 .00 .00
808.55
Plan Check Total 457.94 .00 .00
457.94
Other Fee Total 55.57 .00 .00
55.57.
Grand Total 1322.06 .00 .00
1322.06
LQPERMIT
Bin #
Qty of La Quinta
Building &r Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address: 80266 Hermitage PGA West
Owner's Name: William & Diana Conley
A.P.Number: 7-62-230-025
Address: 80266 Hermitage - PGA West
Legal Description: Lot 10, Tract 21118, Eagle Bend-#6
City, ST, Zip: La Quinta, CA 92253
Contractor: Lang Construction
Telephone: (
Address: 80590 Camino San Gregorio
Project Deser iption: Construct a Single Story Single
City,ST,Zip: 'Indio, CA 92203
Family Residence Addition. Consisting of an.
Telephone: (760) 934-9020
Office Room, additional Ma st.er Closet
StateLic.ff: B-748605
City Lic. ff. 0104571
and a Casita bathroom. All construction to
Arch., Engr., Designer: Larry W. Lang, P.E.
match existing exterior architecture.
Address: 80590 Camino San Gregorio
City.,ST, Zip: Indio, CA 92203
X.... X.
Telephone: (�60) 702-7744 ...... �.xx
StateLic.#: 3-5749 X ............ .. . . .......
2 519
C onstruction Ty -"V B Occupancy: Single Family
PV
Prej ect typ New Alter Repair Demo
�Oircle one):
Gp
One
Sq. 64 # Storie's.. # Uniw N/A
Name of Contact Person: Larry W. Lang
Telephone# of Contact Person: (760) 702-7744
Estimated Value of Project: $100,000.
APPLICANT: DO NOT WRITE BELOW THIS LINE
# Submittal
Req'd
Rec1d
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural CaIcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cates.
Called Contact Person
3
Plan Check Balance.
Title 24 Cates.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2" Review, ready for correctionit/ssue
P
Electrical
Subcontactor List
Called Contact Person
'15
Plumbing
Plans picked up
4
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
HOUSE:-
Review, ready for correctionIts sue
1 ';!7
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.:.
Pub.
Pub, Wks. Appr
I
Date of permit issue
Schodl Fees
Y.
J
---r—
JA
Total Permit Fees
A/---5, fil-7-bP -
Coachella Valley Unified School District
83-733 Avenue 55, Thermal, CA 92274
(760) 398-5909 — Fax (760) 398-1224
This Box For District Use Only
DEVELOPER FEES PAID
AREA:
AMOUNT
LEVEL ONE AMOUNT:
LEVEL TWO AMOUNT:
MITIGATION AMOUNT:
COMM/IND. AMOUNT:
DATE:
RECEIPT:
CHECK #:
INITIALS:
CERTIFICATE OF COMPLIANCE
(California Education Code 17620)
Project Name: Date: April 29, 2011
Owner's Name: William Conley Phone No.
Project Address: 80-266 Hermitage, La Quinta, CA 92253
Project Description: Addition to Existing
APN: 762 230 025 Tract #:
Type of Developmen Residential XX
tal-Square Feet of Building Area:
Commercial
Lot #'s:
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/developer.
Dated: %/ Signature: aj,
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
Gov. Code
65995
Project Agreement Existing Not Subject to Fee
Approval Prior to 1/1/87 Requirement
NN ote
Number of Sq.Ft.
Amount per Sq.Ft.
Amount Collected
702
$2.97
$2084.94
Building Permit Application Completed: Yes/No
By: Jamie T. Brown, Asst. Supt., Business Services
Certificate issued by: Marcela Valdez, Construction Analyst Signature:
NOTICE OF 90 DAY PERIOD FOR PROTEST OF FEES AND STATEMENT OF FEEdst Section 66020 of the Government Code asserted by Assembly Bill 3081, effective January 1, 1997, requires that this District provide n 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 protion of these
Fees and (2) the amount of the fees. Therefore, in accordance with section 66020 of the Government code and other applicable lawa shall serve to
advise you that the 90 -day protest period in regard to such Fees or the validity thereof, commences with the payment of the fees orce of any other
requirements as described in section 66020 of the Government code. Additionally, the amount of the fees imposed is as herein set fort 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.
; V:rs„dc:cs :1Lt: ee, c.r iiic.�Ie of conIplial cc €bm upd, Ied 3-2Q'i?7 11/2010
W�A
PGA�VES1:.
February 14, 2011
William & Diana Conley
80-266 Hermitage
La Quinta, CA 92253
PGA WEST II RESIDENTIAL ASSOCIATION, INC.
39755 BERKEY DRIVE STE A
PALM DESERT, CA 92211
PHONE (760) 776-5100 • FAX (760) 776-511.1
MAR > 4 2011
Reference: 80-266 Hermitage, La Quinta, CA
Architectural Change Request - Master bedroom addition, new exercise room,
additional closet and casita bathroom
Dear William & Diana Conley:
The Architectural Committee met on February 10, 2011 and reviewed and approved your
architectural plans and approved with the following conditions being met.
• All other Architectural Rules & Regulations of PGA WEST II Residential Association dated
Revised 8/1/07 pertain.
• A Maintenance Agreement will be required, one will be sent to you for proper execution
as soon as it is prepared by counsel.
• Your contractor must meet with Bob Pantanella, Director of Community Services prior to
commencing any work so they are aware of access, parking and other regulations of the
Association, Mr. Pantanella's phone numbers is 760-564-1032.
• There are no landscape changes approved in this application as none are being
submitted.
Review by the Committee is only for general conformance with the Architectural
Rules, It is the responsibility of the owner to fully understand and conform to the
Architectural Rules 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 proiect design will be final. Please refer to the
Architectural Rules for a# required submittals.
Please contact Luis Umana, Sunshine Landscape at 760/346-3999 and Joanne Rose, the
Association Manager, prior to any irrigation modifications associated with this change. Damage
to landscaping, i.e. shrubs, trees, flowers and turf is the responsibility of the contractor. The
original landscaping must be brought back to its original condition when the project is completed.
Your contractor must schedule a meeting with Bob Pantanella, Director of Community Services
prior to commencing any work to review the Rules of the Master Association and Rules relating to
Res II regarding construction activity. Mr. Pantanella's phone number is 760/564-1032.
Approvals given by the Architectural Committee are good for only six months from the date
on the approval letter. If construction has not commenced within six months after the project
approval date, a new application must be submitted.
Page II
PGA WEST II Residential Association
Architectural/Conley 2.14.11
Upon completion of your project, please complete and return The Notice of Completion of
Architectural Change.
For additional information or questions, the Board has directed that you contact Joanne Rose,
CCAM, Association Manager, at 760/776-5100, Ext. 320.
Sincerely,
PGA WEST II Residential Association
Joanne Rose, CCAM Manager for the
Architectural Committee
Cc: unit
Arch