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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
a,jlt. 79 fit •il riilJ
dDate �� /� ` y Signature of Contracto
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'
compensation, as provided for by Section 3700' of the Labor Code, for the
performance of the work for which this permit is issued.
fi() 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 , t7,„ t Policy No. p
(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
bode, I sha I f tthwith comply with those pro .is oaS
,Date: �iApplicant---::2,. , > �1
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
t e above-mentioned property for inspect) p purposes.
fi
Signature (Owner/Agerit) /' Date
PER # CONTROL #
BUILDING PERMIT
DATE J t VALUATION 3eLOT TRACT
'
JOB SITE
ADDRESS !�U•t$Z i�l�iil!'!("iI rl_: ;
APN 761-490.0"
OWNER
CONTRACTOR / DESIGNER /ENGINEER
T:.'�llfil�ii�i�4.1'i�i�'Z
rifi2W. HERIMl'1'AGE
7'1_185 CALIX R.:it 9FER.i:Y
LA QUiNi'A CA 9«53
[A C1E.tII+i`i.'A CA 0441 3
4'? -?7
USE OF PERMIT
#Z.is »i! ►t::N It,aL Ai),vi.Ti(JN - a i7 a.F- . A V iNU AREA, Z34 S.{;.
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ORA)}f�f't 11. il)t.t,1(1(j-X171-fi�?tl �^Fir€i
PAI�ti 't'ttty�:ON-KI'�'.{..lf:'1')ON AND PLAN f;�M',"'..
�i2�i; 35
USS PRE -PAID FEES
"W'00
DEC 0 2 1997
CITY � L� C�U�•�"° ` ��
��
EECEIPT
DATE
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
j1d'
ReturnAir
Steel
Combustion Air
Roof Deck
ALA.,Q
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
.. G
Compressor
Insulation
- a p .
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
steei>
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
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
FixturesMain Service
Sub Panels
Exterior Receptacles
G.F.I.
Sr6oke Detectors
`'Temp. Use of Power
Final
r Utility Notice (Perm)
COMMENTS:
Coachella Valley Unified School District
P.O. Box 847, Thermal, CA 92274
(760) 399-5137, Ext. 235
This Bos For District Ilse Only
CERTIFICATE OF COMPLIANCE
(Government Code 53080)
Project Name: Date: December 2 1997
Owner's Name: Fumi o & Rei ko Uchida Phone No.
Address: 80-282 Hermitage, La Quinta, CA 92253 PGA
Project Description: Residential Addition
APN: 761 480 044 Tract #:
Type of Development: Residential x x x x
Lot #:
Commercial Industrial
Total Square Feet of Building Area: 777 Sq . Ft.
Certification of Applicant/Owners: The person signing certifies that the above information is correct and makes this statement
under penalty of perjury and fiuther represents that he/she is autorhized to sign on beludVof the owner/developer.
:/�-" </. ;2
Dated: )4-11Aba —q� Signature:
SCHOOL DISTRICT REQUIREMENTS FOR THE ABOVE PROJECT HAVE BEEN OR WILL BE
SATISFIED IN ACCORDANCE WITH ONE OF THE FOLLOWING (CIRCLE ONE):
Gov. Code Gov. Code Project Agreement Existing Not subject to fee
53080/65995 65970 Approval prior to 1/1/87 requirement.
Number of Sq./Ft.
Amount per Sq/Ft.
Amount Collected
777
$ 1.94
$ 1,429.68
Note:
By: Foch "Tut" Pensis, Assistant Superintendent Administrative Services
Administrator in Charge
Certificate issued by:
Marcela Valdez
Facilities Clerk
Signature:
NOTICE: Section 66020 of the Govenunent Code emcted as Assembly Bill 3081, set forth as Chapter 549, Statutes of the State of Califonua, 1996 effective Jan. 1, 1997, requires tlmt this school district provide a written notice to
the project applicant at Mie tuue of payment of school fees, litigation payment or other exactions. This notice is to advise you that any protest in regard to such amounts or Mne validity thereof i n accordance with Section 6o020
of the Govermnant Code and other applicable law, corumerces with such payment or perfonuance ofany otherrequimuent as described in Section 66020 of the Govenunent Code. Additionally, this notice advises that the
protest thereof nmst occur within 90 calendar days thereafter.
Note: AB 2926 and SB 201 fees are capped at $1.84 per square foot for all residential construction, and at $0.30
per square foot for commercial/industrial projects.
Dev. Fees Disk: Misc\Cert-Com.Sa m (REV. 1/97)
PGAWEST.
1�1 'Iir,F'I 4JP(Ili[
November 12, 1997
Mr. & Mrs. Fumlo Uchida
C/O Magdelana S. Fukuda
3410 W. Mac Arthur Blvd,
Santa Ana, C A 92704
9 (:h Cil j
PGA WEST II RESIDENTIAL ASSOCIATION, INC,
F 0. BOX 1252, L-A QUIN TA, CA 92253
(61.9) 776-5 WO FAX (619) 776-5111
Post -its Fax Note
TO [
tom.
codDet?t.
Phone k
Fax d _
RE: Architectural variance request for 80-282 Hermitage
Dear Mr, & Mrs. Uchida
7671 111/ ,( t1,lo��s"
01 -
The
The Architectural Committee of the PGA WEST II Residential Association has
reviewed the plans for your room addition as resubmitted by your contracto' r
Mike Bergen. The Committee is pleased to report that it has approved this room
addition as submitted.
This approval is good for a period of six (6) months, if work is not begun within
that time period; a variance request must again be made to the committee.
Please contact me for a final walkthrough Inspection.
Should you have any questions or if I can be of any further assistance please call
me at (760) 776-5100.
Sincerely,
John 7. Monahan
Assistant Association Manager
CC: John Handel, Association Manager
Architectural Committee
Board of Directors
From : CARLOS ELIAS CIVIL ENGINEERING PHONE No. : 619 328 7271 Dec.02 1997 1:29PM P01
Simple Span
Parallel TJI Joist Load Tobles/Non,5now (11101g
Sloped Root Only Allowable Uniform Load (PV)
TJ1/35C Joist
OSB Web Material
Multiple Span Note: Tables below can be used for two or more span conditions. Use longest span for
Parallel TJI Joist sizing. Where ratio of short span to long span is less than .4, contact Technical
Sloped Roof Only Repre3enlalive fur astiWance.
TJ1/35C Joist
OSB Web Material
Notes:
t. TJI joisla. when used In simple seen applications, can be cambered to 2250' radius upon request
S TJI 1816ts am not available with camberir, mW.pin alma npplk:utions.
3. Provisions meal be made for positive drainage. Mlnlmum slope = w' per loot.
4. Values In may be Increased 4% for repetitive nlemberusage If the criteria Is mei. Refer to page 9.2.
5.2 REV. 7/82 W