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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
/4i
ate - 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 Sionature 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.
'i cAiz:1 ',ND 229 94 =11=1 Z
(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 Calif, rnia, nd agree that if I should become
subject'Eo the workers' compensat�Prl , agfSection 3700 of the Labor
�de,alLfort ith comply with vyeid"bate: !ti Applicant(((
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. e
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 rpre entatives of this City to enter upon
the above-mentioned property for inspe on purposes.
' nature (Owner/Agent) b' .I Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT TRACT
ADDRESS U 4>1.3 ITAGE APN �1 .�I,
JOB SITE
OWNER CONTRACTOR / DESIGNER / ENGINEER
ROURT• BE'EBF 110TR Ei?t14'ARDS CONSTRUJi' ON
80412 HERMMA(M 79-920 FIESTA DRM
LA QUKrA CA 92253 1.A (j1J1M1'A CA 42253
Obt>1', 7;- 74M CRI1# 1212
USE OF PERMIT
KESIL* NTIAL AMAt lUl i
46 S.F. CrUEST 0,AiS.A1)01fk*
:. i �..i41 �: vi�iiaii►1i'i 1i.'riv 3Ci.0i1 Si
"I'A AL (T)NWRt k "II(Nd AND MAN ViIRCY �E+31 '1
LESS PRE PMD FEES 1 $000
TOII'Al, PF.RM IT Y11M.8 DUE N(YW I Wilt
BY DATE FINALED INSPECTOR
f3TI1t4AILT CTAT Off' CONSiTRUMON
Jt..'[4!Et 3sli
PKIRMil F'1~sF Sill 'I 4afri RN..
PLAN CH160K Fb%
101 -(Kg)-439-318
$143.:38
c't)ttil�tfRlft'TIC)N t f'F'
10141f1 _11$41(1ff
Vwr S0
1vf1't' b%NI Ai t t:1i
101-000--121-000
S41.110
WA. k*'flac "NL I 1 Is
10149)0_420431)0
V5.011
KUM694(i F14H
101-00("194"
$40,Y)
IRIV4 ONO Nk Vrf' rN VP
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1014'14'(1 -•74i -1(N)
tt 1i
liltAIANt � 1.1X
101 WXY 123 000
$20.00
"I'A AL (T)NWRt k "II(Nd AND MAN ViIRCY �E+31 '1
LESS PRE PMD FEES 1 $000
TOII'Al, PF.RM IT Y11M.8 DUE N(YW I Wilt
BY DATE FINALED INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings 4Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck iylz M1Exhaust
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 D S
Drywall - Int. Lath
Final
.Final
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Baclo Ji`.
Electric Bond
Footings y' ''
Main Drain
Bond BiaFh
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
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:
Bin #
City of La Quinta
Building 91 Safety Division
31�
P.O. Box 1504
Permit # 78-495 Calle Tampico
La Quinta, CA 92253
Building Permit Application and Tracking Sheet
Project Address: Owner's Name: V-4kQz� C"4pc,
A. P. Number: Address: 0,9 4(2 --
Legal Description: City.ST.Zip:
Contractor: e�;ldb k-�� -�VC4^ Telephone:
-A2�aAddress: -72-4:� ( C1 —? Project Description:
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Ag. Approval
pec owx
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Desert Sands Unified School District
47-950 Dune Palms Road
Notice: La Quinta, CA 92253
Document Cannot Be Duplicated 760-771-8515
CERTIFICATE OF.COMPLIANCE
Date 8/20/99
No. 19224 Jurisdiction
Owner NameRoBert Beebe
No. 80-412 Street Hermitage
City La Quinta zip 92253
Tract #
Lot #
Type of Development Residential Addition
Comments
105 sq. ft. Guest house addition
APN # 761-560-019
La Quinta
Permit #
Log #
Study Area
Square Footage 405
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:
Residential Addition 500 Sq Feet or Less
EXEMPT
This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of
0.00 X 405 or $ 0.00 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 N/A - Bob Edwards - 775-7933
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by
Signature I �."
Sylvia Carrasco Exempt
Telephone
$0.00
Check No. N/A
NOTICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified
above will begin to run from the date on which the building or installation permit for this project is sssued or on which they are paid to the District(s) or to another public entity authorized to
collect them on the District('s)(s') behalf, whichever is earlier.
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
PGA WEST.
July 14, 1999
M & M Bob ft—"
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PGA WF T II RESIDENTIAL ASSOCIATION, INC.
V PO. BOX 1282, LA QUINTA, CA 92253
�nak (760) 776-5100 PAX (760) 776-5111
I . rs. /_
f U.&JO
Reference: 84.412 Hermitage
Architectural Change Request to Install Guest Nouse
Dear Mr, & Mrs. Beebe:
The Planned Unit Development Architectural Committee at its July 14,1999 meeting has reviewed
your plans to install a guest house. Your application has been approved with the Following
exceptions:
• Meyers Fern – not on plant parte; please replace with plant material on the Association's
approved plant palette (copy enclosed)
• Replace fluorescent light fixtures with 45 watt Hubbell bullets on Queen Palms
• Relocation of existing Queen palm – Association will not be responsible shwid palm not
survive after relocating
• Lighting -- there shall be no additional lighting on the street side of the guest house
If there are irrigation modifications associated with this change, please coordinate these changes
prior to commencement with your landscape maintenance contractor and Valley Gardening. The
supervisor, Miguel Vatenzueia, can be reached at 760/399-1844, or contact the Association
Manager, Carol Fuller.
Approvals are good for only six months from the date on the approval letter. Atter that time
a new application must be submitted,
If you have any additional questions or concerns, please do not hesitate to contact Carol Fuller,
Association Manager, at 760/776-5100, Ext. 20.
Sincerely,
PGA WEST II RESIDENTIAL ASSOCIATION
For the PUD Architectural Committee
Carol Fuller
Association Manager
Enclosure
cc: Board of Directors
Unit File
Beebe Approval Guest House
Ci of La Quinta
Developers Project Approval Form
Prior to the issuance of Building Permits for the project listed below, the following Departmental
clearances must be obtained. Please return this form to the Building and Safety Department only
afiLerapproya. Contact applicant for resolution of conditions preventing or delaying approval.
Project: Guest House @ 80-412 Hermitage
Applicant Contact: Bob Edwards - 775 7933
Application / Circulation Date:
Community Development Department
OV "C /xv,
Christine di Iorio, Planmhhg Manager
Public Works Department
Steve Speer, Senior Engineer
Building and Safety Department
Mark Harold, Building and Safety Department Manager
Health Department
Fire Department
Schools Fees Paid
Date
Date
Date
8-20-99 nig
Date
61 Z011W
Date
Date
Date