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9912-161 (AR)
U) N U) W ►�v� 6ZI� O O J ~a rn Z Cl) LO N ON U °) Q ELZ `rQCr 0 LL 0 JJ mUU O CL Z_ Cb 7) Q Q J _ 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 6"57 B O3r'31/20( r Date � 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' compensation, as provided for.by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. t (y) 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. S X-11,'s:d Clivwt Z29,t ►': 5 (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-ofrSection 3700 of the Labor Code, I shall forthwith comply with h � se pr vision§,% Applicant l --t) 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 pprformed 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 the above-mentioned property for iris ectlon purposes. " Signature (Owner/Agent)` �c Date "t/, )I (7 �! BUILDING PERMIT PERMIT# VolDATE j VALUATION :s5'S© 9.(k�i LOT TRACT JOB SITIJ ADDRESS 230-4Z81CRAUTAGE, APN 761-5110-018 OWNER CONTRACTOR / DESIGNER / ENGINEER "0}3 �:^? �'A '?S C O'`,` ?'�C�T .IOI`: 80-4211 ImuirrAGe 79-920 FIESTA 43,ti.M Uk QiJINrA CA 92253 LA QUINTA CA 92253 f7601IT15-793;1 0111411 3212 USE OF PERMIT U-SiDF 1 A'L AND 1: MOAN 2�i at�a�-i�Ei'Ii4r a Gv1:at .i. fU5 SQ.�'.GiiCS'i UT31i'1S tiU3�rliJ t3 `i'G &KI131'1N(f WV') CIi S"s' iivl e:i31�T5 '.Ici;C7Ivl+i ii ki.gii 3 tti/RCH&IATICI 2V-00 W T. S a J%4 i %i,,D COST -OF CONS IRU ON 50,94 .60 PLAN 1r,HECIh. kTR 10.11-000-439-318 $272.35 4"i)itlrT{ lJ "1't(7TJF ? 1()i41100-A.18•4m i 9Z4;;I1ANICAL tits =),50 :'� •• FI,l;,Crilic AI. VE 141-I3fl{►•�; �-Gt"tu � ��. i� _ ; � � t � I PLUJtbil:i2(di FEF- 101-00-41.9-0110 �a'z.t�tt t ..•� �,� ' .t'CF(liT+f(:'A1tl't`(C)NPT _R.1' (t� (t}t-(i(}tl-:2 1-1(2(1 $5 fir, GItAD1.1KOI'% 101-OM4210W SF -!1 "OT AT._ CO,'N,•f R I(,T](.)','v !�.NT? KAN (;.'f's}?C;K V16.12 LESS PRE -11"'18D IV Es $0,00 TOTAL P ERAHT .Hi i+: S DU CN51W M36,12 RECEIPT DATE BY DATE F ALE INSPECTOR 3 INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs I A Underground Ducts Forms & Footings A Ducts Slab Grade Return Air Steel Combustion Air Roof Deck ofExhaust Fans CK 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 J. 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 D 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 3 Q p Utility Notice (Perm) COMMENTS: Desert Sands Unified School District 47-950 Dune Palms Road Notice: La Quinta, CA 92253 Document Cannot Be Duplicated 760-771-8515 Date 1/3/00 No. 19864 Owner NameMark Lucovsky CERTIFICATE OF COMPLIANCE APN # 761-560-018 Jurisdiction La Quinta No. 80-428 Street Hermitage city La Quinta zip 92253 Tract # Lot # Type of Development Residential Addition Comments Permit # Log # Study Area Square Footage 605 Addition to guest suite adjointed to existing residence. 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: EXEMPTION NOT APPLICABLE This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of 1.93 X 605 or $ 1,167.65 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 CC/1 st Bank/Bob Edwards Tel' phone .,` Name on the check By Dr. Doris Wilson �� v Superintendent Fee collected /exempted by Ellen Patino Signature Payment Received $1,167.65 Check No. 52817 40'nCE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified above will begin to run from the date on which the building or installation permit for this project is sssued or on which they are paid to the District(s) or to another public entity authorized to wllect them on the Distdct('s)(s') behalf, whichever is earlier. Collector: Attach a copy of county or city plan check application form to district copy for all waivers. kiaibossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting i:_ Group October 1, 1499 Mr. &'Mrs. Mark Lucovsky 811 Windsor Drive S7 Redmond, AWA 98053-923 Reference: 80-42$ Hermitage, La Quinta Architectural'Change'Request – Guest -Suite Addition Li199 a rIrs.'LGC'uVSr, . _016.t. cp:re It Arciiitectt.'rui'Coiiiriii:tee''ut it�a Septeriib�r 5,3997 �etirg haS T'te-Planned Unit '1L tttrcv�.' p '.P\y___a_� w..'.y°u'`, ..�.....a\.� Y._.._ \s-"r'�\r�'uai�� Y� rti9�:furttte.ad0bowof,. RIiCSErrviia.. "�'vui req 5 fur aeViiti ufaal Cllange was presented av the Board of Dlret:�sors as its regularit sche_ uled Ing an Manday, See ternbe; 27"'. Tk^ 1?—A 6— ,v.+',,,.'..'a^^,:,.�tl;.r, as submitted, except for the following landscaping issues. The landscape chairman feels that having all, and only, Indian Hawthornes on one side of the house is less than aesthetically desirable and requests that.you revise.your landscaping.plan and return for review at the landscape committee meeting to be held October 13, 1999. We cannot understand what is being "relocated". Please clarify on revised landscaping plan. Please contact Miguel Valenzuela, supervisor for Valley Gardening Service at 760/399-1844 and Carol Fuller, the Association Manager, prior to any irrigation modifications associated with this change. Upon completion of changes, please contact Carol Fuller. Damage to the landscaping, i.e., shrubs, trees, flowers and turf is the responsibility of the contractor. The landscaping must be brought back to its original condition when the project is completed. Approvals for architectural changes are good for only six months from the date on the approval letter. After that time a new application must be -submitted. In the meantime, 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 Board of Directors Carol Fuller Association Manager cc: Board of Directors Unit File Lucovsky.Guest Suite Approval f11 M8 O MRoj MAP -14 GvcoY-V*--- y 80 40X/571/V`6 49C,,eL e- 7A)6 - 3 isb s4p fE sMqu. ,OPpt . / ,:Rpo v.o ?.00 VO 840 Yg . c PAGTo2 $ 6V ✓4 x X. /Zen X 7 X3¢0 -9PD<r- 6OF ZQ let x 3 Y4 "- v (a) vc i IaD Y* f /.eG,r /,O Pe0 VA v X 00 . ,P AoVA14. !Z -19,81-6r Y4 A ,%D "o iyEeTi�sl c*L .9t G. (3 j x It� 600 Y4 6q to � 2 4&0 5 0o0 5v670,r,W- W, 740 00,8115- -3 0,8115-3 tsov V-4. Y4 Yq.. V4. W YW VV YI? vd. VA Y4t 'ror*ll 35 6-5s V4. !4" 00L) Y4 14 400 Yf 70741- 30 74L Y4. / t��G� / = y 3¢ 742 VA=- /4r4 V. -Z40 AXI*r/A16 V..4AQ*-f- .. 20D *M 1v ✓4179 REGISTERED INSPECTOR'S WEEKLY REPORT JON TANDY ^ ,�37630 Medjool Ave. r`Palm Desert. CA 92211 psoz i- ' ~', Office (760) 772-7192 Fax (760) 772-7193 .'Pager (760) 776-3338 TYPE OF INSPECTION PERFORMED ❑ REINFORCED CONCRETE ❑ STRUCT. STEEL ASSEMBLY ❑ ❑ POST TENSIONED CONCRETE ❑ ASPHALT ❑ OTHER ❑ REINFORCED MASONRY ❑ FIRE PROOFING JOB LOCATION /J_� g e 'n rA j 64 L� VG• l7�►PERMIT r� ` REPORT SEQUENCE N0. TYPE OF STRUCTURE U / +C�+ 1�1C_ icS V NO. DATE_ l _ DAY OF WEEK MATERIAL DESCRIPTION ARCHITECT INS 0;4 HRS. CHARGED ENGINEER ASSISTANTS MRS. CHARGED INSPECTION DATE GENERAL `` CONTRACTOR �( j4 -t SUB CONTRACTOR - ( -v u Sop- i to rla ctwv- .v U -S S l wwn ov, FO V N ►9 4 Ue v T I Q COPY SENT TO CLIENT O CONTINUED ON NEXT PAGE O PAGE OF CERTIFICATION OF COMPLIANCE I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MY KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE NOTED. I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED PLANS, SPECIFICATIONS. AND APPLICABLE SECTIONS OF THE - GOVERNING BUILDING LAWS. 0 SIGNATURE 00 REGISTERED IN ECTOR DATE OFEPO RT REGISTER NUMBER r