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LICENSED CONTRACTOR DECLARATION
hI here`�'�,.affirm under penalty of perjury that I am licensed under provisions of
ChapteY 9 (commencing with Section 7000) of Division 3 of the Business and
Professionals Code, and my License is in full force phd effect.
License # Lic. Class Exp. Date)
41:7541
13 C.1Q «. 2/29, Do
rDate �� 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 thefollowing declarations
( ) I have and will maintain a certificate of consent to self -insure for workers'
I
compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
(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. ,
(This section need not be completed if the permit valuation is for $100.00 or less).
( ) I certify that in the performance of thefwork for which this permit is issued,
I shall not employ any person in any m nner so as to become subject to the
workers' compensation laws of Califor , and agree�it at if I should become
subject to the workers' compensation visions of Section 3700 of the Labor
Code, I hal�ortlawh comply with tho rovisions,.
Date: _ �9' 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.
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 4ity, and State laws relating to the building
construction, and hereby author' representatives of this City to enter upon
thefabove-mentioned property inspection purposes.
LSignature (OwnedAgent) - _'"" Date
BUILDING PERMIT PiC°NTR°`�
4��S-E2b
DATE VALUATION- 64.0 LOT 1^d TRACT TO el J� t)
ADDRESS EW�1{I f1�R11VOTAGE JOB SITE
APN f�l. ^.1GG IJ2F3
OWNERlC�
CONTRACTOR / DESIGNER / ENGINEER
`�
..AND !fl
to & 1%4 C0NS rRUUP11..)N
55920 PGA. BLVD
78=070 C:A<LU CADIZ _
LA QUID A CA 97253
LA QUlN` A CA 92753
(76_0)564-4832 C I I L P :526
USE OF PERMIT
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PERMIT FEE SUMMARY.
P], AN CHECK YE
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PIXIV113-ING WX 101-000-4194W
STtIONOr P4iY1'!C,-N$3.40
IZ�iiyltA�2'.t2i1C, i VAt2 I'J3F� 22`x-000-143-34'1 �S?tl8..l'f3
ARS]' 114 Pl: RVAC PLAC ',$ - R SID 701-000-755-000
,) A
C
' FiCONsrRucirio'.NAND PGANCA! ECK
?.LSS PIU -PAID .FEES
rl1.00
JUN 10 1998 TIM Al, d°FX4' IT FE'RS DUE NOW
3ITY®F'LiaQUI TA� �
s
RECEIPT
DATE
°BY
DATE FINALED
INSPECTOR
It
INSPECTION RECORD
OPERATION
F77D
INSPECTOR
OPERATION
DATE
INSPECTOR
to BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
� 2=
Ducts
Slab Grade
Y7 r"
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
ay=
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
% 10
Drywall - Int. Lath
Final
�� 3 —� �-
Final
POOLS -SPAS
BLOCKWALL APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
I
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
;r
Appliances
Final
COMMENTS:
Final
-Qd'
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)
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Date:
Time:
TO: `e l -T Y p CA- 8D i tj 7A — --
Attn:�
Re: SD - �90 14Er2Mt-FM e&-14AeG-Tj&-M
flock- CT' Z- L9 - d US- e �
Number of Pages (Including Cover):
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Return FAX: (760) 564-0406
This Document Generated From (760) 564-4832. If Problems Occur in Transmission, Please Call
P.O. BOX 366 / LA 9UINTA, CALIFORNIA 92253 / PHONE: J*M 564-4832
A-;
City of La Quinta.
�M 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
after approval. Contact applicant for resolution of conditions preventing or delaying approval.
Project: Add detached G2 Guest House to existing Heritage 1C main house
PGA West, Lot 12, Tract 28118 (LLA 97-246) (80-460 Hermitage)
Applicant Contact: Rick Morris, A M Construction, 564-4832 G D
ApplicationCirculatio Date: 6/2.81/16
Date
Community Developmegt Department
istine Di Iorio, Pla4ing 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
Date
Date
Date
ttsVQ Celro/g8
veA
Attn. Rick Morris
AM Construction
P.O. Box 366
La Quinta, CA 92253
VANDORPE CHOU ASSOCIATES, INC.
CONSULTING ENGINEERS
295 N. Rampart Street, Suite A
Orange, CA 92868
Tel: (714) 978-9780 Fax (714) 975-9926
Subject: The Heritage Collection
Lot #12, Plan 1C
Dear -Rick I - - - - -= _ -
Since 1979:
Facility Planners
Code Consultants
Structural Engineers
Fire Protection Engineers
May 21, 1998
This letter is in response to the G-2 guest suite at the subject house. In accordance with our
phone conversation on 5/20/98, the guest suite will be completely detached from the main
structure with no roof connecting them. The guest suite may be built detached from the main
structure provided the only difference is the removal of the roof between the guest suite and the
house. ,
If you have any further questions please call Abe Blunda of our office.
Very truly yours,
VAN DOR.PE CHOU ASSOCIATES:
Chou, S.E.
Attachments: none
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9&
PGA WEST
May 26, 1998
Mr. Louis Kapcsandy
80-460 Hermitage
La Quinta, CA 92253
Re: Application for Architectural Change
Dear. Mr. Kapcsandy,,�
— --
PGA WEST II RESIDENTIAL ASSOCIATION, INC.
P.O. BOX 1282, LA QUINTA, CA 92253
(760) 776-5100 FAX(760)776-5111
We received y6ui ipplication for architectural change:- We could -not process the application due
t6 the fact that your home has not closed escrow. If you would like to have us consider your application
i after the escrow has closed, please re -file it at that time.
Sincerely
John Monahan
Association Manager
DEVELOPMENT CORPORATION
TM
April 14, 1998
City of La Quinta
Building Department
Attn.: Greg Butler
Dear Greg,
-This letter is to give formal approval to A & M Construction to submit for plan check,
`guest-house plans for Lot 12 Tract 28118, Phase 5 Heritage on behalf of Mr. Kapscandy. They
will be building this after the .close of escrow.for Mr. Kapscandy f
Sincerely,
:3V---
1
Woj�
JR Mauro
Director of Construction
55-920 PGA Boulevard 0 La Quinta, CA 92253 • (760) 564-7166 9 Fax (760) 564-7131
il
Coachella Valley Unified School District
P.O. Box 847, Thermal, CA 92274
(760) 399-5137, Ext. 235
This Buz For District Use ONv
DEVELOPER FM PAID
AREA: QQ
AMOUNT: p RCFTJk
CK. M: CAS
INITIALS: DATE:
CERTIFICATE OF COMPLIANCE
(Government Code 53080)
Project Name: PGA WEST - HERITAGE COLLECTION Date: May 28, 1998
Owner's Name: KSL LAND I I I Phone No.
Address: 80-460 HERMITAGE,-,:LAi.QUINTA, CA 92253
Project Description: ADDITION TO HOME (GUEST HOUSE)
APN: 761 560 016 Tract #:
Type of Development: Residential XXX
Lot #:
Commercial Industrial
Total Square Feet of Building Area:
Certification of Applicant/Owners: 'Fhe person signing certifies
under penalty of perjury and further represents that he/she is autorhized/
Dated: 5- -2- S— Iqg Signature:
436 Sq.Ft.
the above information is correct and makes this statement
n on behalf of the owner/developer.
P
SCHOOL DISTRICT REQUIREMENTS FOR THE ABOVE PROJECT HAVE BEEN OR WILL BE
SATISFIED IN ACCORDANCE WITH ONE OF THE FOLLOWING (CIItRE-A#E}:
Gov. Code Gov. Code Project
53080/65995 65970 Approval
Number of Sq./Ft. 436
Amount per Sq/Ft. $ -0
Amount Collected $ -0
Agreement Exist' g Not subject to fee
prior to 1/1/87 requirement.
Note: Maxi_ m Mi ti aati on Fee has
iallready been paid. (August 15, 19977
By: Foch "Tut" Pensis. Assistant Superintendent Administrative Services
Administrator in Charge _
Certificate issued by:
Marcela Valde2
Signature:
lie,
NOTICE: Section oo020 of the Government Cade enacted as Assembly Bib 3081, set forth as C.lapter 549, Statutes of the State of C4Uomia,1996 dfecd" len 1, 1997, requires that this sthod dbtdd provide a writtm notice to I
the project applicant at the thue of payme t of school fees. ®tigation payment or other atactiots. lbs notice is to advise you tham
t any protest in regard to such amounts or the validity thereofin on t aowrdwm with Section 6MO
of the Govennuou Cade and other applicahla law. co®mnces with such payment or perfonoetnce of any other regnmanad as described in Section DOM of the Wvea�au Code. AddificoaBy. brit 0000 adritn dint the
potent thereof must occur within 90 calendar days thereat.
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. A ;�