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9707-023 (ADD)LICENSED CONTRACTOR DECLARATION 1 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 45555 $ J 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: ( ) 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 & Professionals Code). ( ) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business & Professionals Code). O la ex fnpt finder Section „B&P.C. for this reason,z' Date i i� Signature of Ow e - c- 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. XI 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 STATF- FUND Policy No. y2�-1'F f -Y7 (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 Code,I shhall'f�orthwith comply with those'provisionsr` yDate: `7 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 City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon tth2 above-mentioned prope for inspection purposes, ­ /Signature " ti/Signature (Owner/Aggnt)- -�^� -'"i Dat 7�f PERMIT # CONTROL # BUILDING PERMIT 9747-023 5455 DATE /j : ' �/J VALUATION $71,947.50 LOT TRACT / JOB SITE ADDRESS 80.15M V1S7 A BOND A TRAI L APN 769-4Z04i47 OWNER CONTRACTOR / DESIGNER / ENGINEER DENNIS T & RENEE A MARUYANIA DON VfIMELS CON91'RUC !'10N ROFM VISTA BONITA TRI, 302 TA VA I.N LA QUINTA CA 92253 PALM DESERT CA 42211 (760)310.0342 CBI.# 4520 USE OF PERMIT ADDN 1325 SF MASTER 9F7)Rt:K-All ADDITION TRAM. T C«NSTRL1r7110N f -325.W 5F ESTIMATED C OST OF CONSTRUCTION 71.947-54) PERMIT FEE SUMMARY PLAN CFMCK FFiE 101-000.439-318 $333 78 CONSTRUCTION FEE 101-M)-418-000 S513.50 kir- 11ANICAl, FF F 101-000-421-000 131.0 EI.PC-I'RJCAL FEV 101-000-420-000 S68.89 F 11MIDING i•TEE 101400-410-000 $3300 STONQ NIUTION FEE - RE, 80 101-000.211-000 $7.17 GRADING FEF 101-000-123-000 SZO,ttt1 r. SUB-TGUAL CONSTRUCTION AND PI kN C'14ECK $1,007.86 AID® LOSS PRE -PAID FEES S000 TOTAL PERMIT F EFS DUE NOW $1,007.86 JUL a 7 1997 RECEIPT DATE i BY DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE I INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade Return Air Steel Combustion Air Roof Deck Exhaust Fans O.K to Wrap F.A.U. Framing Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath Final Final POOLS - SPAS BLOCKWALL APPROVALS Steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground PI . Test Final Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection Encapsulation Gas Piping Gas Test Appliances Final COMMENTS: Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Fbdures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) lAddress: .,30-2- Project Description: Aew� CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. 0LUM6'7NG FEES ST FL. 2ND FL. POR .GAR :AR P WALL ESTIMATED CONSTRUCTION SO FT ;r S UNITS ROUGH PLUMB, SO. FT ,$ YARD SPKLR SYSTEM SO FT & MOBILEHOME SVC. GAP SINK SO FT. -g POWER OUTLET ROOF DRAINS j0. FT .t DRAINAGE PIPING SO FT _t DRINKING FOUNTAIN 30 CT R URINAL VALUATION S WATER PIPING NOTE. Net to Ce :.seo as ,rooeny :an �a!uallon TEMP. POLE FLOOR DRAIN MECHANICAL FEES GROUT WATER SOFTENER VENT SYSTEM FAN EVAP COOL HOOD SIGN WASH ER(AUTOMOISHI APPLIANCE DRYER WATER SYSTEM GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRY TRAY AIR HANDLING UNIT CFM FINAL INSP. KITCHEN SINK ABSORPTION SYSTEM B.T U TEMP USE PERMIT SVC WATER CLOSET COMPRESSOR HP POLE.TEMIPERM, LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SO. FT.c BATH TUB SO. FT. c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SU. FT. RESIO rA 114 c SEWAGE DISPOSAL SO.FT.GAR $• x.c HOUSE SEWER GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE OBl j TOTAL FEES MICRO FEE MECH.FEE PL.CK.FEE CONST. FEE ELECT. FEE SMI FEE PLUMB. FEE STRUCTURE PLUMBING ELECTRICAL HEATING A AIR GOND. SOLAR SETBACK GROUND PLUMBING UNDERGROUND A.C. UNIT COLL AREA SLAB GRADE ROUGH PLUMB, BONOING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINALl OTHER APP/EQUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING CLL yd. LUMBER GR. FINAL INSP. FRAMING FINAL INSP. ROOFING REMARKS VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATIOWSOUND FINISH GRADING FINAL INSPECTION CERT. OCG FENCE FINAL IAiriV � Vn J AVnw � YAW11�� � V\l0 - _ GARDEN WALL FINAL Coachella Valley Unified School District P.O. Box 847, Thermal, CA 92274 (619) 399-5137, Ext. 235 This Box For District Ilse Only CERTIFICATE OF COMPLIANCE (Government Code 53080) Project Name: Date: July 7, 1997 Owner's Name: Dennis & Renee A. Maruyama Phone No. 775-1176 Address: 80=800 Vista Bonita Trail, La Quinta, Ca 92253 Project Description: Room Addition APN: 769 420 007 Tract #: Type of Development: Residential XX Commercial Lot #: Total Square Feet of Building Area: 1325 Sq.Ft. Industrial Certification of Applicant/Owners: The person signing certifies that the • vel ormation is -correct and makes this statementement under penalty of perjury and further represents that he/s11e ' utorhize o on beL-alf of the owner/developer. Dated: � er7��7 Signatur 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 1325 $ 1:$4 $ 2,438.00 Note: By: Foch "Tut" Pensis, Assistant Superintendent Administrative Services Administrator in Charge _ Certificate issued by: Marcel a Valdez Facilities Clerk NOTICE: Section 66020 of the doventiuent Code enacted as Assembly Bid 3081, set forts as CJhapter 549, Statutes of tie State of Califomia,1996 effective Jan. 1, 1997, requires that this school district provide av f tten notice to Ithe project applicant at We time of payment of school fees, mitigation payment or ober exactions. This notice is to advise you that any protest in regard to such amorous o.- the validity thereofin accordance with Section 6020of the Govenuu e t Code and otter applicable law, continences with such payment or performance of a y other requirement as described n Section 66020 of the Govenument Code. Additionally, alis notice advises that the protest thereof mast 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-C:omSant. (REV. 1/97) DEVELOPER FEES PAID AREA: AMOUNT: RC'PT.#: ac #: CASH: UVITIALS: DATE: CERTIFICATE OF COMPLIANCE (Government Code 53080) Project Name: Date: July 7, 1997 Owner's Name: Dennis & Renee A. Maruyama Phone No. 775-1176 Address: 80=800 Vista Bonita Trail, La Quinta, Ca 92253 Project Description: Room Addition APN: 769 420 007 Tract #: Type of Development: Residential XX Commercial Lot #: Total Square Feet of Building Area: 1325 Sq.Ft. Industrial Certification of Applicant/Owners: The person signing certifies that the • vel ormation is -correct and makes this statementement under penalty of perjury and further represents that he/s11e ' utorhize o on beL-alf of the owner/developer. Dated: � er7��7 Signatur 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 1325 $ 1:$4 $ 2,438.00 Note: By: Foch "Tut" Pensis, Assistant Superintendent Administrative Services Administrator in Charge _ Certificate issued by: Marcel a Valdez Facilities Clerk NOTICE: Section 66020 of the doventiuent Code enacted as Assembly Bid 3081, set forts as CJhapter 549, Statutes of tie State of Califomia,1996 effective Jan. 1, 1997, requires that this school district provide av f tten notice to Ithe project applicant at We time of payment of school fees, mitigation payment or ober exactions. This notice is to advise you that any protest in regard to such amorous o.- the validity thereofin accordance with Section 6020of the Govenuu e t Code and otter applicable law, continences with such payment or performance of a y other requirement as described n Section 66020 of the Govenument Code. Additionally, alis notice advises that the protest thereof mast 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-C:omSant. (REV. 1/97) LA QUINTA POLO ESTATES ASSOCIATION c/o FORTUNE WEST MANAGEMENT G. E. WIEDLE COMPANY f 73-900 El Paseo, Suite 3 (Rear) 00 !! Palm Desert, California 92260 (760) 346-8052 FAX (760) 779-1370 June 26, 1997 Dennis & Renee Maruyama P.O. Box 1482 La Quinta CA 92253 - 11111 WHOM Dear Mr." PRaruyama ; The Architectural Review Committee of La Quinta Polo Estates Association has reviewed your plans for an addition of 1,300 square feet on to the Master Bedroom for an exercise room and has approved your plans, with ratification by the Board of Directors on May 13, 1997. The Association will want to retain one set of plans which you should arrange to leave in the management office and the Association will require a final inspection after the addition is completed. If we can be of any further assistance please call the management office at (760) 346-8052. Thank you. FOR THE ARCHITECTURAL REVIEW COMMITTEE LA QUINTA POLO ESTATES ASSOCIATION Gary Wiedle, PCAM, CCAM, CMCA, Managing Agent FORTUNE WEST MANAGEMENT, AAMC cc: Don Wessels, Contractor