13020 (SOTB)Buil
in
Addrdpc9 54-'733 Inverness
A ukrav
4 C
. P.O. BOX 1504 No.
78-105 CALLE ESTADO A
LA QUINTA, CALIFORNIA 92253
Owner
Richard Hassei
Mailing
Address Same
City Zip Tel.
La Quinta, CA 192253
Contractor
Owner/Builder
,.Address
Zip
...State Lic. City
'. & Classif. Lic. #
Arch., Engr.,
Designer
Address I Tel.
City ( Zip ( State
Lic. #
LICENSED CONTRACTOR'S DECLARATION V
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
70 OO) of Division 3 of the Business and Professions Code, and my license is in full force and
effect.
_SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason:,.(Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permit'to construct, alter, improve, demolish, or repair any structure, prior to its issuance also
,"-requires. the applicant for such permit to file a signed statement that he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing. with Section 7000) of
- - Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis
for the -alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
s owner of the property, or my employees with wages as their sole compensation, will
crd'the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Professions Code: The Contractor's License Law does not apply to an owner of property who
builds or improves thereon and who does such work himself or through his own employees,
provided that'such improvements are not intended or offered for sale. If, however, the building
or improvement is sold within one year of completion, the owner -builder will have the burden
of proving that he did not build or improve for the purpose of sale.)
O I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner of property who builds or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
D 1 am exempt under Sec. B. &'P.C. for this reason
aleI,'--i '��' Owner / •.i'./ ,J -+s' i_�
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
O Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
or less.)
1 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.
Date Owner
NOTICE TO APPLICANT. If, alter making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I certify that I have read this application and state that the above information is correct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives .of this. city to enter the above-
mentioned property for inspection purposes.
Signature of applicant Date
• Mailirg Address
City, State, Zip
a
11LDING: TYPE CONST. OCC. GRP.
P. Number
13020
Legal Description
Project Description Golf cart storage
Sq. Ft. No.
Size Stories
No..Dw.
Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
1
Estimated Valuation $2,176.20
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
36.lu
Const.
54.00
Mech.
Electrical
18.00
Plumbing
INSPECTOR
S.M.I.
Date Permit
Grading
Driveway Enc.
Validation:_
Infrastructure
TOTAL
REMARKS
5rrvi..r x s.�..f�a°i°il I `�'1.� 7 t"�t': •i,u ..-ri O f .'+i.t .
ZO N E:
BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE
INSPECTOR
Issued by:
Date Permit
Validated by:
Validation:_
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. p $
UNITS
f
r
SLAB GRADE
Y
ARD SPKLR SYSTEM
21D FL. SO. FT. p
BONDING
POR. SQ. FT. @
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
DUCT WORK
ROCK STORAGE
DRAINAGE PIPING
CARP. SO. FT. ®
METER LOOP
WALL SQ. FT.
HEATING (FINAL)
DRINKING FOUNTAIN.
SQ FT ®
GAS (FINAL)
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
GROUT
FLOOR DRAIN
MECHANICAL FEES
SERVICE
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN-
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT . WALL . FLOOR SUSPENDED
GRADING
cu. yd.
—Plus—X$—=$
LAUNDRYTRAY
AIR HANDLING UNIT CFM
KITCHEN SINK
ABSORPTION SYSTEM B.T.U,
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SQ. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
SPARK ARRESTOR
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMSSEWER
OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
$
GRADING
cu. yd.
—Plus—X$—=$
LUMBER GR.
FINAL INSP.
FRAMING --7 p�
FINAL INSP.
ROOFING
T74—
�(1
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
AL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
ARCHITECTURAL/LANDSCAPE VARIANCE APPLICATION
PGA WEST RESIDENTIAL ASSOCIATION, INC.
Please complete and include this request form, along with four (4)
sets of your proposed home improvement plans to:
PGA WEST RESIDENTIAL ASSOCIATION, INC.
P.O. Box 1060
La Quinta, CA 92253
or, 55-940 PGA Boulevard
La Quinta, CA 92253
Attn: Property Manager
NAME: ---[T �c�.ez�� .� /%/BSc r� DATE: -Z3
ADDRESS: .SS/- y33 %i81yc2sycs r .
PHONE:_ UNIT:
PROPOSED STARTING DATE:
APPROXIMATE COMPLETION DATE: % z0-93
Homeowner's Signature
The following appropriate information should accompany your
completed application:
1. Four (4) sets of complete plans to include:
a. Improvements and/demolitions
b. Plot plan
C. All dimensions proposed
d. Relationship to neighboring units
e. Material and color. scheme
f. Planned modifications of all external systems (land-
scape, sprinklers, gas lines, electrical, etc.)
2. Agreement and Covemant Running with the Land completed
and notorized. Two (2) original.
3. Conditions of Approval and Disclaimer form (signed)
4. Facing and Adjacent Neighbor form. (if applicable)
5. Construction Regulations form (signed)
ELECTRI u [ ] Approved [ ]., is pproved
ign u Date
LANDSCAP,LjG /� [ Approved [ ] Disapproved
/!5
S1 gnat a Date
ARCHITR COOITTEE [1[] Approved [ ] Disapproved
'U
S1 jin'a t Ure Dake r
ARCH/Rev 5/93 -1-
I1
� 1 �� J
1 , 1
a
PERSONAL UMBRELLA This insurance is provided by
LIABILITY POLICY CIVIL SERVICE EMPLOYEES
INSURANCE COMPANY
P.O. Box 567
DECLARATIONS San Francisco, CA 94101
These DECLARATIONS form a part of POLICY NUMBER 4-5-1206-75-9
ITEM 1: ITEM 2:
Named RICHARD L. AND ARDITH B. MASSEI Mailing
Insured Address
ITEM 3: 10/24/92 10/24/93
Policy FROM: TO:
Period 12:01 A.M. at.the Mailing Address of the Named Insured
Producer Name, Address, and I.D. Number
R. L. SCHENONE INSURANCE AGENCY
#4-0724
ITEM 4: YOUR PERSONAL LIABILITY LIMIT OF INSURANCE S1 mp.000. per occurence
' S
ITEM 5: SCHEDULE OF UNDERLYING INSURANCE /
The named insured agrees that the following underlying insurance, which covers all residences,
automobiles, and watercraft owned, leased or regularly used by the name insured or any member of the
named insured's household, is in effect at the start of this policy. Also, the named insured agrees that
such underlying insurance is for at least the Minimum Underlying Limits as follows:
TYPE OF POLICY MINIMUM UNDERLYING LIMITS
COMPREHENSIVE PERSONAL LIABILITY
AUTOMOBILE LIABILITY
S300,000 per occurence
5250,000 per person and
$500,000 per occurence for personal injury
and
$100,000 per occurence for property damage
OR
$500.000 per occurence for personal injury
and property damage
combined single limit
Underlying insurance for all other liability coverages must be listed in a Supplemental Schedule of
Underlying Insurance Endorsement attached to this policy.
Underlying insurance, including renewals or replacements. shall be maintained without alteration by the
named insured during the policy period, except for any reduction of the aggregate limit due to payment of
claims.
Forms attached to this policy:
�,iV-
PREMIUM DUE
$ 80.00
MINIMUM PREMIUM DUE
F.30000B 107921
09/18/92 a jb Countersigned by G;;ZL
Authorized Representative