12788 (AR)• , 1 r,Twyl 4
'r
P.O. BOX 1504
Building 55-405 Pebble Beach -Dr. 78-105 CALLE ESTADO,
ArlrirPcc LA QUINTA, CALIFORNIA 92253
Owner
A1 -
rl & Mrs.. Charles Hathaway
Address Same
City Zip Tel.
La Quintan CA? 92293 1 771--1421
CO,tractor
Langlois Construction Inc.
Address
75-145 St. Charles Place #5
City Zip • Tel.'
Palm Desert, CA 92260 1 341--77.24
State Lic. I City !
& Classif. 41t}376 Lic. #
Arch., Engr.,
Designer hoiden & Johnson Architects
Address Tel.
44-267 Monterey AVe. 340-1981
City lZip State
Palm Desert, CA 92260 Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under orb -visions of Chapter 9.(c`ommencing with Section
7000) of Division 3 obthe Business and Piotessions Code, and my license is in full force and
SIGNATURE DATI
OWNER-BUILOER 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).
❑ 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, 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.)
❑ 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.)
❑ 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's Com-ensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No .Company
❑ py 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.)
I certify that in the performance of thg 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, after 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—
Mailing
ateMailing Address
City, State, Zip
LDING: TYPE CONST
A.P. Number
No.
OCC: GRP.
12788
Legal Description
Project Description
Addition
Sq. Ft. 119
Size
No.
Stories
No. Dw.
Units
New ❑ Add ❑
Alter ❑
Repair ❑ Demolition ❑
1
Estimated Valuation
M2132.00
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
76 . X15
Const.
117.00
Mech.
_
21.04
Electrical
19.16
Plumbing
.00
S.M.I.
.92
Grading
Driveway Enc.
Infrastructure
TOTAL
234.13
REMARKS
ZONE: 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
Issued by: Dat " p Permit=
Validated by: f B l�i 199
Validation:
ES
CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. � PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SO. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. I SQ. FT.
WALL SQ. FT.
SO. FT. ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
A.C. UNIT
FLOOR DRAIN
MECHANICAL FEES
ROUGH PLUMB.
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE - DRYER
SEWER OR SEPTIC TANK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
DUCT WORK
LAUNDRYTRAY
AIR HANDLING UNIT CFM
GAS (ROUGH)
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.
SQ. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1+/4 c
SEWAGE DISPOSAL
$
SO.FT.GAR ® 3/ac
HOUSE SEWER
LUMBER GR.
FINAL INSP.
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
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
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 Y: ' L
[C
FINAL INSP.
ROOFING .� (/ �%
/ �` r v ✓ ��
`` ��/C�
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING 1j [ A ( (11
MESH
NSULATIONISOUND , —1
[
FINISH GRADING
AL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
ARC$ITECTURAL/LAND SCAPE VARIANCE APPLICATION
HEST RES I EN'PI L AStSOCYAT ON . YNC .
Please complete and Include this request form, along with four (4
sets v` your proposed home improvement plans to: )
PGA WEST RESIDENTIAL dSSOCIATION, INC.
P.O. Box 1060
Iia Quinta, CA 92253, '
-'or, 55-940 PGA Boulevard
La Quinta, CA 92253
Atta: Property Manager
NAME :._L
ADDRESS:
PIT. CNE:I /C1
-�
PROPOSED STAATINC DATE:
APPRcx;* r' CxOMAL_F.':ION
Homeowner'sSignat;lre
DATE:
The following appropriate in=ormat_an should accompany your
completed application':
1. Four (4) sets of complete plans to include:
a• Improvements and/demvlttions
b. ?lot plan
a•_ All dimensions proposed
d. Relationship to neighbori,q un_ts
'e. Material and color -scheme
f. Plan.*led mod:ficatyons of all- systems ( land--
$cape, sprinklers, gas lines, electrical, etc.)'
2. Agreement and Covemant Running with the Land completed"
and notorined. Two (2) original.
3. Conditions of Approval and Disclaimer form (signed)
4.' Fac -ng and Adjacent Ne4ghbor form (if applicable)
5.Construction Regulations form (signed)
EL£CTR_CAL [ ] Approved
I I.Disapproved
Signatu:s
LANDSCAPE Date
[ J Approved [ J Disapproved
Szgna=ure
ARC,:T_'_'EC— �L "i_ TE"' Date
[ ApprovedJ Di approved
azure Dae' -
/Re V
/ReV