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9901-088 (SFD)
LICENSED CONTRACTOR DECLARATION 'gl h?reby affirm under penalty of perjury that I am licensed under provisions of ., Nter 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 447883 B 10/31/99 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). ( ) 1 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. ( ) 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. , CLARENDON NATIO) TBA082198 (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 shall forthwith comply with those provisions. Date: 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 the above-mentioned property for inspection purposes. Signature (Owner/Agent) Date Fla BUILDING PERMIT PERMIT p -� 9901-088 DATE VALUATION LOT _ TRACT 3 1 CI$516,793.70 10 25397 APN ADDRESS 55-600 PEBBLE BEACH 769-620-010 OWNER CONTRACTOR/DESIGNER/ENGINEER ABESUB HALUM SOUTH POINT CONSTRUCTION 78-755 MARTINIQUE DR.77-899-WOLF RD. #102 INDIO CA 92201 PALM DESERT CA 92201 (760)345-5521 CBL# 4320 USE OF PERMIT SINGLE FAMILY DWELLING SFD - PERMIT DOES NOT INCLUDE BLOCK WALLS OR POOL. CUSTOM.CONSTRUCTION 6,320.00 SF PORCH/PATI0 721.00 SF GARAGE/CARPORT 759.00 SF ESTIMATED COST OF CONSTRUCTION 516,793.70 PERMIT FEE SUMMARY CONSTRUCTION FEE 101-000-418-000 $2,090.50 PLAN CHECK FEE 101-000-439-318 $1,723.74 FEE DEPOSIT 101-000-439-318 -$1,250.00 MECHANICAL FEE 101-000-421-000 $201.00 ELECTRICAL FEE 10.1-000-420-000 $362.38 PLUMBING FEE 101-000-419-000 $352.75 STRONG MOTION FEE - RESID 101-000-241-000 $51.68 GRADING FEE 101-000-423-000 $20.00 INFRASTRUCTURE FEE 225-000-443-342 $6,000.00 ART IN PUBLIC Pf..ACES - RESID 701-000-255-000 $1,041.98 SUB -TOTAL CONSTRUCTION AND PLAN CHECK $11,844.03 LESS PRE -PAID FEES -$1,250.00 TOTAL PERMIT FEES DUE NOW $10,594.03 RECEIPT DATE BY DATE FINALED INSPECTOR Er" Building t,� Address Owner A8 � -Su Mailing 7S 75S Address �j T4ht 4 4 " P.O. BOX 1504 78-495 CALLE TAMPICO A(ALA QUINTA, CALIFORNIA 92253 HAW M MA5-7I N W UE city ' N� I � zip C'A Contractor , G_ TH FD I NT Address Tel. 1 6e'.VQ ST"C ((A City Zip Tel. Statei�� City & Classit. f. 4-4--7 Lic. # Arch., Engr., /� 1� y� p� FAN -9 j�er AI Designer � V ✓ f'r � ' r Address/" -7 �d H `, ,� ` I Tel. ZZ C'zip State L-22_!;&� 4tWCklo MI��+. .-g2Z7D Lig.# LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. l 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 e permit to construct, alter, improve, demolish, or repair any structure, prior to 'Its Issuance also f- 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 thathe is exempt therefrom, and the basis �r for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit i subjects the applicant to a civil penalty of not more than five hundred dollars 1$500). I: 1, as owner of the property, or my employees with wages as their sole compensation, will .I 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.) 1 1 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.) 1-1 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 Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) V Policy No. Company n Copy is filed with the city. O 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 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 1 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 complywlth 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 'r Lender's, Address' This isa building permit when properly filled out, signed and validated, and is subject to expiration it work thereunder is suspended for 180 days. I certify that 1 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 sof this city to enter the above- mentioned property for inspection purposes. Signature of applicant Date Mailing Address -• City, State, Zip APPLICATION ONLY GV.S'foM H G M.� BUILDING: TYPE'CONST. OC:. GRrP-.., A.P. Number 7 Grl� 6" Ur Description t Description �1 A1rGLL-_-:f0SToM Hdf �,t t ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback Pom Center Line Side Setback from Property Line FINAL DATE INSPECTOR .- -y Issued by: Date er1 t Validated by: DE 2- 9 1998 Validation: JIiY CSE Ll, Q�II'� I,' WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION * k Sq. Ft. /0©Q Size c�G� No. ' No. Dw. ! Stories Units 1 New Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation C� I PERMIT AMOUNT Plan Chk. Dep. ZA y o ""'""- Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL REMARKS ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback Pom Center Line Side Setback from Property Line FINAL DATE INSPECTOR .- -y Issued by: Date er1 t Validated by: DE 2- 9 1998 Validation: JIiY CSE Ll, Q�II'� I,' WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION * k Coachella Valley Unified School District P.O. Box 847, Thermal, CA 92274 (760) 399-5137, Ext. 235 a Thk a,.v r.,,r NoT4,r I Iia r-li CERTIFICATE OF COMPLIANCE (California Education Code 17620) Project Name: Date: March 15; 1999 Owner's Name: Abesub Hal um Phone No. Project Address: 55-600 Pebble Reach. La Quin a .' CA 92253 Project Description: Dwelling APN: 769-620 010 Tract #: Lot #'s: Type of Development Residential XXX Commercial ILdustrial Tota qu t of'Building Area: 6,320 Sq.Ft. Certification of Applicant/Owners: The person signing certifies that the above information is correct and makes this statement. under penalty of perjury and further represents that he/she is authorized to sign on behalf of the owner•developer. Dated: �S -SS' Signature: SCHOOL DISTRICT'S REQUIREMENTS FOR THE ABOVE PROJECT HAVE BEEN OR WILL BE SATISFIED IN ACCORDANCE WITH ONE OF THE FOLLOWING: (CIRCLE ONE) Education Code Gov. Code Project Agreement Existing Not Subject to Fee ' 17620 65970 Approval Prior to 1/1/87 Rrquiremenf Note: Number of Sq.Ft. 6320 Amount per Sq.Ft. $ 1:.93. . y , Amount Collected $ 12•,197.60 By: Foch "Tut Penis. Assistant Superintendent Administrative Services Administrator in Charge Certificate issued'] Section 66020 of the Government Code asserted by Assembly Bill 3081, effective January 1, 1997, requires that this District provide (1) a written notice to -the project appellant, at the time of payment of school fees, mitigation payment or other exactions ("Fees"), of the 90 -day period to protest the.imposition of these Fees and (2) the amount of the fees. Therefore, in accordance wits section 66020 of the Government code and other applicable law, this Notice shall serve to advise you that the 90 -day protest period in regard to such Fees or the validity thereof, commences with the payment of the fees or performance of any other requirements as described in section 66020 of the Government code. Additionally, the amount of the fees imposed is as hereinset forth, whether payable at this time or in whole or in part prior to issuance of a Certificate of Occupancy. As in the latter, the 90 days starts on the date hereof. P ry IVA PGA WEST RESIDENTIAL ASSOCIATION, INC. September 28, 1998 Abesub & Mona Halum Dear Mr. and Mrs. Halum: Your request for an architectural variance has been approved by Mr. Don Adclph, Architectural Committee Chairman. Specifically, you have the approval to construct a custom home at your 55- 600 Pebble Beach lot. Please be advised that prior to commencement of work our office must be in receipt of a $10,000.00 refundable deposit. The signed PGA West Residential... Association, Inc. Notice of Architectural Apprnval form must be submitted to the City of La Quinta prior to their issuance of permits. We reserve the right to make a final inspection of this change to make sure f=iat it matches the original request. An approval is based only on the aesthetics of your proposed plan and should not be taken as any certification as to the construction worthiness or structural integrity of the proposed change., We appreciate your cooperation in submitting this request for approval. If I may be of further assistance, please contact me at the HOA office, (760) 771-1234. Sincerely, C VKelIttGaalliard Operations Manager cc: Architectural Committee enclosure(1) P.O. Box 1060, La Quinta, California 92253, Telephone 760-771-1234 FAX 760-771-5125 ^c IY � PGA WEST RESIDENTIAL ASSOCIATION, INC. PGA WEST RESIDENTIAL ASSOCIATION, INC. Notice of Architectural Approval This shall serve as written notification to the City of La Quinta that Mr. and Mrs~ Halum of 55-600 Pebble Beach have gained written approval from the PGA West Residential Association, Inc. Architectural Committee and from a Management Employee of the Homeowner Association.. Specifically, Mr. and Mrs. Halum have the approval to construct a custom home. This signed approval must precede the issuance of permits from the City of La Quinta. Ito, AmhiCommitAe ar�9lq� Date Date -P.O. Box 1060, La Quinta, California 92253, Telephone 760-771-1234 FAX 760-771-5125 4 Dear Builder: PUBLIC WORKS CLEARANCE LETTER FOR CUSTOM HOME LOTS Prior to issuance of a building permit, you will be required to obtain clearance from the Public Works Department for one, or more, of the following: 1. Verification that rough grading is complete, and the pad elevat on certifications prepared by al licensed surveyor, or engineer, are on file in 'the Public Works Department. 2. Verification that infrastructure improvements and other required tract improvements are complete, or sufficiently advanced to warrant building permit issuance. 3. Prepare an engineered grading plan that provides for on -lot storrr, water retention, and have it checked and approved by the Public Works Department . di Tract 26524 (Estancias) • Tract 26769 (Mountain View Estates) - 4... Prepare an engineered grading plan that provides for building pad grading in accordance with the existing soils report and tract grading p 'an, and have it checked and approved by the Public Works Department. • Tract 28034 (South Valley Estates) FOR INTERNAL USE BY PUBLIC WORKS DEPARTMENT TRACT: LOT: 3� h 7 PUBLItWWORYS AUTHORIZATIO DATE F:IPWDEPTIDOCSTORMSVPW CLEARANCE LETTER.ss