15269 (ELEC)No. 15269
P.O. BOX 1504'
Buil=ding 78-495 CALLE TAMPICO
AddFess 55 665 Pebble 'Beach' LA QUINTA, CALIFORNIA 92253
ower Chariea ' P. Wehrly
Mailing
Address SdEttf3
CityZip
.. i'I. Quinta,, �. 92253
Contractor •
C&li tori i6 Fouls a 'Sp
Address
.41-910 Boardwalk .A-2
aYalm Desert, zk 92211'
State Lica
& Classif.. C-5 3 .656128
-Arch., Engr.,
Designer . , ,
BUILDING: TYPE CONST. - OCC: GRP.-
A.P.
RP_ A.P. Number
Tel.
7.71-280C Legal Description - 40
Project Description .-Electric-for water , feature
340�9t�0a `
Lic. #
3551. Sq, Ft. No.
Size Stories
New ❑ Add ❑ Alter ❑
No. Dw
' Repair -D.
Demotitioit. ❑
.Address t ,
Tel.
:� »,•R
City
Zip
State
Lic. #
LI NSED CONTRACTORS DECLARATION
I"hereby affirm;that I ami icensed under provisions of Chapter 9 (commencing with Section
tof Division 3 of th Business'and Professions Code, and my license is in full force and'
fe 2fect.
tV� .. ...
!F•
,J SIGNATURE I DATE
'
tp OWNER -BUILDER DECLARATION
1 hereby aitilm that I am exempt from the Contractor's License Law for the following•...aV
Estimated Valuation
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
. permit to construct, after, improve, demoitsh, or repair any structure, prior to its issuance also
I `
requires -the applicant for such permit to rile a signed statement that he is licensed pursuant to - •
PERMIT AMOUNT
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 Any Section 7031.5 'any
_ - • •
Plan Chk. Dep.
alleged exemption. violation of by applicant for a ,permit
subjects the applicant toa civil penalty, of not more than five hundred dollars ($500): _
- -
Plan Chk, Bal.
_ ❑ I, as owner of the property, or my employees with wages as their sole compensation, will
do the work, and the stricture is not intended or offered for sale. (Sec. 7044, Buisness and -
Const. 15 {�'�.
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,
' Mech.
provided that such improvements are not intended or offered for sale.. If, however, the building
C,r Improvement is sold within one year of completion, the owner -builder will have the burden
Electrical - �".'•"„
of proving that he did not build or improve for the purpose of sale.)
-
b I, as' owner of the property, am exclusively contracting with licensed contractors to con-
_
Plumbing , .
• struct the project. (Sec. 7044, Business and Professions Code: The •Contractor's License Law
- -
does not apply to an owner of propertywhobuilds or Improves thereon, and who contracts for
S•M•1• _- -
such projects with a contractors) (Icensed pursuant to the Contractor's,Ucense Law.) _ -
-
Grading
❑ 1 am exempt under Sec B. & P.C. for this reason
Driveway Enc.
• Date Owner
Infrastructure
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's Comp cation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
-
Policy No! Company
[Eopy, is til with the city. . ❑ Certified copy is hereby furnished..
TOTAL
i.
CERTIFICATE OF EXEMPTION FROM
-REMARKS
• - WORKERS' COMPENSATION INSURANCE
(This section need not be completed it 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 Owner.
NOTICE TO APPLICANT: If, after, making this Certificate. of Exemption you should become
' ZONE: •BY:•
subject to the Workers' Conrpensatfon provisions of •the Labor Code, • you must forthwith-
comply with such provisions or this permit shall be deemed revoked.
- '
.Minimum Setback Distances: _ -
•
Front Setback from Center Line
Rear Setback from Rear Prop. Line
WARNING: FAILURE TO SECURE WORKERS'COMPENSATION,COVERAGEIS UNLAWFUL. AND
-• Side Street Setback from Center Line • '
SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE
-
HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION,
Side Setback.from Property- Line.
DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE, INTEREST, AND
ATTORNEYS FEES.
FINAL DATE INSPECTOR
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. - .
'
Issued by: Date _Perm) _
I agree to comply with all city and county ordinances and state laws relating to building
consWction, and he authorize representatives .of this. -city. to enter- the above. -
w ) I /��
L
mentioned property for ins_ pection purposes.
j#
Validated by:
Signature of applicant Date-
ate
Mailing
Mailing Address
Validation: I 1 t I1 11 n 1(7 C1
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBIW FEES
1ST FL. SO. FT. @ $
UNITS
SLAB GRADE
2ND FL. SO. FT. @
BONDING
YARD SPKLR SYSTEM
POR. SO. FT. @
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. @
POWER OUTLET
ROOF DRAINS
CAR P. SO. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SO. FT. @
OTHER APPJEQUIP.
DRINKING FOUNTAIN
SO. FT. @
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
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.
SO. FT. @ c
BATH TUB
SO. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID @ 11/4 c
SEWAGE DISPOSAL
GAR. FIREWALL
SO.FT.GAR @ 3/ac
HOUSE SEWER
LATHING
GAS PIPING
PERMIT FEE
MESH
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 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
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL 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: DATE: S'3b-19 S
ADDRESS: 'S5 -(o (os �EBE3c �_ 13EAc_i-�1
PHONE: lo\ -1 '-1 UNIT:
Eq
APPY
-Ty . TEOMPG DATE
• "Arr f 8- t
llf41 /'
e ...
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 (landscape,
sprinklers, gas lines, electrical, etc.)
2. Agreement and Covenant Running with the Land completed and
notarized. Two (2) original.
3. Conditions -of Approval and Disclaimer form (signed)
4. Facing and Adjacent Neighbor.form (if applicable)
5. Construction Regulations form (signed)
ELECTRICAL [ ] Approved [ ] Disapproved
Signature Date
LANDSCAPE [ ] Approved [ ] Disapproved
Signature Date
ARCHITECTURAL CODWTEE [ Approved [ ] Disapproved
Signature Date
&C
ARCH/Rev 4/95 1