9802-015 (AR)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
r
59(1090 k3 Y31/98
ate Signature of Contractor ' i t'1-7
C'
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).
( ) I 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
Setion 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.
STATE FUND 1297971-97
(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. {
ate: _.. t Applicant–
Warning:
pplicant Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person. upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
thhee,above-mentioned property for inspection purposes.
Signature (Owner/Agent) #. t r Date + ti
f
// BUILDING PERMIT
PERMIT# CONTROLNDATE
�..l ���Q VALUATION LOT
98025�s,-015 TRACT . O
11111 = i9fcl 511,757.40
JOB SITE
APN
ADDRESS W391 PEBBLE RF.AC H
- 4
OWNER
CONTRACTOR / DESIGNER / ENGINEER
JOSEPH 0 NVOODLEV
CAL TECH BUILDERS
150393 PEBBLE BCH
52.711. AVE NIDA VELA.SCO
LA QXRNTA CA 92253
LA QUINrA C.A 92253
(760):564-M CBL# 402
PSDAl)i)N
USE OF PERMIT
ATRrUJM CNCL0$;URE 106SF
FEB 2 7 1998
CUS'Ct)M COiva'MIJC1 ON
01 -TY Of
1(360) SF
`LA CUNTA
L'STUMAXED CMT OF
CONSTRUCT ION
8,257.41)/'
PERMIT .FEE SUMMARY
PLAN CHECK M -T3 101-000-,139.3113
$70.20
C®NSTRUCTION F(0,: 101-000-118-000
$103.00
MECHANICAL FIX, 10L -000-421-0t30
$15,00
lsLEC1'EICAty h10; 101-1100420-000
sift.?t
1 LUMHIN0 10i•(X)(3-4I9_0 30
$21.00
STRONOIVI 'fL M FEE - RE SID 101-(W-241-000
5.83
SUB -TOTAL CONSfItUMION AND PLAN CHECK
$233.7,1
LESS PRE -PAID FEE, S
Woo
TOTAL PERMIT FEES DVE NOW
S233.74
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings ,/O
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 Wail Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final - ?-
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. 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
iN :3 02 — c
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G. F.I.
Smoke Detectors
Temp. Use of Power
,r
Final
Utility Notice (Perm)
COMMENTS:
Coachella Valley Unified School District
P.O. Box 847, Thermal, CA 92274
(760) 399-5137, Ext. 235
is�(efy),P-7-
This Boz For District Use Only
DEVELOPER FEES PAID
AREA: .
QQ
AMOUNT: p RCPTA
Cs. a: CASH:
MIT1ALS: DATE:
CERTIFICATE OF COMPLIANCE
(Government Code 53080)
Project Name: Date: February 5, 1998
Owner's Name: Joseph G. Woodley Phone No. 564-1309 (760)
Address: 80-393 Pebble Beach, PGA West, La Quinta, CA 92253
Project Description: Room Addition
APN:
Tract #:
Lot #:
Type of Developmern% Residential XX ommercial Industrial
-Square-Feet of Building -Area: 106
Certification of Applicant/Owner :-Fie-person signing certifies that the above information is correct and makes this statement
under penalty of perjury and further represents that he/she is autorhized to sign on be of % owner/ eveloper.
Dated: �%� 6-.1J g Signature: dr >
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
53080/65995 65970 Approval
Number of Sq./Ft. 106
Amount per Sq/Ft. $ -0
Amount Collected $ -0
Agreement Existing Not subject to fee
prior to 1/1/87 requirement.
Note: Pursuant to AB -181 anyi room additions
or enclosures of 500 sq.ft. or less are
exempt from developer fees.
By: Foch "Tut" Pensis, Assistant Superintendent Administrative Services
Administrator in Charge
Certificate issued by: Marcela Valdez Signature: �
(NOTICE: Section titi0211 of the t vetmo-t Code atacted es Assembly Ei113081, set foNt as Chapter 549, Statutes of the State of Califontia 1996 effective Jmt 1,1997, requires tlut tltis school d M p a vnitte�t police to I
the project applicant at the tune of paymatl of school fees, mitigation paytnatt or otlter exnctio�u. Tttis notice is to advise you tlut a,ty protest ut regard to such o<nomtts ar the validity tltereof ut acco dance vritlt Section titi010
of the uovenuuatt Code end older applicable lew, conunatces ..,pa cyment or pedonnance of eny.t�ter requirement as describedut Section 0.020 of the Qovenmtau C'.ode. Additimwtly, tltis notice advises tltat the
protest tltereof must occtn vrtttit 90 celaidar days Uuseafter.
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-ComSam (REV. 1/97)
PGA WEST
RESIDENTIAL ASSOCIATION, INC.
January 26, 1998
Joseph G. Woodley
80-393 Pebble Beach
La Quinta, CA 92253
Dear Mr. Woodley:
Mr. Don Adolph, Architectural Committee has reviewed your request to enclose the atrium and to
install a new garage door at your 80-393 Pebble Beach residence. Mr. Adolph has approved the plan
contingent .upon compliance that the garage is compatible to existing doors in the community.
Please provide a cut sheet of the garage door.
We reserve the right to make a final inspection of this change to make sure that 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 maybe of further
assistance, please contact me at the HOA office, (760) 771-1234.
Sincer ly,
Kelly McGalliard
Operations Manager
cc: Architectural Committee
P.O. Box 1060, La Quinta, California 92253, Telephone 760-771-1234 FAX 760-771-5125