9812-204 (AR)LICENSED CONTRACTOR DECLARATION
r.Qhdeby 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
523837 B 214 ,
ate ' Signature of Contractor
V g
OWNER -BUILDER DE/CLARATION.
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
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.
(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 fo�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 Califorpia, and agree that if 13should become
subject to the workers' compensation provisions of Section X0.0 of the Labor
,Pode, II h II fo �hwith comply with those•provision / {
t(Date: ate:/, k APPlicantl/'��..x
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
1. Each person upon whose behalf this application is made & each person at a
whose request and for whose benefit work is performed under or pursuant to n,
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 voidIif
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 authori'ie• representatives of- this City to enter upon
the above-mentioned property,fo inspection purposes .
Zignature (Owner/Agent) ' `Y✓ Date
BUILDING PERMIT PERMIT#
9811,204
DATE VALUATION S42,724.:C LOT TRACT
d
JOB SITE
ADDRESS 55-692tit .t% � +
7N_6.9-351'41016
OWNER
CONTRACTOR/DESIGNER/ENGINEER
YCPOSUNG 1 WAi
soun-1 tiV .n C(71Vf;,';;ITS
55592.OAK `1 REE
62723 DR. < .t11ZiZ:,0JN BLVD.
LA. C,UINTA CA, X3225:3
IN D10 CA. 92.201
(N041-5555 t:KN 1461.
SOUTH WEST C0ivC' 9' S1'
USE OF PERMIT
RX..&D ;1ti1HAL A.1.3OI`.[°101;il
8=23 C;AkREOIN BLVD.
A:MMON C)F 35 SQ T , 2 b1C`ar[ CH T rS.KaCkff.Ni REMOD&
WSTOM CONST RUC" i'IGIN 35.00 33,
CONTRACT AMOL'TP1Ff 40,000.00 LS
'
0S # b,d+ A t E- C(Rw'1 ii Of CONST,RUC 8.'10
4e2.726,50
FEC SUAIMARY
CONS'I'RUC:. r'IO'N Ff?1. 101.000 -41,4 -OW
�.kN CKC , illi-r>Q{1..439-31 t '227,9._%9
NIEC€ A'11-4iCAAIL :RIM 1!)1-OG(1-i�1 � $2i.5^
Eut7,r,KICAf. FEE 1fl 1-flfl0,f12fl-OGQ 51.6.23
PLUN413i;NO FEE 101 0)0-419-M
:ST'IMNf,141 T-IOaN WRIE = RFS:1`#"1 01-000-241.-000
ORAIA140 FEX 101-000-423-000 $20.00
0
',15zJB-'1 'A I.. C ON - TR tc710N AND MAN CfIFCK
$7?14.89
x U -SS PRE -PAID CF.1?S
$0.00
r
L ,fi y� t, �,�A t,� B,9 e,� 7ptp 3cr
,N'�.7r+��AL .�'14'w�]�x.l�e8 A''.A'rro!.ri d/0.�T�.611R�y�V
TOTAL
�i�f a �,if�
S 34.199
JAN 0 6 099 0
. ( •'
RECEIPT/ r • "-
DATE- — -
BY !
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade AX
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 Wall 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
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
Final
Utility Notice (Perm)
COMMENTS:
Coachella Valley Unified School District
P.O. Box 847, Thermal, CA 92274
(760) 399-5137, Ext: 235
This Any Fnr Nctrirt i len rtnly
CERTIFICATE OF COMPLIANCE
(Government code 53080)
Project Name: Date: December 28, 1998
Owner's Name: Y00 Sung KwakPhone No. 342-555
Project Address: 55-692 Oak Tree, La Ouinta, CA 92252
Project Description: Room Addition
APN: 769^351 006 Tract #:
Type of Development: Residential XX Commercial
Total Square Feet of Building Area: 35 Sq. -Ft.
Lot #'s:
Industrial
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: v'. �8 �✓ �® Signature: t ✓1.��
SCHOOL DISTRICT'S REQUIREMENTS FOR THE ABOVE PROJECT HAVE BEEN OR WILL BE SATISFIED IN
ACCORDANCE WITH ONE OF THE FOLLOWING: (CIRCLE ONE)
Gov. Code
53080/65995
Number of Sq.Ft.
Amount per Sq.Ft.
Amount Collected
Gov. Code Project
65970 Approval
3S
$ -0
$ -0
Agreement Existing Not Subject to Fee
Prior to 1/1/87 Requirement
By: Foch "Tut" Pensis. Assistant Superintendent Administrative Services
Administrator in Charge
Certificate issued by: Marcela Valdez Signature:
acs sties epartment
time of a ent of school fees, Mitigation
p ym _ _ Goo paymml or ottm exactions. This 000a is w advise yoo thn my paem in teed b mob amoattu or the validity Wacof io accotdarce with Sepioo 66010 of 16e Gover®em Cade and other tinkle lav
NOTE: AB 2926 and SB 201 fees are capped at $1.93 per square foot for all residential construction, and at $0.31 per square foot
for commercial/industrial projects.
DEVELOPER FEES PAID
AREA:
AMOUNT:
RCPT q:
CK. p:
CASH:
INITIALS:
DATE:
CERTIFICATE OF COMPLIANCE
(Government code 53080)
Project Name: Date: December 28, 1998
Owner's Name: Y00 Sung KwakPhone No. 342-555
Project Address: 55-692 Oak Tree, La Ouinta, CA 92252
Project Description: Room Addition
APN: 769^351 006 Tract #:
Type of Development: Residential XX Commercial
Total Square Feet of Building Area: 35 Sq. -Ft.
Lot #'s:
Industrial
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: v'. �8 �✓ �® Signature: t ✓1.��
SCHOOL DISTRICT'S REQUIREMENTS FOR THE ABOVE PROJECT HAVE BEEN OR WILL BE SATISFIED IN
ACCORDANCE WITH ONE OF THE FOLLOWING: (CIRCLE ONE)
Gov. Code
53080/65995
Number of Sq.Ft.
Amount per Sq.Ft.
Amount Collected
Gov. Code Project
65970 Approval
3S
$ -0
$ -0
Agreement Existing Not Subject to Fee
Prior to 1/1/87 Requirement
By: Foch "Tut" Pensis. Assistant Superintendent Administrative Services
Administrator in Charge
Certificate issued by: Marcela Valdez Signature:
acs sties epartment
time of a ent of school fees, Mitigation
p ym _ _ Goo paymml or ottm exactions. This 000a is w advise yoo thn my paem in teed b mob amoattu or the validity Wacof io accotdarce with Sepioo 66010 of 16e Gover®em Cade and other tinkle lav
NOTE: AB 2926 and SB 201 fees are capped at $1.93 per square foot for all residential construction, and at $0.31 per square foot
for commercial/industrial projects.
January 5, 1999 `
Yoo Sung Kwak
75-605 Camino De Paco
Indian Wells, CA 92210
Dear Ms. Kwak:
Your request for an architectural variance has been approved by Mr. Don Adolph, Architectural
Committee Chairman. Specifically, you have the approval to proceed with the extension of the rear
wall, installation of a sliding glass door and two skylights at your 55-692 Oak Tree residence. Upon
completion, please submit the enclosed Notice of Completion form to this office.
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 may be of further
assistance, please contact me at the HOA office, (760) 771-1234.
Sincerely,
�C
McGalliard
Operations Manager
cc: Architectural Committee
enclosure (1)
P.O. Box 1060, La Ouinta, California 92253, Telephone 760-771-1234 FAX 760-771-5125
CITY OF
LA QUINTA 5Ut3-CUN 1 KAV 1 UK Ll, l
s E (�j0 S9hl
106 ADDRESS
PERMIT NUMBER 41$12 • 204 OWNER YDO S(nN(9 4WM4 BUILDER
form shall be Rosted
on the job with the Buflefing Insmmition
Card
at all times in a consRkums
. Only persons appearing on this list or their employees are authorized
to worko
in this job. Any changes to this list must be approved by the Building Division prior to commencement of work. Failure to comply will result in a stoppage of work and/or the voidance
of building permit. For each applicable trade, all -information re uested below must be completed
by apglicant. 'On File" is not an acce table rNil
c,
Trade I Classification
Contractor
State Contrmar's License
Workers C naatlon Inavrseiee
iank��s Lleenp
a
Z
Company Name '
Classification
(e.g. A. B, C-8)
License Number Exp. Date
Ixxsxxxl Ixx/xxlxx)
Corrie+ Name Poky Numbere
Ie.g. State Fund, CaiComp) (Format Veriestxxxl
Number
Exp. Date
Ixx/xxhtx)
u
I
EARTHWORK (C-121
CONCRETE (C-81
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738S105 82-39
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STRUCT. STEEL (C-61)
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MASONRY IC -291
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DRYWALL (C-8)
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ELECTRICAL (C-10)
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SHEET METAL IC431
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FLOORING IC -161
GLAZING (C-17)
-- I>rl
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$ - 31
S , l 39l�2
6-1-�5
S a$ 5
1 z i 99
N
INSULATION (C-2)
66D, Aa4 ;
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S�Z HIJD ;,229 - 0012 (070. .
1-09. 9
0/ (0
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SEWAGE DISP. IC42)
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PAINTING IC -331
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a
CA8(NETS (C-81
FENCING IC -131
LANDSCAPING IC -271
POOL IC -l'