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9512-130 (BLCK)LICENSED CONTRACTOR DECLARATION I hereby affirm 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 Date Signatureof Contractor OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason: �.1�4--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). O I am exemp under Section --_BKP:C: for this reason n Date i' 2 179 4t %ignature of Ow�- 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 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 triose 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 behalf1his 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 application agrees to, & shall, indemnity . & hold harmless the City of Indian Wells, 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 "`C' BUILDING PERMIT PERMIT—T.2-130 5 DATE VALUATION "WWO-IMI LOT TRACT JOB SITE, ADDRESS 53-720 Avenida piaregon APN 77441-5-01.1 x' OWNER CONTRACTOR w 04VvlF't1BW1der "TONY A & V RGIRIA MMM $4we `as above 53720 AVENIDA OBRWON � LA QUiN1'A,CA. 92253 CBLP: DESIGNERIENGINEER USE OF PERMITS 311f 4' Ciao;tt WMV 113M 3 Course -a tadurlera. to eiffis ttg Iwainuig wash South rill:. Eng requimd for ghK anent =d 4' gwde. twatil. Wa11, bu& without, pCCntit and required pro- vW6 t�QOiUL' asrt(I: e.,'fCtll V�t7tICRktO ' FEE DESCRIPTION FEES 4 FT. WALL. 31.00 LF t JUS1'1A A TED COST OF C;:ONST RUC'R IOIV . 4,96.00 PC, RMi1 F EF, SUMMARY CONSTRUCTION M 101 -Oats -41 8-4110 $34.04 lY7T.AL ct�I+iSTf iJC 1 lON AND PLAN CHECK K $30.40 .LESS PRE -PAR) FEES $0.00 -Dec 2 ,TOTAL TERMITFE&S DUE NOW $30.00 ! 1995 RECEIPT ). DATE -ZZ` r BY DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE I INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings 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 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: toNY +� vI►2lntN�/� M�'fi � � '• =i 3 - '17 w7 �-J G.�l 1 h n� � � f1��if1 � ' j( D� OJ i N r- y r C. a. 0 t1j GMy = �v Mp ytaNE ' C�XCPx to FJ A -Y 1? -0 1�i17 W 3/9 -T1 61 �� 5� 2 5 OrGIG 3/ori j3�ia�1MONd' TO P111"OrJ Ir j fio G v 1 {1 =1 i -': -,*--I I I `T e o a I" may' 4 4Qut«tw P.O. BOX 1504 Building 78-105 CALLE ESTADO Address LA QUINTA, CALIFORNIA 92253 Owner - ITZ- 57 - Mailing Address City Zip Tel. Wk—&117-744476 1, 1, nlr/a- ZZ7zj ( $I�l -Slo¢�lp15' Contractor © `N N t� i3 v i 1, t71=ih� City Zip Tel. State Lic. City & Classif. Lic. M Designer Address I Tel. City Zip State Lic. M LICENSED CONTRACTOR'S DECLARATION 1 hereby affirm that t 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. SIGNATURE DATE OWNEWBUILDER DECLARATION I hereby affirm that I aim exempt from the Contractors License Law for the following reason: (Sec. 7031.5,Business and Professions Lode: Any city or county wltidr requires a permit to construct, after, improve, demolish, or repair any structure, prior to its issuance .also requires the applicant for such permit to Me 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 Mat. he is exempt therefrom, and the basis for the alleged exemption. Any violation of Sectlon 7031.5 by any ap~ for a Permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). . 1-1 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, Bufsness 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 ftown employees, provided that such improvements are not intended or offered for safe. N, however, the building orimprovement is sold within one year of completion, the owner-buider will hero the burden of proving that he did not Rudd Or srprove for the purpose of sale.) 1, 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:) ,'. I am exempt under Sec. B. S P.C.'fet this reason Date I - Sow. er\ - WORKERS' COMPENSATION DECLARATION I hereby affirm that 1 have a certificate of consent to self -insure, or a certificate of Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800. Labor Cade.) Policy No. Company 9 Copy is filed with the city. C 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 dolars ($100) vaAsdon or less.) 1 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. Dale Owner NOTICE TO APPLICANT: ft, after making this Certificate of Exemption you should become subject to the Workers' Compensation provisions of the Labor Code, you must forMwfth 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, CMI Code.) Lender's Name Lender's Address This is abuilding 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 Mailing Add City, state, APPLICATION ONLY P X ties lb '+,PAC -H -r OF c I Sri r� y �il-O SIL w�1.V -�G�-,qj r3i N 11LDING: TYPE CONST. OCC. GRP. P. Number LOT 11 D I.0 � l 9 0 OP 9MdTa A'tT- M P i, l rA gal Description_&r I/q-L�t%- 1 _Lot 6 viMTil , uwtr 19 13cok14F t V oject Description _ i^1 b I !JO ., L- ' F_ PjZ�GI `7101) -yA-V1- Oij & 4-r A -t,1 ,A'C7p 1 Tl D N L /L i_O rl ,i/ �FIrA'1 ►�I N U WAL'V i/o �— ArV Sq. Ft. No. No. Dw. Size Stories Units New ❑ Add O Alter O Repair O Demolition ❑ Estimated Valuation SAO o0 i PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing S. M.1. 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 from Center Line Side Setback from Property Line FINAL DATE INSPECTOR Issued by: Date Permit Validated by: Validation: I/ � % c -*2 - 2+ -2 N I gni � � ()FEss F v o Nq Fy � �� � � O Iz0 j� rj(2-('�{ Qc`O R, C. * xp. Q� �L-L'.11- NA v l,oG �� �-►., pil // X 1 Ertl N �ZiM 0 V OF - -1 ---- - -------------��--o-n rte+.- � _ 6 LZ=r�1-� �t� x_-5—b—�g---------- -- _— U 1T� -rp l -I'D VOOT(N 6- '!�, Ir q�{2j --- — -- JOB Cal West Engineering SHEET NO. OF 81-159 Durango Drive CALCULATED BY DATE Indio, Ca. 92201 (619) 342-9695 Fax (619) 342-9695 CHECKED BY DATE SCALE 5 e 11 1 2 J .. 5 1 e 1 2 1 11, 1 1., "oo, Pt '1 :1. 1 11: .A u M MEM -0 December 19, 1995 To: Mark From' Danny Subj: Mr. Tony Mitre, 53-720 Avenida Obregon 1. Mark, for your information the following information is submitted to update you on un -permitted work at above referenced address. 2. Today, I observed, ,A constructed 4' garden block wall front yard, no permit, no inspection. A 3 course block addition to an existing retaining wall,-no.permit, no inspection and no engineering. A re -roof in progress, no permit, no inspection, owner reported that he added a 3/8" plywood to roof. A 6' drywell insulation front yard, I don't know what was required for that. 3. Mr. Tony Mitre did contract me after red tag was issued. He is in the process of making application for permits for the above mention items. 4. Please advise me if investigation fees are appropriate, and assist me in inspection determination for construction in place. Thank you, Danny Page 1 APN 774-115-011 Use: SINGLE RESIDENCE 'Phone Owners: MITRE,TONY A & VIRGINIA Pg-Grd: 224-C2/ Site :.53720 AVENIDA OBREGON*LA QUINTA CA 92253 Census: 0451.048 Mail PO BOX 1203*LA QUINTA CA 92253 Zoning:_R1 FloodP. Legal LOT 11 BLK 188 MB 019/033 SANTA CARMELITA AT VALE Map: MB -019-033 Tr/Lot/Bl: 00000-00/L-0011/188 Assd $89,138 TRA 020015 SaleDt: 10/01/87 SaleAm: Land . : $7,550 Tax $1,355.48 Doc # : 303395 1st Td: PerImp: 91% Sta/Ex: CUR Lender: Addl: Ownshp: JOINT TaxYr 95-96 Title PrevDt: Last Trans W/O $: $/SgFt: PrevAm: Yr Blt: 1978 SgFeet: 1,222 OutImp GarSgF: 400 BedBth: 2/2.0 Addtnl: 40 StSurf: Y GarTyp: ATTACHED.- #Story: 1 Roof :.TILE MscBdg: CarSgF: #Units: l Electr: DEVELOPED Ht/C1 : B GarSF2: LotSz : 4,791 Gas : DEVELOPED FirePl:. Y GarTy2: Water DEVELOPED Pool Y CarSF2: Sewer NO View ------------------- ---------------------------------- 7------------------------- Copyright.(C)1995 Dataquick Information Systems Itz �M�