401-0091 (SFD)c1)
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LICENSED CONTRACTOR DECLARATION
•
I 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
533670 B I IC 06130/2(
/Date-/i>�,z' ct ! 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).
() 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:
Carder . STATE FUN!) Policy No. 1640462-01
(This. section need not be completed if the permit valuation is for $100.00 or less).
() I certify thatinthe 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: --1.•* kro•f 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 applicator 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.
• 1
Signature (Owner/Agent) • `y��`=-'� • • Date°`` • `f ' Ott'
-i\ -BUILDING BUILDING PERMIT PERMIT# 1
DATE.••`+y u/VALUATION 1.,1. 4.11%.00 LOT 22 TRACT K 253
ADDRESS 501-040 �t� EVIDA,. .ALi 1 JOB SITE
APN 74-22043-003
OWNER
CONTRACTOR / DESIGNER / ENGINEER
MARX T uvim.,. -
SUNROSE C" ORPOR,AI'I.ON
50455 WAMIO GTON ST #149
49.950J.ITY.E1 ON ur, 4130 .134. '
LA QUINTA CA 92253
INDIO • CA 92201
.
(760)777.7522 CI3L0 1137
USE OF PERMIT
SINGLE Fs .Y DWELLING
17)8 S.F. SPD, PFR -MIT DOES NOT INCLUDE BLOCK WALL, POOUSP.A.
OR DRIVEWAY APPROACH
•
TRACT CONSTRUCTION 4,77S,00 SF
PORCH/PATIO 20.00 SF s
OARA()EICARPOR`I' 441,00 AF
ESTIMATED COSI' 01 " CONSTRUCTRON
1.05,4S5.00
PER '1' I3`1t«.FS SUMMARY
CONSTRUCTION FEE •l 01.000-41 S-000 $660.59
PLAN CHECK PEE 101-000-439-31S $547.90
FEE DEPOSIT 101.0004439.318 4250,00
MECHANICAL FEE 101 -000-421-000 $59.00
ELECTPJCAL FEE 101.000.420.000 $119.34
PLUMBING PEE 101-000•419-000 $124.00
STRONG MOTION FEE - RESID 101.000-241.000 $10.55
GRADING FEE 101-000-423-000 $15.00
DEVELOPER R IMPACT FEE $2,405.00
PRECISE PLAN 101-000-441-345 $100.00
_ `i'
1 f TRTIC ZION• AND PLAN CHECK
$4,041,50
D.
&
LES PR&&FA) F1D'
-$250,00
_
MAR 04 2004
'.' L,P_I: IT FEES DU OW
53,791.50
FINANCE DEPT. CITY OF LA QUINTA
11111111 IIIII III
IIIII IIII 76
IE
RECEIPT
DATE'? r .- `j
BY (- •„ •
D ELFIN 211
INSPE�
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE •
INSPECTOR—
• BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
3��a �/
�J
Underground Ducts
Forms & Footings
(`
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
pW p� ,-
�/
.
/ r
Exhaust Fans '
F.A.U.
O.K. to Wrap
Framing
/ �..,.
��
,.40,,..--
Compressor
Compressor
Vents
Insulation
. , �`�/ p
Fireplace P.L.
, "
Grills
-
Fireplace T.O.
Fans. & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath'
6 (
G�
Drywall -Int. Lath
/- cat-
—7
Final
POOLS
- SPAS
• Final
BLOCKWALL APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond BeamApproval
to Cover
,
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
, —7' de -(_e
Heater Final .
Plumbing Final
Water Piping
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection,wf
Encapsulation
Gas Piping
.
Gas Test
Appliances
Final
COMMENTS:
•
...
,,
•
•
Final
Utility Notice (Gas)
7.--6—CA(
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
G. t-23--40 1
/(40-_
Final -
Utility Notice (Perm)
% 6' 7_-
—
40(
044. 01
•4'4saai
P.O. BOX 1504
Building r 78-495 CALLE TAMPICO
Address 7 � —� /O ,UVJ ,4G✓ IZ_4De LA OUINTA, CALIFORNIA 92253
Own r
dit'A 17>
Mailing ,+�
Address S"O �> W/k'SH,r,j ,TO4% S t
City
G if- QL>.eN>44
Z
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Tel.
272 —lQOyy
Contractor
iNG,
Address
5.1-/-r 0' /1
APPLICATION ONLY
BUILDING: TYPE -CONST. ifteW OCC. GRP.
A.P. Number 9 -2-03 —003
Legal Description Le -r ZZ a Ltd 2 > 3
Project Description ,cr-D
City
Zip
Tel.
State Lic.
& Classif. 5-3.36 70
City
Lic. #
Arch., Engr.,
Designer
Sq. Ft.
Size / (2
No.
Stories
No. Dw.
Units.
New ❑ Add ❑
Alter 0
Repair 0
Demolition 0
Address
Tel.
: City
Zip
State
Lic. p
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.
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permit to construct, alter, improve, demolish, or repair any structure, prior to 'its Issuance also
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 that. he is exempt therefrom, and the basis
for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit
subjects the applicant to a civil penalty of not more than live hundred dollars ($500).
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, 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.)
I'I 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.)
i? I 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.)
Policy No. Company
fl Copy is filed with the city. 0 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 Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
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, Civil Code.)
Lender's Name
Lender's Address
This is a 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 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 applicant Date
Mailing Address
City, State, Zip
WHITE = BUILDING DEPARTMENT
Estimated Valuation
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
AMOUNT
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 from Center Line
Side Setback from Property Line
FINAL DATE
INSPECTOR
Issued by' Date Permit
Validated by:
Validation:
YELLOW = APPLICANT
PINK = FINANCE
,,,
Certificate of Occupancy,c.i.
aditia,
-
-- - 4V
Tay, at 4
4OF TVV' BuildingSafety Department
De artment
This Certificate is issued pursuant to the requirements of Section 109 of the California Building
Code, certifying that, at the time of issuance, this structure was in compliance with the
provisions of the Building Code and the various ordinances of the City regulating building
construction and/or use.
BUILDING ADDRESS: 54040 AVENIDA ALVARADO
Use classification: SFD Building Permit No.: 0401-091
Occupancy Group: R3 Type of Construction: VN Land Use Zone: RC
Owner of Building: MARK TUVELL Address: 50-855 WASHINGTON ST #149
City, ST, ZIP: LA QUINTA CA 92253
By: KIRK KIRKLAND
r-.4., 14-L4-
Date: 7-6-04
Building Official
IN A CONSPICUOUS PLACE
(14)POST
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