AR (9805-092)78840 Lowe Dr
9805-092
LICENSE
D 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
572928 B C6 U31/00
Date I 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).
(y) I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
( Zl am exempt under Section B&P.C.Jor this reas
0- ly Signature of Owner( -.Ol
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 sect n'ne "d Qt l9completed if the permit valuationor $QI`b'8.%900Aess)
( 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
sub1ect to the workers' compensation provisions of Section '3700 of the Labor
Yde, I.shall forthwith comply with those p `ovionstj
e: t • f ' k Applicant,
1
Warning: Failure to secure Workers' Compensation' -cove rage 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
the above-mentioned property for inspection purposes.
/ignl t/1 C
ature (Owner/Agent) / N ' 'r Date '& / r
5
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 91J(),"92 TRACT
JOB SITE
APN
ADDRESS
79-940 O604-232-031
OWNER
CONTRACTOR/DESIGNER/ENGINEER
GARY STANGELO
DILLON CONSTRUC 100 COMPANY
78840 L.OWE M
653 COMMERCIAL ROAD #13
LA QU.M-A CA 92233
PALM SPRINGS CA 92262
(i0}325>i3h2b CBL# 5265
USE OF PERMIT
iv
. f 35 S.F. ROOM ADDITION
A13DITION 135.00 SF
E, STI.MATED COAT OV CONSTRUO110N
7.33o.5o
PERMIT FEE Stf11TNURY
PLAN C'HFXK FEE 101400-139-318 VA 335
CONSTRtJCTION FEX 101-000-418-000 $99,00
MECHANICAL FEE 101-000-421.000 $15.00
ELECTRICAL rEE .101-000-420-000 $19.73
STRONG MOTION FFE - RESfD 101-000-211-000
SIM -TOT -AL CONSTRUMON AND PLAN CHECK
$198.81
LESS ME -PAID FEES
60.1317
TOTAL PERMIT FEES IDUENONV
5198181
rte,
RECFIPT f
Itie
/•
DATE / ,f
) -\
BY ` \
'DATE FINALE
INSPECTOR
\ \'
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & FootingsDucts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck A
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
POOLS - SPAS
BLOCKWALL APPROVALS
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
COMMENTS:
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)
I
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FRCS
!ST FL.
2ND FL.
POR
GAR
CAR P
WALL
ESTIMA'. ED CONSTRUCTION
Su FT it S
UNITS
a.
•
SO. FT..,g
YARD SPKLR SYSTEM
SO FT E MOBILEHOME SVC.
BAP SINK
SO FT. •g POWER OUTLET
ROOF DRAINS
JO. FT 3
DRAINAGE PIPING
SO FT %2
DRINKING FOUNTAIN
50 T.
URINAL
VALUATION S
WATER PIPING
NOTE: Net to he Msec as prooeny :as +atuahon
FLOOR DRAIN
MECHANICAL FEES
WATER HEATER
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTOX OI SHI
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LUMBER GR.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FRAMING
KITCHEN SINK
ABSORPTION SYSTEM B.T.0
TEMP USE PERMIT SVCWATER
CLOSET
COMPRESSOR HP
POLE. TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. e , c
BATH TUB
FIRE ZONE ROOFING
SO. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SU. FT. RESID rd 1+.a c
SEWAGE DISPOSAL
SPARK ARRESTOR
SO.FT.GAR @ 4,c
HOUSE SEWER
GAS PIPING
PERMIT FEE
RMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE rPL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR GOND. SOLAR
SETBACK
SLAB GRADE
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL AREA
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 APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM r '
GRADING
CLL Yd,
= plus x$
=S ,
LUMBER GR.
'
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
t
r
r
REMARKS
VENTILATION
FIRE ZONE ROOFING
FIREPLACE ,
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPEGTVRS SI{iNA7YNE311NIT1Alb
GARDEN WALL FINAL
a
Desert Sands Unified School District
47-950 Dune Palms Road
Notice: La Quinta, CA 92253
Document Cannot Be Duplicated 760-771-8515
Date 6/30/98
No. 17259
Owner NameGary St. Angelo
CERTIFICATE OF COMPLIANCE
APN # 604-232-031
Jurisdiction La Quinta
No. 78-840 Street Lowe Drive
City La Quinta Zip 92253
Tract #
Lot #
Type of Development Residential Addition
Comments
135 sq. ft. addition
Permit #
Log #
Study Area
Square Footage 135
No. of Units 1
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered
patios/walkways, residential additions under 500 square feet, detached accessory structures or replacement mobilehomes.
It has been determined theabove-named owner is exempt from paying school fees at this time due to the following
reason:
Residential Addition 500 Sq Feet or Less
EXEMPT
This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of
0.00 X 135 or $ 0.00 the property listed above and that bii+,ilingf4
permits and/or Certificates of Occupancy for this square footage in this proposed project riaynow be issued', '--; ,t,
A
Fees Paid By Gary St. Angelo Te eohgne 3W-, 4101
o
Name on the check
By Dr. Doris Wilson_ r
Superintendent
Fee collected /exempted by
Signature
Juanita Green Exempt $0.00
Check No. N/A
NOTICE: Pursuant of Asserry Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified
above will begin to run from a date on which the building or installation permit for this project is sssued or on which they are paid to the District(s) or to another public entity authorized to
collect them on the Dislrict('s)(s') behalf, whichever is earlier.
Collector: Attach a copy of county or city plan check application form to district copy for all waivers.
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting
OWNER/BUILDER INFORMATION
Dear Property Owner:
An application for a building permit has been submitted in your name listing yourself as the builder of the property
improvements specified: —
For your protection you should be aware that as "Owner/ Builder" you are the responsible party of record on such a
permit. Building permits are not required to be signed by property owners unless they are personally performing their
own work. if your work is being performed by someone other than yourself, you may protect yourself from possible
liability if that person applies for the proper permit in his or her name.
Contractors are required by law to be licensed and bonded by the State of California and to have a business license
from the City or County. They are also required by law to put their license number on all permits for which they
apply.
If you plan to do your own work, with the exception of various trades that you plan to subcontract, you should be
aware of the following information for your benefit and protection:
If you employ or otherwise engage any persons other than your immediate family, and the work (including materials
and other costs) is $200.00 or more for the entire project, and such persons are not licensed as contractors or
subcontractors, then you may be an employer.
If you are an employer, you must register with the State and Federal Government as an employer and you are subject
to several obligations including State and Federal income tax withholding, federal social security taxes, worker's
compensation insurance, disability insurance costs and unemployment compensation contributions.
There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with
respect to worker's compensation insurance.
For more specific information about your obligations under Federal Law, contact the Internal Revenue Service (and, if
you wish, the U.S. Small Business Adminstration). For more specific information about your obligations under State
Law, contact the Department of Benefit Payments and the Division of Industrial Accidents.
If the structure is intended for sale, property owners who are not licensed contractors are allowed to perform their
work personally or through their own employees, without a licensed contractor or subcontractor, only under limited
conditions.
A frequent practice of unlicensed persons professing to be contractors is to secure an "Owner/Builder" building
permit, erroneously implying that the property owner is providing his or her own labor and material personally.
Building permits are not required to be signed by property owners unless they are performing "their own work
personally.
Information about licensed contractors may be obtained by contacting the Contractors' State License Board in your
community or at 1020 N. Street, Sacramento, California 95814.
Please complete and return the enclosed owner -builder verification form so that we can confirm that you are aware of
these matters. The building permit will not be issued until the verification is returned.
Very truly yours,
CITY OF LA QUINTA
DEPT. OF BUILDING AND SAFETY
78-495 Calle Tampico
La Quinta, CA 92253
(760)40_
7012 &4
F 777-7
SIGNATUU /JDATE
PROPERTY ADDRESS
61805 - Oa 2 -
PERMIT
PERMIT NUMBER(s)