Loading...
BLDG (0110-310)51500 Madison St 0110-310 'LICENSED CONTRACTOR `DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisioris;of=r? Chapter 9 (commencing with Section 7000) of Division 3 of the Business aril Professionals.Code, and my License is in full force and effect. t License # Lic. Class Exp. Date ; Date -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:. Carver 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 those 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 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 cer'iiiy ihai i have read ibis aNNiicaiioii and Mate that the above 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 BUILDING PERMIT PERMIT# 1 0 OT DATE VALUATION LOT 10110-1.31.0 - 1"unam 919J23.6-0 JOB "SITEAPN ADDRESS Tqq! g ipp Gita [y f r 1 A ya J.A'^walfa/ 1v"d eV.5.fd 14 W A V19 y 'T ls g i! ' •' %{9"ilA, 2. OWNER CONTRACTOR / DESIGNER / EN INFER 1A QU PUPa POLO CikCM>'cD PARIMS 0WnAMIUBU'.MDE11p INDJAW WEXIS CA 92210 azlot USE OF PERMIT 1GJ?XV 1 POU DU40 .AGIUt'Lfj:.1`URA':...:PUIL '1140 1496 SM "U" 0MURANC r. DIV % MMOR SHAD FOR ORCHARD EQUiPMUT. WWRICA 3F E, t lAB' IEW COST OF COPFI7ri'"C":I: N PLA14 C111WLE PER, 101 -000 -OR -338 $1903 COaaST'RL.TC T.iON FARM' , 101-000-418-000 $.284.50 STRONG MOTION ITER - WID 101 p00a . I 000 S1:91 tl A l il3 tf 3 4(1 y f »:t7U{7 tJ1Dt) 00.00 ,3?WE. Pl.yydtylc d •p?: CIC $419234/ •. :.l7ip''XiJ J she?'°J: .C'A.S, ;c .L:.{.' t $0.m `C'O'L Pa> T -T' MIX VOR slow $492. RECEIPT DATE BY DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms 8 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 8 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 Bord 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 i Bin 4 City of La Quinta BuildingIr Safe Dh*i Safety on P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Perrr,it # PiojcctTAddressdjidQ >IVG- — E. .. A. P Number: '7 -?2;2 p D 1 1 — % Owner's Name: LA 9)P31 -A Pol-0 0 (J PA1ZP, Address:1200 04N0VV&r - 7PS Leggy Description: q. N5 M /mp yr City, ST, Zip: /A ,0j.4 f i f LL.S C4q > Contractor: h1 v fi LQ j2 Telephone: ?ri0• 270. SOSO Add3ess: Project Description: . City. ST, Zip: I S1-Df`cl e SIVA &)r- © `r lq d. Telephone: hone: 1 1't't C. State Lic. # : City Lic. #: Arch., Engr., Designer: — OCG. G Address: City. ST, Zip: Telephone: Construction Type: Pe. AbDO u Occ u a ncv: State:Lic. #: Pr e of ct type (circle on ew Add'n Alter Repair Demo `' Nam_ of Contact Person: OD VAN iNBOs Sq. Ft.: )LJ?(:> # Stories: # Units: Telephone # of Contact Person: 7(p. 275, SoSp Estimated Value of Proiect'$ 15? C)M , APPLICANT: DO NOT WRITE BELOW THIS LINE # Z Submittal Plan Sets Req'd I of ZNE PI/ Rec'd TRACKING PERMIT FEES D / Plan Check submitted / Item Amount Structural Calcs. Reviewed, ready for corrections ( 31 Plan Check Deposit Truss Calcs. Called Contact Person Plan Check Balance Title 24 Calcs. Plans picked up / / Construction • Flood plain plan Plans resubmitted I Mechanical Grading plan "'' RevieA', read for corrections/issue lectrial Subcontactor List Call tael Person ffilPlumbicng Grant Deed Plans picked up S.M.I. H.O.A. Approval IN HOUSE:- Plans resubmitted Grading '"' Review, ready for correct io s/issue0-4 eveloper Impact Fee Planning Approval Called Contact Person 2 Alp p I) Pub. Wks. Appr Date of per ' School Fees 2/ 1- (!/ —was t ydw S Ali/ Amer, Total Per it Fees D - 'Coachella Valley Unified School District P.O. Box 847, Thermal, CA 92274 1, (760) 398-5909 — Fax (760) 398-1224 This Box For District Use Only CERTIFICATE OF COMPLIANCE (California Education Code 17620) Project•Name: Date: . 30 X06 / Owner's Name: La Qui nta Polo Orchard Partners Phone No. Projet.t Address: Nlf di snn AvP _ , La (l t i n a , CA 92253 Project Description: _ Mri culture RUi 1 di nq (tt nragp ) APN:IE 772 270 .011 'Type iif Development: Residential Tract #: Lot #'s: Commercial Industrial XX Total Square Feet of Building Area: .1,486.00 ` Certifiication 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 authorize behalf of the owner/developer. Dated :X A 3 el d/ Signature: 0/A1 OeAE ew G SCHOOL DISTRICT'S REQUIREMENTS FOR THE ABOVE PROJECT HAVE BEEN OR WILL BE SATISFIED IN ACCORDANCE WITH ONE OF THE FOLLOWING: (CIRCLE ONE) Education Code Gov. Code. Project Agreement Existing Not Subject to Fee 176201! 65995 Approval Prior to 1/1/87 Requirement I!I Note: No Fee for Agricultural Buidlings Number of Sq.Ft. 1,486 Amount per Sq.Ft. $ Amount Collected $ — Building Permit Application Completed: Yes/No By: Foch "Tut" Pensis, Assistant Superintendent Administrative Services Administrator in Charge Certificate issued b Marcela Valdez Y Signature;1 : Facliltle Clerk ' NOTICE OF 90 DAY PERIOD FOR PROTEST OF FEES AND STATEMENT OF FEES Section 66020 of the Government Code asserted by Assembly Bill 3081, effective January 1, 1997, iequires that this District provide written notice to the project appellant, at the time of payment of school fees, mitigation payment or other exactions ("Fees"), of the 90 -day period to protest the imposition of these Feix and (2) the amount of the fees. Therefore, in accordance with section 66020 of the Government code and other applicable law, this Notice shall serve to lidvise you that the 90 -day protest period in regard to such Fees or the validity thereof, commences with the payment of the fees or performance of any other requirements as described in section 66020 of the Government code. Additionally, the amount of the fees imposed is as herein set forth, whether payable iit this time or in whole or in part prior to issuance of a Certificate of Occupancy. As in the latter, the 90 days starts on the date hereof. This Certificate of Compliance is valid for thirty (30) days from the date of issuance. Extension will be granted only for good cause, as determined by the School District, :and up to three (3) such extensions may be granted. At such time as this Certificate expires, if a building permit has not been issued for the project that is the subject of this Certificate, the owner will be reimbursed all fees that were paid to obtain this Certificate of Compliance. ii MV:c/mydocs/devfees/certificate of compliance 07/24/01 DEVELOPER FEES PAID AREA: .. , AMOUNT: RCPT CK #: CASH: • INITIALS: - DATE: CERTIFICATE OF COMPLIANCE (California Education Code 17620) Project•Name: Date: . 30 X06 / Owner's Name: La Qui nta Polo Orchard Partners Phone No. Projet.t Address: Nlf di snn AvP _ , La (l t i n a , CA 92253 Project Description: _ Mri culture RUi 1 di nq (tt nragp ) APN:IE 772 270 .011 'Type iif Development: Residential Tract #: Lot #'s: Commercial Industrial XX Total Square Feet of Building Area: .1,486.00 ` Certifiication 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 authorize behalf of the owner/developer. Dated :X A 3 el d/ Signature: 0/A1 OeAE ew G SCHOOL DISTRICT'S REQUIREMENTS FOR THE ABOVE PROJECT HAVE BEEN OR WILL BE SATISFIED IN ACCORDANCE WITH ONE OF THE FOLLOWING: (CIRCLE ONE) Education Code Gov. Code. Project Agreement Existing Not Subject to Fee 176201! 65995 Approval Prior to 1/1/87 Requirement I!I Note: No Fee for Agricultural Buidlings Number of Sq.Ft. 1,486 Amount per Sq.Ft. $ Amount Collected $ — Building Permit Application Completed: Yes/No By: Foch "Tut" Pensis, Assistant Superintendent Administrative Services Administrator in Charge Certificate issued b Marcela Valdez Y Signature;1 : Facliltle Clerk ' NOTICE OF 90 DAY PERIOD FOR PROTEST OF FEES AND STATEMENT OF FEES Section 66020 of the Government Code asserted by Assembly Bill 3081, effective January 1, 1997, iequires that this District provide written notice to the project appellant, at the time of payment of school fees, mitigation payment or other exactions ("Fees"), of the 90 -day period to protest the imposition of these Feix and (2) the amount of the fees. Therefore, in accordance with section 66020 of the Government code and other applicable law, this Notice shall serve to lidvise you that the 90 -day protest period in regard to such Fees or the validity thereof, commences with the payment of the fees or performance of any other requirements as described in section 66020 of the Government code. Additionally, the amount of the fees imposed is as herein set forth, whether payable iit this time or in whole or in part prior to issuance of a Certificate of Occupancy. As in the latter, the 90 days starts on the date hereof. This Certificate of Compliance is valid for thirty (30) days from the date of issuance. Extension will be granted only for good cause, as determined by the School District, :and up to three (3) such extensions may be granted. At such time as this Certificate expires, if a building permit has not been issued for the project that is the subject of this Certificate, the owner will be reimbursed all fees that were paid to obtain this Certificate of Compliance. ii MV:c/mydocs/devfees/certificate of compliance 07/24/01 Lai I TAiyl OF T1 78-495 CALLE1AMPICO LA QUINTA, CALIFORNIA 92253 11' TELEPHONE (760) 717-7012 FAX (760) 777-7011 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*toput their license number on all permits for which they apply. j If you plan to do your own work, with the exception of variuus 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 bean 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 awarleof- 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) 7 - ( - ti ABV -. LPO _ OWNER'S S TURF/DATE Y1 (S 'Arne Z 2 - 2? 0. PROPERTY ADDRES ®two -310 PERMIT NUMBER(s)