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BLDG (9804-127)53280 Avenida Madero 9804-127 jL'ICE.tEDCONTRACTORDECLARATION ri 1 hereby affirmKUnder penalty_of^perjury that l am,licensed under proyiislor of >,. jrtChapfef 9 (commencmg;with Section,7000) of Division 3`of4he Business ands Professionals Code and -my License is in.full force and effect. " License # Lic Class Exp. Date =fa Date Signature of,Contractor ' KV OWNER -BUILDER DECLARATION H f < ra 1 hereby affirm under penalty of perjurythat I am exemptfromthe Contractor License Law for the following reason ( ) I, as owner of the, property, or my, '.employees with wages as their sol compensation, will do the work, and the structure isnot intended or offered fo sale (Sec. 7044, Business & Professionals Code). „( ) I, as'owner of the property, am 'exclusively contracting with'Ilcense r contractors to construct ;the project (Sec: 7044 Business &Professional ;( a e//,6mpt under Section. B&PC. foJr this re son ate f f Signature, of Owner/ J of WORKER'S COMPENSATION DECLARATION" I hereby affirm under'.penalty of perjury one of the following declarations: ' 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 perfor. Dance of. the work for which this permit is issued I/'have and .will maintain workers' compensation insurance, as required by Sectiofi" 3700 of the Labor Code, for the performance of the work for which this permit is issued: My workers' compensation insurance carrier &'policyi oo.'are: Carrier.` , 1.4t Policy ( P (This.section if thP 4.be,com leted e ermit,valuation is for $100.00 or less). . , (.) l,certify that in the performance of the worktfor;which this permit is issued, I shall not employ•any person in any manner eo as to become subject to the workers' compensation laws of Californiaand agje that if I should become subject to the workers' compensation-provisonrs of Section 3700 of the Labor Code I shall forthw ith;comply with those provisions.,; ` .Da e: -(Applicant—?' t 23 Warning: Failure., to secure Workers' Compensation coverage is unlawful and shall subject;an'employer to.criminal penaltieY.and,civil fines up to $100,000, in addition to the cost of compensationi-damages/as provided for in Section 3706 of the Labor Code, interest and attorneys Mees ' IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject ,to• the conditions' and restrictions set forth on his application. 1. Each person upon whose behalf this application is made & each person at I whose, request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application•tiecomes null and void if work is not commenced within 180 daysffrom'date - of issuance of such permit, or cessation of work for 180 days willisubject permit to cancellation. I certify that I have read this application and state'that the above information is correct. I agree to comply with all City and,)State laws relating to the building '•.construction, and hereby authorize repres tatives of this City to enter upon '`the above-mentioned property -for inspection purposes. i wn r A ent " ' i r 1 !r Date f (i' PERMIT#, CONT-ROLJ/ BUILDING PERMIT ,. " DATE VALUATION LOT Cy 9804-127 TRACT ,J M -40 71.1, 4/20/98, . S2.165.00 JOB SITE',( ADDRESS a rFe APN f S ' ` • 3-1,80AN NJDA'(litzi ERE + I OWNER , s CONTRACTOR / DESIGNER / ENGINEER , Y 1 t t. 4 y • ... a t ' 1t1L1 R) ? 11WGiZA ' OW'NERIBUI1,DEP. ' ` L `iUINI r1 CA 92253 CBL# [pgy pp' (,jj .USE -OF PERMIT"=` 1001.E OF, 5' CITY STANDARD GARDEN WALL 5 FT, WALL 100.00 LF _ ViTIMA.T:E D COST OF CONSTRUCT WIN 24165.01;i: PERM ITE SUMMARY . Co14S17, rCT ON FEE 101-000-41$-O 0 X54.00 S9J :=1YMAL OAi I RUCl'ION AND NLII.N CHECK s 54.00 .. APR 2 U 1998 Lss. :-k`A1D 11,► % rOT PERMIT FRES LDL1E NOW $54.0 ®F RECEIPT DATE / BY DATE FINALE INSPECTOR ,, INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE 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 POOLS - SPAS BLOCKWALL APPROVALS Steel Set Backs Electric Bond Footings / 8 Main Drain Bond Beam g 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: ,( /V G //V Alt— 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 Utfft Notice (Perm) `^''u-'�y`""'r"'�G w�!':-,r�,''`"ti a �_ �.n _•1;;.:^47r c -_At v'Ai, .QF,µ. iY.s: j :�r�..ti; �.r^.l•'^./._v'„"�''��'•`.C;-.V`t!'�.:"y Li`'�`�--i�: ,.NW^'�W�31.w �+... ,�v�.+:�,�.�r.�l'Lj_.�✓'l:'�''L"�.7`�:s-�ih��,r�.:+n=:....:,�`�;,,.�v'�4`,�y;_;..'C'J�.,.. N CSO/�.� r�11 • Air Oft 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 Eby 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 subcont act, 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,.ihen you may be an employer. If you are an employer, you must register with the State and Federal Government as an employeuand 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.. Ifthe•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 i 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 INTA DEPT. BUILDIN�� 78-495 Calle Tamgi 0 L 0, u CA 92�. ( (0).77 7 FAX 06OO, 7 01 OWNER'S SIGNAT(!J ATE 'PROPERTY ADDRESS d �L �a PERMIT NUMBER(s)