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BLDG (9804-024)53345 Avenida Madero 9804-024 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 Pr fessionals Code, and my License is in full force and effect. License # Lic. Class . Exp. Date Date Signature of Contractor 't 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 )` I, as owner of the property, or my employees With wages as itheir 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) Q/1 am exempt under Section , B&P. . for this reason ,,Date L - ti 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: Carrier Policy No. (This section need not be completed if the permit valuation is for $100.00 or less). ()q 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.` 4w ti Date: = q .3 . 'a .. 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 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 propertyfor inspection purposes. Signature (Owner/Agent) t'" ' Date BUILDINGPERMIT PERMIT#g ... CONTROL# - . TRACT DATE VALUATION LOT 4121919 ;S3,725.00 ..7 ,015 JOB SITEAPN , ADDRESS 53-34 AVE i10A-•MADEI. 0 OWNER CONTRACTOR / DESIGNER / ENGINEER ?jk ' 0Sr PA&i'f3 OM 49W7' $i.lERALDi; 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 BLOCKWALL APPROVALS POOLS - SPAS Steel Set Backs 4Electric Bond Footings LIV Main Drain Bond Beam _ Approval to Cover jam% _ 1p Equipment Location Underground Electric Underground Plbg. Test Final PLUMBING AP ROVALS Gas Piping 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. f Smoke Detectors ,,Temp. Use of Power Final UtiRy Notice (Perm) COMMENTS: I 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. t 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 $200.00 or more for the entire project, and such persons are not licensed as contractors or subcontractors, then you may be an employer. If you are an employer, you must register with the State and Federal Government as an employer and you are subject to several obligations including State and Federal income tax withholding, federal social security taxes, worker's compensation insurance, disability insurance costs and unemployment compensation contributions. There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with respect to worker's compensation insurance. ay .. A '.r on :.l c..r ' .i4' .i .. -_hl ,.,, co.xxt t" , tr:t.­. -.1 :' ,•C•- . bz ( '1. t. •itis 411;7i•nwtio�1 tluut yr -,:r 0111 t tax*rrti, 't- (.4 , : �».. . _ . , :Fu�..r_ - :r cf Tienef r p-. wr.a... t. ' • _ - ..a>r of it ri:zs:r'�,I Ac =+�, � t:.;. 'rt$Ell(•� .`� • , �-'alt, pr4p.ry a, M _ ^�t }zrenryr+-�ntrrnC-_ .x.:'.; _� ; _ � ;-r:' :.i t•1 s's `�y '4 ,*#;�3; �l Sii :1L1+,:� L_r;. : �i"�: • w'Li GOAtt^xt*Jr C ` �.: `:ort*_ : tW". L . ' ti^*.' "i i t :: i NODpii5,, I;+ ? _ -'sten � :1 �er,1,.s ptar Ian- Ai/,�.I.(�IfE\- •`^! �or r 18-432 Csllc,lsnibtco DEW: OL trtffDIL:CVI1D?YLE.LK CI -A OE I'V CSNA.Lv .�"�".:,,t'1.' ' " ty ca...tre tdr'.L.' they rtr pc ,..i.3�•;* ,� , t . ._ t1j i. : CQ:iC.tri`,ttw.*.i' P.O. Building 78-105 C Address -o:-_5i-345Madero LA QUINTA, Owner - . .t . I I w. .- Rego fil"i Ki 0 Mailin Addresg s -,5'3;a545, kadero..' City Uinta;,,: 92253 T.564-6191, ity Zip hta ,,:CAI Contractorl"i Address CityZip' el.: State Lic. City & Classif. _r), Lic. # --Arch., Engr.;t •Designer Address Tel. City Zip State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I -am licensed under Provisions of Chapter 9 (commencing with Section a 7000) of Division 3 of the Business and Professions Code,'and my license is in full force and effect. SIGNATURE DATE OWNER -BUILDER DECLARATION .1 hereby affirm that I am exempt from the Contractor's License Law for the following reason: (Sec. 7031:5,Business and Professions. Code: Any city or1county which requires a permit to construct, after,.improve, demolish, or repair any structure, I 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, andthe 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 five hundred dollars ($500). Erl, 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.) b 1, asowner 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.) 0 1 am exempt under Sec. B. & P C. for this reason I N W).' wner t../D.tsd •7 0 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. t .; I , Company 0 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 thp work for which this peimitis 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. - Ir 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 buildingpermit when properly filled out, signed and validated, and is subject to expiration it work thereunder launder is suspended for 180 days. ' I certify that I have read this application and state that the above information is correct. I construction, to comply with all city and county ordinances and state laws relating to building and here by authorize representatives •of this city to enter the -above-. mentioned properly for, nspection purposes. Signature of,applicant' Date ,Mailing Address City, State, Zip 141- 16'r BOX 1504No. 11791 ALLE ESTADO :- CALIFORNIA 92 BUILDING: TYPE CONST. ..00C'. GRP.. '774-033-015 A.P. Number Legal Description. Lot 7.1° room.. E Project Description Enclose patio to Sq. Ft. 225 No. No. Dw. Ir -Size - - Stories, Units. New 0 Add:A Alter 0 Repair 0, -Demolition 77 ated Valuation $8,775. PERMIT Plan Chk. Dep. .Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL AMOUNT 108.00 22.87 +..v - ............ 216. 9T REMARKS A 177 ZONE: BY: Minimum Setback Distances: Fit 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: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL. SQ. FT. ® $ UNITS COLL. AREA SLAB GRADE YARD SPKLR SYSTEM 2ND FL. SQ. FT. BONDING HEATING (ROUGH) STORAGE TANK MOBILEHOME SVC. BAR SINK POR. SQ. FT. ® ROUGH WIRING; Gl.. GAR. SQ. FT. p POWER OUTLET ROOF DRAINS GAS (ROUGH) DRAINAGE PIPING CAR P. I SQ. FT. ® OTHER APP./EQUIP. REINF. STEEL WALL SQ. FT. DRINKING FOUNTAIN. SQ. FT. ® URINAL ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING NOTE: Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER FRAMING Nt V/ GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED rlyc� LAUNDRYTRAY AIR HANDLING UNIT CFM REMARKS: KITCHEN SINK ABSORPTION SYSTEM B.T.U. TEMP USE PERMIT SVC WATER CLOSET' COMPRESSOR HP POLE, TEMIPERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SQ. FT. ® c BATH TUB SO. FT. @ c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/a c SEWAGE DISPOSAL SQ.FT.GAR ® 3/ac HOUSE SEWER GAS PIPING PERMIT FEE MIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE FPL.CK.FEE CONST. FEE ELECT. FEE SMI FEE PLUMB. FEE STRUCTURE /, PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR SETBACK GROUND PLUMBING UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMSI IVY SEWER OR SEPTIC TANK ROUGH WIRING; Gl.. DUCT WORK ROCK STORAGE. . FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APP./EQUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM FINAL INSP. 3( GRADING cu. yd. $ plus x$ -$ LUMBER GR. FRAMING Nt V/ FINAL INSP. ROOFING l( C, rlyc� � � 3 1-'9 REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GA�FIREWALL „t6 ,4k3 LATHING �- /_d�1 2 1D MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION e CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS GARDEN WALL FINAL