AR (0310-328)53425 Avenida Madero
0310-328
LICENSED CONTRACTOR DECLARATION
I `hereby affirm undpe 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,' grid my License is in full force and effect.
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 -eP; - P/, t,+ 3 Signature of Owner -ZZ, _....( _ .., .
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).
() 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 provi§ionesl
''!..
"Date: 1/ - : . , r Applicant, x.. '``
. r s• 1
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 property for inspection purposes.
'Signature (Owner/Agent)•/te a -= "1 ^ - :- Date III
,a
BUILDING PERMIT PERMIT
031
DATE VALUATION np LOT TRACT t
4W./ PlJyi. 31.✓PAV 'wa`6NQl - .
JOB SITE-_
ADDRESS ..0.425 AYM. D .iWJ
APN i
OWNER
CONTRACTOR / DESIGNER / EN (NEER
53433 AVENMAMAMO ;.
1A QVWA +' _ AA 9223.3
`
-
/
USE OF PERMIT }
WIN PLOOM AP01170114 ..277, S.F. (k=Lasu uISTI7dO C0`f'8i7Z0 PATIO)
2001 CKC
PATIO CONVERSION 222.00 OF .
MATO) C101ST 01' CONSITRIG0710M
Wn
00
1 au= 11'1 * suh9almy
PLAN Of1'ECK ICU 101 -04th -439.318
CONST1dUC'rdON 1?. 101-000-418-000 Sll oc►
ELECTR1CA,L M 101-000-420.000 MIMI
STRO1,113 MO i'ION FEE - R Pull) 1X11-000-241, -000' .4I
[nom '-"
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•t
OCT 31 2003
CITY OF LA QUINTA
FINANCE DEPT.
;SUB -TOM trt54,TMUMC5R.MM PIAN GJ° '
$219,46
LESS PR2?aP,ATD FFM
$0,00
TMALPFRWfFUS D U-9NOW
&219,46
RECEIPT
DATE
BY
DATE FINALED
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 _ -G
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
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
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp, Power Pole
Undergroupd 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)
COMMENTS:
` . ~ CERTIFICATE OF COMPLIANCE ,tFiEDsc
Desert Sands Unified School District
47950 Dune Palms Road ¢ 6ERM'UDADUNES r'
La Quints CA 92253 Cn RANCHO MIRAGE d
Date 10/31/03 INDIAN WELLS
No. 25155 (760) 771-8515 f `fy P QUINT ,
QINDIO `
Owner Timothy F McManus APN # 774-033-019
Address 53425 Avenida Madero Jurisdiction La Quinta-
City La Quinta Zip 92253 Permit # 0310-328
Tract # Study Area
Type Residential Addition No. of Units 1
Lot # No. Street S.F. Lot # No. Street S.F.
Unit 1 53425 Avenida Madero 222 Unit 6 `
Unit 2 Unit 7
Unit 3 Unit 8
Unit 4 Unit 9
Unit 5 Unit 10
Comments Patio Conversion
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patiostwalkways, residential additions under
500 square feet, detached accessory structures (spaces that do not contain facilities for living, sleeping, cooking,:eating or sanitation) or replacement mobile
homes. It has been determined that the above-named owner is exempt from paying school fees at this time due to the following reason:
EXEMPT
This certifies that school facility fees imposed pursuant to
Education Code Section 17620 and Government Code 65995 Et Seq.
in the amount of $0.00 X 222 S.F. or $0.00 have'been paid for the property listed above and that
building permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued.
Fees Paid By Exempt - Timothy McManus Check No.
Name on the check Telephone 760/564-3164
Funding Exempt
By Dr. Doris Wilson
Superintendent
Fee collected /exempted b ron MCGilvrey
Payment Recd $0.00
=' Over/Under
Signature
NOTICE: Pursuant to Government Code Section 66020(d)(1), 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 the date on which the building or installation permit for this project is issued, or from the date on which
those amounts are paid to the District(s) or to another public entity authorized to collect them on the District('s) behalf, whichever is earlier.
NOTICE: This Document NOT VALID if Duplicated
Embossed Original - Building Department/Applicant Copy - Applicant/Receipt Copy - Accounting
j
CERTIFICATE OF COMPLIANCE v i s
Desert Sands Unified School District . zQ c7
o
47950 Dune Palms Road ¢ U
6ERMUDADNES
Date 10/31/03 La Quinta,r
CA 92253 00 RANCHOMIRAGE C7
. INDIAN WELLS "
No. 25155 (760) 771-8515 ry, PIAQUINT y
QINDIO
`Owner Timothy F McManus (C(op
APN # 774-033-019
Address 53425 Avenida Madero Jurisdiction La Quinta
City La Quinta Zip 92253 Permit # 0310-328
Tract # Study Area
Type Residential Addition No. of Units 1
Lot # No. Street S.F. Lot # No. Street S.F.
Unit 1 53425 Avenida Madero 222 Unit 6
Unit 2 Unit 7
Unit 3 Unit 8
Unit 4 Unit 9
Unit 5 Unit 10
Comments Patio Conversion
r'
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 (spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation) or replacement mobile
homes. It has been determined that the above-named owner is exempt from paying school fees at this time due to the following reason:
EXEMPT
This certifies that school facility fees imposed pursuant to
Education Code Section 17620 and Government Code 65995 Et Seq.
in the amount of $0.00 X 222 S.F. or $0.00 have been paid for the property listed above and that
building permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued.
Fees Paid By Exempt - Timothy McManus Check No.
Name on the check Telephone 760/564-3164
Funding Exempt
By Dr. Doris Wilson
Superintendent
Fee collected/exempted by Sharon MCGilvrey
.Signature
Payment Recd
Over/Under
NOTICE: Pursuant to Government Code Section 66020(d)(1), 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 the date on which the building or installation permit for this project is issued, or from the date on which
those amounts are paid to the District(s) or to another public entity authorized to collect them on the District('s) behalf, whichever is earlier.
NOTICE: This Document NOT VALID. if Duplicated
Embossed Original - Building Department/Applicant Copy - Applicant/Receipt Copy - Accounting
.nQ '.... , ...y ,,, p.,Va • ry ( v. . y •• .i i-✓" '1 1. r- i: . _.r .-, - o .v.%'-' _
'OWNER/BUILDER INFORMATION.
Dear Property Owner:. 9.
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.
G 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
t aware of the following information for your benefit and protection:
W: 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 maybe 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 stfuctiXtD is intended for le, property owners who are not licensed contractors are allowed to perform their
work personally ortili'eir own• employees, without a licensed contractor or subcontractor, only under limited
conditions. ti 1
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-builderiver fic aaon form so that we can confirm that you are aware of,
` these matters: The"Building' permit will-ifff be issued uittil'ihe ve ification'rs ietuFned `
A
Very truly yours,
.CITY OF LA QUINTA
DEPT. OF BUILDING AND SAFETY
78-495 Calle Tampico
La Quinta, CA 92253
(760) 777-7012
FAX '(760) 777-7011
D11
OWNER'S SSIGNATURE/ DATE
l W cf rZ o
PROPERTY ADDRESS
PERMIT NUMBER(s)