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RPL (9909-311) + BLCK (14967)
54295 Avenida Madero 9909-311 14967 LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter y '(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 614611 +:.53 GY31/2(X 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. STAR INSiJ MNCU 0 141790/07 (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 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) Date BUILDING PERMIT PERMIT# DATE VALUATION .►.1. 1 i ( LOT TRACT JOB SITE APN ADDRESS OWNER CONTRACTOR/DESIGNER/ENGINEER KI!?VIN, P114-i"ERS t'(JOLS & SFAS 54.295 AiADERO P.t-3. DOX 1791 LA WIWA L't'd 97.253 LA Qlltl+ rA C"A 92253 (760)160-3585 CAIA 1945 USE OF PERMIT F'LI01, t1.N fxi'A :QA POOL & :A11A tV.ARMS ttMVOR BARRIMS REQ01RE D FOR PI2&PLASTIR MOL AIVIYUGR SPA I3,a0(i.041. 3 1.`:'1 IMATED WXY t,21A av"ONSI.'Ri1Ci' ON, AT, "ITT FRE SUMMARY PLAN CIOXN 1131:' 1414X14-439.318 '$9" AS r0Ng1rR1R_rA 14 FFF I(I I-i)f10-4 1 94 3 NIEC13ANICAL 11i13 1"(XX 101 d}0( -4.'.1-0(X1 524.00 EI,k'sC"tI't1t.'AL ELk:— In.:+ :iti. I(f1-rlui'3-la2a 3 15.f►t PL1Jhffl1N(+ FLY. -- IHS 11. 101 A/01}-419-000 5270) SCM-71(11'A1..COMST'+RJK- ON ANT) PlAN('1IfICK, 5348.45 TUTAII MKIRMf`t' V IKKIIS 1WF1 NUW S301.45 :, .. RECEIPT DATE BY D=/ 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 0. 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 Sewer Connection Pool Cover 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 a POOL R 4 4 P.O. BOX 1504 Building 78-495 CALLE TAMPICO Address 54`295 Ave. Madero LA QUINTA, CALIFORNIA 92253 Owner ' Kevin Peterc3 Mailing Address aame City Zip Tel. La Quanta, CA 92253 564-4259 Contractor Owner/Builder Address City State Lic. I City & Classif. Lic. # Arch., Engr., Designer Address Tel. City IZip I State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. SIGNATURE DATE OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractors License Law for the following reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a permit to construct, atter, improve, demolish, or repair any structure, prior to its issuance also requires the applicant for such permit to rile 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, and the 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). 491, 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 knprovements 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.) O I, as owner 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.) ❑ 1 am exempt under Sec. B- & P.C. for this,reason r rf Date t l Owner WORKERS' COMPENSATION DECLARATION I hereby affirm that 1 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. Company ❑ Copy is filed with the city- ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATIONINSURANCE (This section need not be completed N the permit is for one hundred dollars ($100) valuation or less.) I certify that in the performance of t,jiq work for whichthis permit is issued, I shall not employ any person in any manner so as to become,subjeLTt't6-the Workers' Compensation Laws of California ale ' 1 - 'I ° Owiner +j •'" 1J1 t i,4 OT/CE TO APPLICANT: N, after making this Certificate of Exemption you should became s b jectt to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($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. This is a building permit when properly filled out, signed and validated, and is subject to expiration if work thereunder is suspended for 160 days. I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives -of this city to enter the above-. mentioned property for inspection purposes. Signature of applicant -Date- Mailing ateMailing Address City, State, Zip No. 1436T LDING: TYPE CONST. OCC. GRP. P. Number al Description ect Description 1501 of 2 0 high retaining wall 90' of 4' high garden wall Sq. Ft. No. No. Dw. Size Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation $ l e b?5 . gQ PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. . 00 Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure n TOTAL REMARKS ZONE: BY: Minimum Setback Distances: Front Setback from Ce t Line Rear Setback from Pr . Line Side Street Set rom Ce er Line Side Setback rom grope FINAL DATE ? INSPI'TO Issued by: Dat Validated Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBINU FEES, 1ST FL. SO. FT. ® $ 2ND FL. SO. FT. POR. SO. FT. ® GAR. SO. FT. ® CAR P. I SO. FT. WALL SO. FT. SO. FT. ® ESTIMATED CONSTRUCTION VALUATION $ UNITS MOBILEHOME SVC. POWER OUTLET YARD SPKLR SYSTEM + BAR SINK ROOF DRAINS r DRAINAGE PIPING DRINKING FOUNTAIN URINAL WATER PIPING NOTE: Not to be used as property tax valuation ROUGH PLUMB. FLOOR DRAIN MECHANICAL FEES HEATING (ROUGH) WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASH ER(AUTO)(DISH) APPLIANCE DRYER DUCT WORK GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED GAS (ROUGH) LAUNDRYTRAY AIR HANDLING UNIT CFM HEATING (FINAL) KITCHEN SINK ABSORPTION SYSTEM B.T.U. TEMP USE PERMIT SVC WATER CLOSET' COMPRESSOR HP POLE, TEM/PERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SO. FT. ®c BATH TUB BOND BEAM SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/4 c SEWAGE DISPOSAL LUMBER GR. SO.FT.GAR ® 3/.c HOUSE SEWER FRAMING FINAL INSP. GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PL.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 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 GRADING CU. yd. $ plus x$ =$ LUMBER GR. FINAL INSP. FRAMING FINAL INSP. ROOFING / ✓j REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESlINITIALS GARDEN WALL FINAL D: E PREPARED BY I Aft SUBJECT ---- — _ .—"*low L0SI INC — EiORROUGFiS STORAGE EQUIPMENT DIVISION SKETCH NO. ENGINEERING DEPARTMENT SCALE i 1 F F-1 ! I — 1 t , I Al I i -i.. __...- T. m ) of LA CidfT Qffy ; ET- f RTP EDIT _. . , - j t ILDING & SA jY! : -' _.- ._ _ _ -• _.- ! _ _ j ' Cis . ''`' '►T ry + { , ! _. .s :.41. AND ALL APPLICABLE CQDES -i---, . I DATE- ! 3 I rwa x'w OBJ v Q 1 AJG. / / GJ , 1rK //o ! to eass,2rici7on! L /A-S l Er/Ly 7o-o 'l Fi c u r" l Id o C vacs tK9R% G,,o&R aome 01 /vO WORK JRO LdG WALL IBJ / K X r?eF 9F f (EAi -77 Paw 7o- ©F- t / s ' / erwvve /` &u r/'LSF Th g 1AJ V'klf Ar7tfde—, 7x&t