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PLBG (9610-037) + RR (14894)54970 Avenida Madero 9610-037 14894 11075 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 Professionals Code, and my License is in full force and effect. License.# Lic.,Class Exp. Date w t> •:.•t7 0,019 / Date 4' 'C 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. ave and will maintain workers' compensation insurance, as required by Section 3700LOffth'e;,L bor Code, for the performance of tbejw,grki.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 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 cofrect. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this Cityb enter upon Nthe above-mentioned property fo6inspection purposes. Signature (Owner/Agent)'" Date` .I l GAJ BUILDING PERMIT DATE 101111% VALUATION '' >I LOT JOB SITE ADDRESS OWNER ijs 54970 AVEN IDA AlikD UJ bA QUIN!°A i A. .' . 921253 USE OF PERMIT L } .Rk3Jt.?'1 PERMIT# TRACT APN CONTRACTOR / DESIGNER / EENGI NvEER 842-325'TA.HQU.11% M010 fvt?19j !-1 -f►i154 )'ERfV>M.9 r fer,,lei; `4#iR'4 kA Vii' T-1Af1\4P.IN0MEQ:«-.Sr.WIiR .401 -CM -41.4-000 $30.W SUM -TOTAL tC ECK LESS PRE-Fjt1.W FEES CA 92:01 M.; 2,4100.00 $X00 $0100 TCVTA1,'PYRN10'11* F17,1F.S.DUC NOW "0.04) OCT] 1 1996 RECEIPT DATE BY DATE FINALED INSPECTOR sk,? 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 Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Pibg. Test Final I I 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 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) COMMENTS: Se& Sew&" Mailing Address: Box 1255 PALM -DESERT, CA 82261 = Phone: 328-6718 % 346-6916 Calif. State Contractor' lic®nse No. 310813 fit% rJ,:,l / / -,r. i 0Owner Name ❑Tenant Bilito Job at c' ri %., Gz; r r. At CRY 7 . Zip City ap N? 66244 DATE WORKMAN ❑ Old Customer ❑ New Customer Classification Telephone ( ) WORK AUTHORIZATION - I / We hereby audwize rile workdescnbed along with the necessary materials and parts WORK ORDERED: Time From To Hours MATERIAL USED AMOUNT Mon. Al z".., <_ Tues. . — -------- _ Wed. Thurs. y a Fd. s Sat Sun. Total Hours ENTERED Invoice Journal I hedger Cards WAIVER OF RIGHT TO CANCE Havip9 Initiated a contract In connection wi emergency re or sem for the immediate protection of persons or real and perso* property. I hereby state tht1at the fgllowing emergency situation eosts, requiring Irtmediate attention: , Pursuant to Section 1689.13 of the Califomia Civil Code, I a knowledge and hereby waive all rights to cancel the sale w ihin three days. Dated Buyees Signature '. } TO OUR CUSTOMERS: Service men are required to have work slip signed. This Is done In order to protect you, the workmen, and ourselves, and to enable us to give you absolute satisfactory service. You are respectfully requested to examine material and labor statement before workmen leave the job, and If you find everything satisfactory, okay this ticket Ifq service aIs unsatisfactory, In any wa , please phone our goffice Immediately.ree to charges for collection, includin mfial charged efees In Me e satisfactory and t of my to A PENAe onLTY WILL BE CHARGEand fiffmor D AT THE RATE OF 1v1% PER MONTH ON UNPAID BALANCES AFTER 30 DAYS OF INVOICE DATE. ANNUAL PERCENTAGE RATE 18%. Contractors are required by law to be licensed and regulated b ' the Contractors'StateLicenseBoard. Anyquestionsconcerninga Stara , -' -' contractor may be referred to the registrar of the board whose address is: Contractors' State License Board, 9835 Goethe Road, Sacramento, CA 95827, P.O. Box 26000, Sacramento, CA 95826. Total Matey Tax Sevw Permits-lnstlrwm Trucks-Equipmernt TOTAL 01995 by John B. Reeves & Son ACeeUes BUSINESS FORMS - 8598 Warner Drhe. Calver Ctly, CA 90232 rM 31 WAG 44 P.O. BOX 1504 No. 14894 Building 78-495 CALLE TAMPICO Address 54--970 Ave. Mad&ro LA QUINTA, CALIFORNIA 92253 ' Owner Dave Walls ' BUILDING: TYPE CONST. OCC: GRP.- Mailing Address $zf.Sie A.P. Number City 7CA ip Tel. % c uF: ., 92251 554- 06,02 . . Legal Description Contractor- Raroof Owner/$u. lde Project Description x Address. City Zip Tel.: State Lic. City & Classif... Lic. # Sq. Ft. No:. No. Dw. Arch., Engr., Size .Stories- •- •Units Designer New ❑ Add ❑ Alter ❑ Repair ❑ .. - Demolition ❑ 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' 7000) of Division 3 of the Business and Professions Code, and my license is in full force and ' ' - effect. ^DATE SIGNATURE - OWNER -BUILDER DECLARATION '. I hereby affirm that I am exempt from the Contractors License Law forA6 following Estimated Valuation aaSS $1 f yI�vii • reason: (Sec. 7031.5,Bgsiness 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 filea signed statement that he'licensed pursuant to the provisions of the Contractor's License Law, Chapter 9 -(commencing with Section 7000) of PERMIT AMOUNT 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.. Plan Chk. Dep. - subjects the applicant to a civil penalty of not more than five hundred dollars (5500).. '-f as owner of the property, or my employees with wages as their sole compensation, will Plan Chk" BBL. d' o he 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 Const. ✓ 30.00 0Q builds or improves thereonandwho does such work himself or through his own employees, that Improvements intended Mech.' • provided such are not or offered for sale.. If, however, the building or Improvement is sold within one year of completion, the owner -builder will have the burden Electrical or proving that.he did not build or improve for the purpose of sale.) ❑1, as owner of the property, am exclusively contracting with licensed contractors -to con- Plumbing 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 contractors) licensed pursuant to the Contractor's License Law.) S.M.L. _ Grading ❑ 1 am exempt under Sec B. 8 P.C.'for this reason f1 ,y�' Driveway Enc. Date ` Owner & dT� �' Infrastructure 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. Company \ ❑ Copy is filed with the city.. ❑ Certified copy is her furnished. TOTAL' y 30.00 CERTIFICATE OF EXEMPTION FROM WORKERS' -COMPENSATION ANSURANCE REMARKS (This section need not be completed if the permit is for one hundred dollars IS 100) • valuation ' or less.) - I certify that in the performance of the work for wgich this permit is issued, I shall not employ any pparson in any manner 90 as to become. subject to *the Workers' Compensation ws of Califo-ria.,rT r< 14/1115 ♦ j15 - - - r c NOTICE TO APPLICOANT tt, after making this Certifrca of Exemption you . hould be -come '. ZONE: '-' BY: subject to the workers' Compensation provisions o e Labor Code, you must forthwith comply with such provisions or this permit hall be deem revoked. _ Minimum Setback Distarices; - - • • Front Setback fr en r Line - ReafSetback ear Pr . Line WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE. IS UNLAWFUL, AND - SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES TO Side Stree ackfro t Line AND. CIVIL' FINES UP ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, Side Set dC frOITQPwperty ine DAMAGES AS PROVIDED FOR IN SECTION 3706 OF -THE -LABOR CODE, INTEREST, -AND. ATTORNEY'S FEES. CnT 'Y ` This Is a building permit when properly filled out, signed and validated, and is subject to • FINAL DATE INSPWT-Q` R' v expiration if work thereunder is suspended for 180 days: -• - I certify that'I have read this application and state that the above information is correct. Issued by: Da. It I agreeto 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. Validated by: Signature of applicant Date Mailing Address Validation: City, State, Zip CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBINU FEES IST FL. SO. FT. @ $ UNITS SLAB GRADE ROUGH PLUMB. BONDING YARD SPKLR SYSTEM 2ND FL. SO. FT. @ FORMS SEWER OR SEPTIC TANK ROUGH WIRING MOBILEHOME SVC. BAR SINK POR. SO. FT. @ GAS (ROUGH) METER LOOP GAR. SO. FT. @ POWER OUTLET ROOF DRAINS GAS (FINAL) TEMP. POLE DRAINAGE PIPING CAR P. SO. FT. GROUT WATER HEATER WALL SO. FT. @ FINAL INSP. DRINKING FOUNTAIN BOND BEAM WATER SYSTEM URINAL SO. FT. @ , =$ LUMBER GR. ESTIMATED CONSTRUCTION VALUATION $ FINAL INSP. 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 GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRY TRAY AIR HANDLING UNIT CFM 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. SO. FT. @ c BATH TUB SO. FT. @ c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID @ 11/4 c SEWAGE DISPOSAL SO.FT.GAR @ 3/4c HOUSE SEWER GAS PIPING PERMIT FEE ERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE EPL.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 ROCKSTORAGE 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 REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING tY MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS GARDEN WALL FINAL ` P.O. BOX 1504 •;t` N o . 1107 -Building 5'4 -57 7&105 CALLE ESTADO Address Madero.LA QUINTA; CALIFORNIA 92253 Roger Kringen Mailin Address 15415l- C -maim© tae Paco . CitY.i#W* Zip. 9221.0 TeI. E5:-8555 CO ractor .. 90ner/nuilder Address BUILDING: TYPE CONST.'= OCC: GRP. A.P. Number Legal Description Project Description Remodel SFR ' Pati®' a Faranheg ;galls (This section need not be completed if, the permit is for :one hundred doflas ($100)• valuation or less.) I certify that in the performance of trig 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. ;r - . to Owner,\ NOTICE TO APPIJCANT: UUV .after making this;' Certificate of ExemptionX become 1 t - City Zip Tel.: . .., Front Setback from Center Line _ Rear,Setback from Rear Pfop' Line ` - CONSTRUCTION LENDING AGENCY " .- - .. Si , de Street Setback from Center Line I hereby affirm that there is a construction lending agency for.the performance of the —State Lia City ; & Classif. ' Lic. # - Sq. Ft. fib• No:No. DW. -Arch., Engr.; Size-- - . Stories - Units Designer _: New ❑ Add ❑ Alter ❑ Repair ❑ Demolition -0 expiration if work thereunder is suspended for 180 days. t Address Tel. Date Perfnit'- - I agree to comply with all city and county ordinances and state laws relating to building.: t: , construction, and hereby authorize representatives .-of • this city to enter the' -above-. City Zip State - - Signature of applicant Date' Lic. If Mailing Address .LICENSED CONTRACTOR'S DECLARATION „ City, State, Zip 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 Contractor's License Law for the following Estimated Valuation 2989 .0-0 reason: (Sec. 7031.5,Business and,Professions Code:. Any city or county which requires a • permit to construct, alter, improve, demolish, or repair any structure, prior. to its issuance also - requires the applicant for such permit to file.a signed. statement that he is licensed pursuant to PERMIT + 1 AMOUNT 'lk the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of Divlston 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 bi 'any applicant for a permit. .. . Plan Chk. Dep: - .. + " subjects the applicant to a civil penalty ofnot more than rive hundred dollars.($500). • I of the Plan Chk. , Bal. _ _ . 40.95 p as owner property, or my employees with wages as their sole compensation, will 0 the work; and the structure is not intended for or offered sale. (Sec. 7044, Suisness and . . Professions Code: The Contractor's, License Law does, not apply to'an owner of. property. who 'builds. r'COnst. .. ;t ;, , 6:1X00 _ or Improves thereon and who does such work. himself or: through his -own employees, Much.. . +• - provided that' such improvements are not intended or .offered for sale.; If, however, the building ' -or improvement is sold within one yearof completion, the owner -builder will have the burden Electrical ' ` • ► t ° of proving that,he did not build or improve for the purpose of sale.). , - • , b I, as owner of the property, am exclusively contracting with.licensed contractors to con- • - - Plumbing • 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 S.M.I. - - - A 40 . -such projects with a contractor(s) licensed. pursuant to the Contractor's License Law.);..' .. ❑ 1 am exempt under Sec. B. 8, C. for this reason = :'` _ Grading Driveway, Enc. Date ownei -'''•r F? .mo.'s.,°_ ' Infrastructure WORKERS' COMPENSATION DECLARATION I hereby affirm'that I have a certificate of consent'to self -insure, or a certificate of Workers Compensation Insurance, or a certified copy thereof. (Sec. 3800,:Labor Code.).: Policy No Company r // C A ❑ Copy is filed with the city. • ❑ Certified copy is hereby furnished. J ` i ld TOTAL107945 CERTIFICATE OF EXEMPTION FROM REMARKS''- , t WORKERS' COMPENSATION.INSURANCE - ::? / (This section need not be completed if, the permit is for :one hundred doflas ($100)• valuation or less.) I certify that in the performance of trig 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. ;r - . to Owner,\ NOTICE TO APPIJCANT: UUV .after making this;' Certificate of ExemptionX become 1 t - you should ' subject to 'the Workers' compensation provisions of the -Labor Code,;you must forthwith comply with such provisions or this permit shall be deemed revoked. .ZONE: BY: Minimum Setback Distances: - ' _ Front Setback from Center Line _ Rear,Setback from Rear Pfop' Line ` - CONSTRUCTION LENDING AGENCY " .- - .. Si , de Street Setback from Center Line I hereby affirm that there is a construction lending agency for.the performance of the . work.for which this permit is issued.ysec. 3097, Civil code.) Side Setback from Property, Line Lender's Name Lenders Address FINAL DATE INSPECTOR This is a building permit when properly filled out; signed and validated,.and is subject to expiration if work thereunder is suspended for 180 days. t I certify that I have read this application and state that the above information is correct. Issued by: Date Perfnit'- - I agree to comply with all city and county ordinances and state laws relating to building.: t: , construction, and hereby authorize representatives .-of • this city to enter the' -above-. r• mentioned property for inspection purposes. - Validated by: - Signature of applicant Date' Mailing Address Validation: City, State, Zip CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. ® $ 2ND FL. SO. FT. POR. SO, FT, ® GAR. SO, FT, ® CAR P. SO. FT. WALL SO. FT. ® SO, FT ® ESTIMATED CONSTRUCTION VALUATION $ UNITS MOBILEHOME SVC. POWER OUTLET YARD SPKLR SYSTEM BAR SINK ROOF DRAINS DRAINAGE PIPING DRINKING FOUNTAIN. URINAL WATER PIPING NOTE: Not to be used as property tax valuation BONDING FLOOR DRAIN MECHANICAL FEES FORMS WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN, WASHER(AUTO)(DISH) APPLIANCE DRYER FOUND. REINF. GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED METER LOOP LAUNDRY TRAY AIR HANDLING UNIT CFM REINF. STEEL 7 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 _$ SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 1 Vi c SEWAGE DISPOSAL /j% 6 Z IIV7 ( V SO.FT.GAR ® 114c HOUSE SEWER REMARKS: 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. 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