RPL (0302-189)79530 Marigold Lane
0302-189
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
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--thin rea O
mate.. • 1,-1- y_ Signature of Owners I.- `..._ .
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).
certify that in the performance of the work for which this permit is issued,
I shall riot 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, indemnity
& 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 ins f n°pur ses.
rSignature (Owner/Agen Date-r"•—,V ° -
PERMIT #
B _tL 1NG-PERMIT
DATE VALUATION LOT TRACT
JOB SITE
ADDRESS V-530MARIGOLD I- A fr.; _
APN
-
OWNERCONTRACTOR
• r
/DESIGNER / EN INEER
r . a r rsr • : ,> .•
CY'i tY• . ' .J".I.C3:1k: t
991,510 ib ARIO=
lIA QuWTA ?del 92253
USE OF PERMIT
POM. ARDIOR:IVA
i
POi'3LJSP,A; G&S LIyNE; iaV Fi.I'I'h.URF, I HQ 13 LF 4° EQUIPMENT
STANDAR D. ALARM -11A kRIE R.2 SPALL D Z51 14 k%
AT PIR ..e.13I.,PA:iTM INSTEC"P3Z" N. - • .
4 17, WALL Lir
POOL. ANI -1100 SPA 'axS
ILS"rMATED WfF.I!. 1J.67 C0.:V6+ItT0MON
ZE/1VRi`IYL fV
VIER.W-1 l
1jjpp•'
p ' i y: µ 7 n f
FEE
PIAN CI3IE 'Y FEE 103-000439,3118 +97e?.A',,,
CONSTRUCTION WE
MECHANICUU, k' R -- POOL 101-00,0-427-000 $24,00
EL TR CAL I71M -6 P001. 101.1;00-420—= 24°100
I'1,,La,MBIINO MAI - POOL 101.000-419-DOO
D
IR01 003
CITY OF LA QUiNTA 3
RECEIPT
DATE /;
BY + FINA
INSPE
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
Main Drain
_
Bond Beam - d
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
-
Final
Gas Piping
Gas Test
%?
_IL
PLUMBING APPROVALS
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
'Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
1>ewer Lateral
Pool Cover
-.Sewer Connection
Encapsulation
Gas Piping
r Gas Test
Appliances
o
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
---
-- tility Notice (Perm)
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.
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 variuus 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 uitempl"oymentcompensationcontributions.° — - - ---
There may. be financial risks fof 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 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
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 LA QUINTA
DEPT. OF BUILDING AND SAFETY
78-495 Calle Tampico
La Quinta, CA 92253
(760)777-7012
FA 77__-70
-a3
OWN'ER'S XGNATURE/DATE
PROPERTY ADDRESS
PERMIT NUMBER(s)
CITY OF .LA QUINTA SUB -CONT TOR LIST
V'JOB ADDRESS ? QS B % PERMIT NUMBER OWNER •-1ee } tl.Sd l BUILDER C LW Ve _
This form shall be Dosted on the job with the Building Inspection Card at all times in a conspicuous place. Only persons appearing on this list or their,employees are authorized to work'-
on this job. Any changes to this list must be approved by the Building Division prior to commencement of work. -Failure to comply will result in a{stoppage of work and/or the voidance
OT DUdding .permit: For each applicable trade, all information requested below must be completed
by applicant. "On File" is not an' acceptable response:
Contractor _ .::..::
_:.:.;- State Contr actor.s.L cense 7
>.
Workers CompensaLon Insurance z
City Business Ucense'
:'
Company Name
Classification `.
License Number
Exp. Date
Carrier Name
Policy Number
Exp.:Date
License Number
Exp. Date
y
(e.g. A, B, C-8)
(xxxxxx)
(xz/xx/xx)
(e.g. State Fund, CalComp)
(Format Varies)
(xx/xx/xx)
(xxxx)
(xx/xx/xx)
EARTHWORK
r
1
-
•777,
2 -lo
FRAMING (C 5)
STRUCT STEEL
MASONRY (C
PLUMBING (C 36)
r+
t
..
LATH PLASTER (C 35)
Q, ?
C ~-
9aS 5
is
rp "E
G y6 —O . o
+ $ Q
} 7 /
6o~g
DRYWALL::
HVAC IC 20)'
r
ELECTRICAL
i
ROOFING
^
SHEET METAL IC 43)
FLOORING-MA51„
GLAZING (C 17)
•i
•
'
INSULATION IC 21
t
(+
:SEWAGE DISP (C 42►
PAINTING IC 33)
CERAMIC TILE
CABINETS IC 6)
1
?FENCING IC 131
I
LANDSCAPING (C 271
4
1
POOLIC 53) 'r$•
K3
3606
/O $j
"A177— 2 %L`
-
3 8
b .n
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t
1m
%k
Building
Address
Owner
Mailing
Address
A • .. a ' :".", • `. .. { y ,, J 1,.
•• P.O. BOX 1504 N O . -
05900
,, 7&105 CALLE ESTADO -• "
7Lma
9-530,. Marigold LA QUINTA, CALIFORNIA 92253
La. Quinta AwocLatef3
' City Zip' Tel.
POD... 97-260
Contractor
B.G. Vit law Dev. Corp...
Address. .
. Ptah
City Zip
State Lic.
& Classif.,, 493419 .
Arch., Engr.' '
•' Designer
BUILDING: TYPE CONST. ' OCC: GRP,.
A.P. Number
Legal. Description Phafe 11 Lot 42 "
Project Description JA- Cactus Flow.i7—r
`
City
Lic. # 1231 Sq. Ft.,
Size`
,y
New'O
'Address .. Tel.
City Zip State
"g'r..',•i.: ' LIC. #
:a-• ' ... '' . LICENSED CONTRACTOR'S DECLARATION .
'-Thereby 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. ei +
SIGNATURE n •DATE
OWNER -BUILDER DECLARATION'
I hereby affirm that I am exempt from the Contractor's License Law for the following
'-.reason: (Sec. 7031.5,s and Professions Code: Any city or county which requires a
Stories
Add ❑ Alter ❑
tstimateo valuation.,.,
73, 279.00
No. Dwi `.
Units
Repair ❑ Demolition ❑
Pe— to constroct, .ager, hwrove, demolish, or repair any structure,. prior to its issuance also
requires the applicant for such permit to fr7e a signed statement that he is licensed pursuant to
the provisions of the:Contractors 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 civilena
pfty of not more than five hundred dollars ($500). -
❑ I, as owner of the ro
p perty, 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 Contractors License Law does no apply to an owner of property who
?1, , builds , or improves thereon and who does such work himself or through his own employees,
00vded that such cnprovemeds are not intended or offered for sale. It, however, the building
' orimprovement is. sold wither one year of completion, the owner -budder will have the burden6
' •-- of proving that he did no build o improve for the purpose of sale.) _
t` • ❑ I, as owner of the property, am exclusivity contracting with licensed contractors to coo-
struct the project (Sec. 7044, Business and Professions Code: The Contractor's License Law
. does not apply to an owner of properly who builds or improves thereon, and who contracts for
- such projects with a contractors) licensed pursuant to the Contractor's License Law.)
••'.O 1 am exempt under Sea B, & P.C. for this reason
PERMIT-.. . AMOUNT
-
Plan Chk. Dep - - - ,
.
- - ••- _ •-_7
Plan Chk. Bal.` •'
Const. 522.50 .
--
0
Mech.-- 53.50
-
EI2Ct rICBI -' _..l >; . a " , - - _ ' • -
Plumbing _ 123•00 -
¢
S.M.I. •j• - S•
. .
Grading
Driveway Enc.
Date Owner
Infrastructure k648.78
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
Ef Copy is filed with the city. ❑ Certified copy is he reby.furnished.
TOTAL
CERTIFICATE EXEMPTION FROM
WORKEDKERSCOMPENSATION INSURANCE
REMARKSff q; fits` s: d 4k y i z: iii
•kms -- `"-rey, , .,.
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
F or less.)
I certify that in the performance of thg work for which this permit is issued, I shall not
employ any ern in any manner so as to become subject to. the Workers' Compensation
Laws of California
`
Date Owner
NOTICE TO APPLICANT: ff, 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 orthis permit shall be deemed revoked.
ZONE: - BY:
. - -
Minimum Setback Distances: r • .`.
Front Setback from Center,Line
Rear Setback from Rear Prop. Line
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,,cina code.) _
Lenders Name
Side Street Setback from Center Line
, s
Side Setback,ffrrom Property Line
-
Lenders Address
FINAL DATE INSPECTOR
g $
Issued by: Date Permit
w a
'Validated by • '
" This is A building permit when property filled out, signed and validated, and is subject to `
expiration if work thereunder is suspended for 160 days.
I certify that 1 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 Address
Validation:—
alldatlOn:City,.
city,,State, Zip
_ .
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
ROUGH PLUMB. BONDING
HEATING (ROUGH)
STORAGE TANK
YARD SPKLR SYSTEM
2ND FL SQ. FT.
DUCT WORK
ROCK STORAGE
FOUND. REINF.
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
REINF. STEEL 10,
TEMP. POLE
GAS (FINAL) /1D D
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
WATER HEATER SERVICE
FINAL INSP.
DRAINAGE PIPING
CAR P. SQ. FT.
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
WALL SQ. FT.
LUMBER GR.
DRINKING FOUNTAIN.
SO FT ®
FINAL INSP.
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
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
FINAL INSPECTION
SQ.FT.GAR ® 3/ic
HOUSE SEWER
CERT. OCC.
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. k SOLAR
SETBACK
GROUND PLUMBING UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE "7
ROUGH PLUMB. BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH) (((L' 6j METER LOOP
I
(Q
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL 10,
TEMP. POLE
GAS (FINAL) /1D D
GROUT
WATER HEATER SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP. 2/2%
FRAMING
FINAL INSP.
ROOFING h Cj'
L
i
REMARKS:
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
l
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
'
GARDEN WALL FINAL