9606-172 (AR)49100 Marimba Ct
9606-172
_ t
LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty ofperjury'`.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
ate 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) -
A/(/)1 amexem t under Section B&P.C: ohi re
Date "'' Signature of Owner .r^
WORKER'S COMPENSATIONS ECLARATIONN
I hereby affirm. under penalty of 'perjury -one of• the followigg 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:
Carder Policy No.
(This section need not be completed if the permit valuation is for $100.00 611ess).
() I certify that in the performance of the work for which this permit is issued,
I shall not employ any person in any•mannerso as to become. subject to the
workers' compensation laws Of California, and agree that if'I should become
subject to the workers' compensation lyo sions o ectien 3700 of the Labor
tCode, I s all fort with comply with i e( 6 • '
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 represen atives"of this City to enter upon
the above-mentioned prope/forinspeoti ses.
'01Signature (Owner/Agent) Date
UILDING..?TRMIT PERMIT# 1 ci 'CONTROL#
9606.1-72 _ / U35
} ;
DATE 6 96 V LLUnUATION LOT TRACT t
t•
AOB SITE
DDRESS - f) ..PV I EO C
APN 4446-3WO44
OWNER "
CONTRACTOR / DESIGNER / ENGINEER
K a;: & JO WILSOtJ °.
L3V1'A3 It; 431I%i,I k t
49100 'NIA it.fiId A 07 ,
i,.A. (JUINTA• CA ' 92253
- t
USE OF PERMIT
RQCIM A.DDITICit
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S'i' tZ °i:F;, i X5'1" 0V C 'd?i fSTRTIC''T'iW
14,3") 5i)
P.i,.AN('HrCIa.Ff;L , . - 101^ff0tl-439-318'St 0.3(1
CONSTiUi'r]"ON FEE 101 -00041,4100-0
VCC4ppN-1CA1. FrZ.1.01 -00-42t-000
'F<i:;f"s(",J'XICA1, Fgo, 101.4)00-420-000 $24.28
sToNo L•1C{'1ii N Pe - gy4sm-.p 10.1-0()43.241.-000 $1.44
S03w710TAt1 CON$"!"RUC ION AND °t'1;,f N C1'1'WK
$308102
L RSS. RPM -PAM FEES
... !"AD_, PETTMITr,1.F--9 DTJF : Al
X00:00
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
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wali Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL A ROVALS
Steel
POOLS - SPAS
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
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
§moke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
I
4 / !/t/
P.O. BOX 1504 APPLICATION ONLY
Building 49 I DO ,n t AQ t b4, -kA
/ 78-105 CALLS CALIFORNIAESTAD9
Address Yh C 'T LA OUINTA, ORNIA 92253
+ Owner
K d So L.- S4A1- So Al -
Mailing
Address Aq IGO W AO-11,"Za
City Zip Tel.
Za QLtiAlTA IZ25 /
Contractor
C:> W AJ
Address
City
& Classif. I Lic. #
A►rcn., tngr.,
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
7000) of Division 3 o1 the Business and Professions Code, and my license is in full force and
effect.
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I heieby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Business and' Professions Code: Any cay of county which requires a
permit to construct, Mm
er, anprove. demolish, or repair any structure, prior to its Issuance also
requires the applicant for such pamnd to rile a =for
that he is *sensed pursuant to
me provisions of the Contractor's License Law, =for 8 (cormurcing with Section 7000) of
Division 3 of the Business and Professions Code. or that he is axwwt therefrom, and the basis
for rhe aaeged exemption. Any violation of Section 7031.5 by any applicant for a penTIN
subjects the applicant to a civil penalty of not more than five hundred dollars (=500).
1" 1, as owner of the property, or my employees with wages as their sole compensation, will
do the work, and the structure isnot intended or offered for sale. (Sec. 7011, Buisness and
Professions Code: The Contractor's License Law does not apply to an owner of propery' 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 aisle. N, however, the building
orimprovement is sold within one year Of completion. the owner•bui der will have The -burden
of proang that he did not build or improve for the purpose of sale.)
I, as owner of the property, am exclusively contracting with licensed contractors to con,
struct the prolecl. (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 protects with a contractor($) licensed pursuant to the Contractor's License Law.)
I am exempt under. Sec. d P.C. for this on
Date Owner
If
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. n Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed 0 me permit is for one hundred dollars (5100) veklation
or less )
I certify that in the performance of the work for which this permit is issued, 1 shall not
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date at
NOTICE TO APPLICANT: N, after mNiimg this CertNicate Of Exemption you should become
subject to theworkers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions Of this Pemnd shail.be deemed revoked.
CONSTRUCTION LENDING AGENCY
n Ihereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. )Sec. 3097, Civil Code.)
Lenders Name '
Lender's Address
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.
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 notating to building
construction, and hereby authorize representatives oe
f this pity to. anter the abov
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
WING: TYPE CONST. OCC. GRP,
P. Number
gal Description
oject Description easppa,
J
Sq. Ft. ' No. No. Dw.
Size Stories Units
New O Add P--- Alter O _ Repair ❑ Demolition. C
REMARKS
ZONE: BY:
Minimum Setback Distances:
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:
Estimated Valuation
IT, J 2qO .OD
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bat. 0
Const.
Mech.
Electrical
2
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
ZONE: BY:
Minimum Setback Distances:
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:
r!
PARC LA QUINTA HOME OWNERS ASSOCIATION
ARCHITECTURAL COMMITTEE
May 23; 1996
Mr & Mrs KC & JoLe Wilson
49-100 Marimba Court
La Quinta, Ca 92253
Dear Mr & Mrs Wilson;
Thank you for your application to add a room to your home.
The committee has studied the plans and finds them to be acceptable.
You may therefore pursue the addition providing that the colors of stucco,
tile and wood trim all be the same as the existing house.
We particularly appreciate that fact that you sought the.approval of your neighbors
beforehand and thus saving us the trouble.
We wish you luck on your project and look forward to seeing it done. Naturally you
are aware that your contractor must observe all ordinances set by the City of La
Quinta governing such projects.
Sincerely yours
J
j
inz U. o Mann.-
hairmar
Architectural Committee.
cc: Cam Andersen, Avail Property Management
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1
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 inhis 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 peri -nits 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.
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 Stare ,
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
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w,, rr ovn r is ;: - t hc:
it'.ia %'.I :oawo -1 by proper, .trnln, tp- ii
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Contractor Q j(/j ti Address `1ttoo M-AQ(Ok7-- :2,A CT,
Owndr V/1f-e"O'c/ Job Address 49t00- VVtk121vua4C- —
This form shall be posted on the job with the Building Inspection Card at all times
conspicuous place. It is the responsibility of the General Contractor or the Owner/Buil
to monitor the sub -contractors that are on this list are the same persons performing
work. Any changes of this -list must be approved by the City of La Quinta Department
Building and Safety prior to work being performed by a changed sub -contractor. Failure
comply will result in a stoppage of work and/or the voidance of building permit.
OV
TRADE
SUB -CONTRACTOR NAME
CONTRACTOR'S
LICENSE NO.
WORKMAN COMP.
NO. ON FILE
CITY BUSINESS
LICENSE NO.
GRADE/
EXCAVATE
PIPELINES
CEMENT/
FOUNDATIONS
CEMENT/WALKS
& DRIVES
ASPHALT
FRAMING
STEEL/
STRUCTURAL
MASONRY
PLUMBING
t
LATHING
DRYWALL
PLASTERING
+
HVAC
ELECTRICAL
ROOFING
SHEET METAL
FLOORS
GLASS/
GLAZING
'INSULATION
SEWAGE DISP'
r
PAINTING/
DECORATING
TILE
CABINETS/
INSTALLATION
r
ORNAMENTAL
METAL
FENCES/
BLOCK WALLS
LANDSCAPING
OTHERS