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BLDG (9601-175)51030 Avenida Martinez 9601-175 LICENSED CONTRACTOR DECLARATION iiereby,-Arm 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 Signatureof Contractor OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the follov yJng reason: ( 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.a forhis reason Datek-Z'%A b SignatureofOwner , '.T 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). ( tKI 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 'pith those provisions; - Date)' Lq - kiApplicant .. __, ' — -- +...,, 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 application agrees to, & shall, indemnify & hold harmless the City of Indian Wells, 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 day's 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 ALC0 BUILDING PERMIT PERMITi NC f11-175., : DATE VALUATION S.S,111fU.tftR LOT TRACT JOB SITE ADDRESS 51-IM0 AVE. IMA#tTiNEZ, APN OWNER CONTRACTOR OWNER/AUII,DER 11M LYISELL P.O. BOX 74 NIORONGO VALL CA 92256 CB11A (GI9)3'__-lf+50 DESIGNER/ENGINEER USE OFPERNT ENEMAL HUjj ANG R(:K )F REPAlk FEE DESCRIPTION FEES C0N1'RAr_1' Afvt0UNT 3,000.00 LS MA"11MA ED CGS"i' OF CONST-ft'litHON i,viiu.3i) }'ERMI #'I'' F EF::iilil MARY RM. (?C)F FIFE 101-000418-0(X) c0 C' rn CM C12 Q Q SUB -TOTAL CONST' V-7rION' AND PLAN CHECK $30.00 LESS PRF -PAID FEES $0.00 TOTAL PERMIT FEES DUE NOW $30.00 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 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 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: P �_ -" _ • _. �. �. "' ., ,.l �.l.:,/�.. Ax �„iu. ,f`,�� �..� �,:.:%'�1;.,,r.>�-.%yi^t4�.err.«+'D�.an'Y-Fw�il...Sr���.ir,'-.N:rf �� �.r''.�i,.- � >. r..,Y �^�— .'-�:.1 � e , �. ..v 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/ 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 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 carryout 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 78-105 Calle Estado La Quinta,. CA 92253 (619)564-2246 FAX: (6 19) 564-5617 OWNER'S SIGi�P;iTURE/DATE 1- 0 '--'4 " .,, 1,-%1.71 '� L L PROPERTY ADDRESS "A"'a0/ - % PERMIT NUMBER(s) Building Address 51-060 Ave13iia Owner P.O. BOX 1504 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 No. 002563 Mailing: BUILDING: TYPE CONST. OCC: GRP Address SCIM A.P. Number City zip Tel. La Quinta 92253 Legal Description Project Description Contractor Gdfflt s Fenim Address. _ Side Street Setback from Center Line 73--460 Santa Rem v City PaIM DP Zip 9226G Tel.- - 340-"4438 State Lic. City & Classif. 455087 Lic. # 594 Sq. Ft. No. No. Dw. INSPECTOR This is a building permit when properly filled out, signed and validated, and is subject to Size Stories Units Arch.; Engr'., _ Designer New ❑X Add ❑ Alter Repair ❑ . Demolition ❑ Address Tel. Cityzip construction, and hereby authorize representatives -of this city to enter- the above- State 120 1iil. ft. Of 4 -fit high mentioned properly for inspection purposes. Signature of applicant Validated by: Lic. # , tt" ul ✓~i l.ji?* fez= '111i %1112 s, .,, ` LICENSED CONTRACTOR'S DECLARATION q,,, y, , Ct,,,, q plmte . C& ©f final. I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Div/ision 3 of the Business and Professions Code, and my license -is in full force and .effect. l ` . .. _ SIGNATURE I 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, alter, 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). ❑ 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 oroffered for sale. (Sec. 7044, Buisness and Professions Code: The Contractor's License Law does not apply to an owner or property 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 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.) Estimated Valuation 480.00 PERMIT AMOUNT . Plan Chk. Dep. . Plan Chk. Bal. Const. Mech. Electrical. Plumbing ❑ 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 or property who builds or improves thereon, and who contracts for - such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) 0 1 am exempt under Sec. B. 8 P.C. for this reason S.M.1. Grading Driveway Enc. Date Owner 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 O Copy is filed with the city. O Certified copy is hereby furnished. TOTAL 20,M CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE REMARKS (This section need not be completed if the permit is for one hundred dollars ($100) valuation or less.) I certify that in the performance of thg 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. Dat e Owner NOTICE TO APPLICANT., It, after making this Certificate or Exemption you should become ZONE: BY: subject to the 'Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line CONSTRUCTION LENDING AGENCY Side 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. (Sec. 3097, Civil Code.) Side Setback from Property Line Lender's Name Lender's Address FINAL DATE ' INSPECTOR This is a building permit when properly filled out, signed and validated, and is subject to expiration it 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: Date"" Permit 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 properly for inspection purposes. Signature of applicant Validated by: l+ Date Mailing Address ! ` Validation: City, State, Zip A6Z98 9 8 2aGG CK HARD COPY CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBINGFEES IST FL. SQ. FT. @ $ 2ND FL. SQ. FT. POR. SO. FT. @ GAR. SQ. FT. @ CAR P. SQ. FT. WALL SQ. FT. @ SQ. FT. @ ESTIMATED CONSTRUCTION VALUATION $ UNITS MOBILEHOME SVC. POWER OUTLET YARD SPKLR SYSTEM i BAR SINK ROOF DRAINS 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.000L 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, TEMIPERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SQ. FT. @ c BATH TUB BOND BEAM SQ. FT. @ c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID @ 11/4 c SEWAGE DISPOSAL LUMBER GR. SQ.FT.GAR @ 3/ac HOUSE SEWER FRAMING FINAL INSP. GAS PIPING PERMIT FEE r,997 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 I CSETBACK _C/ S l ,ROUND PLUMBIN -1. UNDERGROUND A.C. UNIT COLL. AREA 7y,e'SLAB GRADE _ G ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK ^6j(—/FORMS — 6l SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APP.IEQUIP. 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 a DEC 17 r,997 REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL