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PLBG (0107-001)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 Professionalnode and my License is in full force and effect. License # Lic. Class Exp. Date 39661" C12 0,14•rt4% f .311"x( Date Signature of Contractor�a"7+ C �` f .OWNER-BUILDER.,D,ECLARATION 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, Busines's & Profe5siorials "Code). - ( ) 1, 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: Carrier res Ay� Dt }}gy�pp �y)� {� Policy No. Q (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 v w 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 -menti ned propertyr inspection pI[ poses. - Signature (Own�dAg hT • xjt-��� Date^ "r BUILDING PERMIT PERM T# 1 DATE VALUATION LOT 0107-001 TRACT 43'rflti' i f?in 2:0: �1€i X-210 . n z- JOB SITE APN ADDRESS '40 -.fed'! AVVNMA! 7k VATL'In7A OWNER a1�,:�3`d:,1' M SCHU,CT11%1 31 32.031 AVINID >,It>.1EWd OZ .i.h (�LTwYJtl. CA USE OF PERMIT CONTRACTOR/DESIGNER/ 92253 COAC. TILL& CA. 92236 k (760Y.398-5544 CRUt 31 SEPTIC ABAND[oPdR{iEAT'P-Urz WU C0h1+,6CT 030.0 W 'EFIX"IED Cori, 41y, COMINUCT11011 P, o�.V, M .1JCa,1083' .t1,t3D PUN C!;11XX $30.00 JUL -2 2001 CITY OF LA OUINTA RI R DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Farms & 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 Wail insulation Condensate Lines Party Wail 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 �. �_?� . O ( S7 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 Ext5 or Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) 0 COACHELLA VALLEY WATER DISTRICT CASH RECEIPT DETAIL �9} ( ®'GD4 A 8 l; Received From: Date: Address: t«� 1 �.a k C � )� �.. �� `.r ��k j � �i(,.A t t d �� f a• �� `( Account No. (r% 1 "Jo l *�( { ,: a� f.. � - Lot(s) i Tract Service Address G.A. Code ❑ Meter(s) $ ❑ Service(s) ❑ Backflow(s) ❑ House Lateral(s) ❑ DetectorCheck(s) I� ❑ Meter Surcharge k' ©''Sanitation Capacity Charge�j t ❑ W.S.B.F.C. ); ❑ Temporary Construction Meter ❑ Turn on Charge ❑ Uncollected Account - Name ❑ Inspection Fee - Tract - Fee - t ❑ Plan Check Fees Water I Sewer - f: Tract - ❑ Bond Payment - A.D. - Bond ) Assmt. ❑ Customer Deposit % ❑ Other �}< t TOTAL ' Remarks: 5._l ._�.`al V) I *-,N--., t t 'L OCopy to: Cash z°alar jCheck . f Money nulvr r n WaterService nCashier T 6 0 WV1 4 4 Qum& P.O. BOX 1504 Building ���� Ave.78-105 CALLE ESTADO Address Mendoza LA QUINTA, CALIFORNIA 92253 Owner Scott Schlicting Mailing Same Address City Zip Tel. La Quinta, CA 92253 1 564-1098 Colf-a0% construction Ad res 76S 891 Florida .Ave. Gity Zip Tel.' halm desert, CA 92260 360--0717 State Lia B 622308 City & Classif. Lic. # Arcn., tngr., Designer Address Tel. CityI Zip I State I Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that.1 am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of e: u Ines fan/d7 Professions Code, and my license is in full force and SIGNATURE _ rr DATE OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's 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 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 improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year or completion, the owner -builder will have the burden of proving 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 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 Date 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' COMPENSATION INSURANCE (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 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. Date Owner NOTICE TO APPLICANT: If, 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 or this permit shall be deemed revoked. 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, Civil Code.) Lender's 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 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 Address City, State, Zip BUILDING:- TYPE CONST A.P. Number Legal Description No. OCC: GRP. 13653 Project Description 1041 of 41 high, 20' of 51 high, and 651 of 6' high block wall Sq. Ft. No. No. Dw. Size Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation $3,963..28 PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. ,� Const. �' `' • Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure r A, TOTAL REM. ,,, tiitd ARKS'.,_ ila cor-J i.. n tit. `h .i=tLor _ 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 INSPEC,TO'R Issued by Validated Validatior CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL. SQ. FT. p $ UNITS SLAB GRADE 2ND FL. SQ. FT. BONDING YARD SPKLR SYSTEM POR. SQ. FT. ® MOBILEHOME SVC. BAR SINK GAR. SQ. FT. ® POWER OUTLET ROOF DRAINS CAR P. I SQ. FT. GAS (ROUGH) DRAINAGE PIPING WALL SQ. FT. OTHER APPJEQUIP. DRINKING FOUNTAIN SQ FT ® TEMP. POLE URINAL ESTIMATED CONSTRUCTION VALUATION $ GROUT WATER PIPING NOTE: Not to be used as property tax valuation FINAL INSP. FLOOR DRAIN MECHANICAL FEES WATER SYSTEM WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER FINAL INSP. 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, TEM/PERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SQ. FT. ® c BATH TUB SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 11/4 c SEWAGE DISPOSAL GAR. FIREWALL SQ.FT.GAR ® 3/ac HOUSE SEWER LATHING 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 APPJEQUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. / BOND BEAM n •� �s G� �o G 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 MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTIO CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL NOTICE: THIS IS NOT A BUILDING PERMIT DISTRICT / z APPLICATION TO CONSTRUCT Permit No DEPARTMENT OF BUILDING AND SAFETY COUNTY OF RIVERSIDE 284 199A 9/74 CANARY—FILE, PINK—APPLICANT 0wn,e,6-r08 6'1; W,- U-4-1 &4 Architect —. Contractor_—_— Ad®feL�__—_ Address___— Address-- City rza-City-- _ City____ — 6 % Phone (' .6 Phone _ Phone— 'W I (we) the undersigned, hereby certify and acknowledge that I (we) have read the application and agree that if Curb and Gutter, and Z Paving, and/or Dedication of right of way is required by the County of Riverside, the Riverside County Department of Building and Safety 3 shall not make a Final Inspection until said requirements have been met. I am also aware that no work is to be done within the County R/W O without an encroachment permit. , NOW, therefore, it is agreed that I (we) will not occupy said property and will not cause said property to be occupied until I (we) have complied with all laws of the County of Riverside and the State of California governing said property. �'Lj� DATE _ __ SIGNATURE OF OWNER AND/OR AGENT Approval by Signature from the Following Departments Listed Below Must Be Obtained Prior to the Issuing of a Construction Permit. I SPACE NO. USE OF STRUCTURE _/% JOB ADDRESS �d-33 v-� �'� SINGLE FAMILY ' DUPLEX Z L AL DESCRIPTION OF�P�RO RTY ,Z�—� - APARTMENTS [] AGRIC. COMMERCI9L E]INDUSTRIAL n '^ COMMUNITY . A TERATIONS _ z Z NO. OF SUBMITTED PLANS --- USE OF PERMIT — us Q CASE NO. — C Z JZON NO. OF P IRKING SPACES REQUIRED — NO F BUILDINGS NOW EXISTING SETBACKS: FRONT SIDE —� REAR m GRADING PERMIT REQUIRED? YES ❑ NO ❑ LOT SIZE SETBACK ORDINANCE# — OF FEET REQUIRED ON STREET DATE 4L SIGNATURE OF LAND USE OFFICIAL -- DEDICATION REQUIRED: YES ❑ NO ❑ NO. OF FEET_ - F W CURB AND GUTTER REQUIRED: YES ❑ NO ❑ -STREET I- ot a W CAN CURB AND GUTTER FEASIBLY BE INSTALLED? YES ❑ NO ❑ HAS AN ACCEPTABLE APPLICATION BEEN MADE FOR ENCROACHMENT PERMIT FOR DRIVEWAY AND STREET Q IMPROVEMENT? YES ❑ NO ❑ O °C DATE SIGNATURE OF ROAD DEPT. OFFICIAI Z SWIMMING POOLS PUBLIC QW DISPOSAL SEWAGE S FOOD ESTABLISHMENT WATER POLLUTION REMARKS vt FLOOD CONTROL t- W AIR POLLUTION mi _ � DIV OF HWY c a — YOUR PROPERTY MAY BE SUBJECT TO a c FLOOD. RIVERSIDE COUNTY ASSUMES, NO RESPONSIBILITY IN EVENT OF FLOOD. 284 199A 9/74 CANARY—FILE, PINK—APPLICANT DEPARTMENT OF BUILDING AND SAFETY APPLICATION CERTIFICATE c COUNTY OF RIVERSIDE PERMIT N Effective July 1, 1980, Chapter 1301, Section 19825 of the Health and Safety Code requires the execu- tion of the following applicable declarations prior to the issuance of a building permit. Please print ostype and sign below. LICENSED CONTRACTORS DECLARATION i I�hereby affirm,that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of "" I Division 3 of the Business and Professions Code and my license is in full force and effect. 1 License Class License No. % Date Contractor — F-1 I OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reasons: [� 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. If I sell within one year of completion, I understand I will have the burden of proving I did not build or improve for the purpose of sale (Sec. 7031.5, B.&P.C.). [__1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, B.&P.C.). I am exempt under Section B.&P.C. for this reason: j `� Date 4%2 / r�'i'G/ Owner r .r?r /_!_.__ .► c .�+. Q 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, Lab. Code). Policy No. Insurance Q Certified copy is hereby furnished. Q Certified copy is filed with the County of Riverside, Department of Building and Safety. Date Applicant Q CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if 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. I further understand that if after making this Certificate of Exemption, I should become subject to the Workers' Compensation provisions of the labor code, I must forthwith comply with such provisions or this permit shall be deemed revoked. Date Applicant 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, Civ. Code). ; Lender's Name Lender's Address DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION Q I hereby certify that no excavation five (5) or more feet in depth into which a person is re- quired to descend, will be made in connection with work authorized by this permit, and that no building, structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap 3.2, Grp 2, Art 2, Sec 341, Title 8, C.A.C.) Q As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from that division. [] Division of Industrial Safety Permit /No. Date �r/�,FU Applicant /fD.t*GG /�i/tr�ri-C f �� CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF -ENTRY- I certify I have read this application and state that the information given is correct. I agree to comply with all state laws and county ordinances relating to building construction, and authorize a representative of the County of Riverside, Department of Building and Safety to enter upon the 'pro-, perty for which I have applied for this permit for the purpose of making inspections. Signature of Applicant/Agent Date Print Applicant/Agent Name 284-2000 7/80 DEPARTMENT OF BUILDING AND SAFETY COUNTY OF RIVERSIDE OWNER -BUILDER VERIFICATION 1 Owner �. v Address An "owner -builder" building permit has been applied for in your name and bearing your signature. t Please complete and return this information in the envelope provided at your earliest opportunity to avoid unnecessary delay in processing and issuing your building permit. No building permit will be issued until this verification is received. 1. I personally plan to provide the major labor and materials for con- struction of the proposed property improvement {yes'.or no) 2. I (have have not) A�),9,9 s signed an application for building permit for the proposed work. 3. I have contracted with'the following person (firm) to provide the pro- posed construction: Name Phone Address City Contractors License No. 4. I plan to provide portions of the work, but I have hired the following person to coordinate, supervise, and provide the major work: Name Phone . Address City Contractors License No. 5. I will provide some of the work but I have contracted (hired) the fol. lowing persons to provide the work indicated: Name 'Address Phone Type of work Signature Property .Owner Date Social Security Number 284-2002 7/80 DEPARTMENT OF BUILDING AND SAFETY COUNTY OF RIVERSIDE 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 re- cord 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 pro- per permit in his or her name. Contractors are required by law to be licensed and bonded by the State of California and, where required, 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 an persons other than your immediate family, and the work (including materials and other costs is $200 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, workers' compensation insurance, disability insurance costs, and unemploy- ment 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 workers' 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 Administration). 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. Sincerely, DEPARTMENT OF BUILDING AND SAFETY Leopoldo Rojo, Jr. Director 284-2001 7/80 1