SFD (0212-158)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.07ffor this reason,.. .
Date Signature of Ownerit��fr. • ��a •,r
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).
( ) 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 wit "those provisions.
Date:%-' 731. Applicant .T'rns o , VL .a
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each p son a
whose request and for whose benefit work is performed under or pur an to:dl
any permit issued as a result of this applicaton agrees to, & shall, in em I y
& hold harmless the City of La Quinta, its officers, agents and em IS.
2. Any permit issued as a result of this application becomes null an if
work is not commenced within 180 days from date of issuance ch
permit, or cessation of work for 180 days will subject permit to can I
I certify that I have read this application and state that the above infor is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) .. <, :-/ // f,' .,�` ; r. r r� Date'- ^ 1 -_�
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PERMIT #
BUI! SING PERMIT
DATE VrCL'`UATION LOT~ TRACT
+1 3
JOB SITE ADDRESS'. :. �IM6-0555, INFMAl�:rxq-.007A
APN 1?M2_32 7014
OWNER, 'k •
CONTRACTOR/DESIGNER/EN (NEER
RR ARK J at; W, C, 0
LA QMATA C7A 92253
LA quram Citi:i••��2��125
USE OF PERMIT
EW(9.13 RMaly 1'?Vi LLNC
SM 1650 SQ, IM. RV. 1DRI & PERMI.:3' does Not Indo& Mock
WAA Feno s, Ped or flptj. A se'pnw. P z4 for the
Lhi$eb q Approach L- riquiretl.:€vm t1ie P691: Works
TRACT COMMYRUCT ON ExOAD$ Vin •
PORCt' IP,7AO, I93A, s1i'
t9q
t&I' IA17D COST C1)' CyOAM:UG`HON
IOD93_91.10
CORSTRU 130114 MR 101 400.4 H R-000 0645,00
PLA14 CHECK V94 101-000-4-39-318 MO.'*
�51101-000,439-318 4250100
&4F0L,kN) °.A1, F-
V., CTRIZ r.I...V£::I: X 4i d� �«42(4nU t 1 a.►l
P1.t31'JI1111,10 FYw
STRONG MOTIONPU - AMID 1014000-241-M) CAM
GRAD1140 FEE $113.00DEVELOPER
MPACT RM 62,405,00A
FI1.�S� 74�.Ir N $ (A 1 �f��►••�ti«S 1-��$S '$ I OO. Qb
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d30 30NVNId
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RECEIPT
DATE
TE
BY
DA FINA
//II1
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INSPE �1/f
V
'
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set BacksUnderground
Ducts
Forms & Footings ,
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
0. K. to Wrap
F.A.U.
Framing X —�
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— G3
BLOCKWALL APPROVALS
Final
Steel
POOLS - SPAS
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 LQ-
Heater Final
Water Piping
Plumbing Final
F lumbing Top Out
Equipment Enclosure
'hower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
_
`Seaver Connection C.r< `!i
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:
Date
11/26/02
No.
23903
Owner
M/M Frank Greco
Address
52055 Avenida Mendoza
City
La Quinta Zip 92260
Tract #
Type
Single Family Residence
CERTIFICATE OF COMPLIANCE
Desert Sands Unified School District
47950 Dune Palms Road
La Quinta, CA 92253
(760) 771-8515
APN #
Jurisdiction
Permit #
Study Area
No. of Units
4����FIEDSIC
Q,' BERMUDA DUNES r
RANCHO MIRAGE
INDIAN WELLS
d� PALM DESERT y
LA QUINTA
�3'INDIO
773-232-014
La Quinta
Lot # No. Street S.F. Lot # No. Street S.F.
Unit 1 52055 Avenida Mendoza 1650 Unit 6
Unit 2 Unit 7
Unit 3 Unit 8
Unit 4 Unit 9
Unit 5 Unit 10
Comments
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patios/walkways, residential additions under
500 square feet, detached accessory structures (spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation) or replacement mobile
homes. It has been determined that the above-named owner is exempt from paying school fees at this time due to the following reason:
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to
Education Code Section 17620 and Government Code 65995 Et Seq.
in the amount of $2.14 X 1,650 S.F. or $3,531.00 have been paid for the property listed above and that
building permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued.
Fees Paid By CCNIB - Frank Greco Check No. 277943
Name on the check Telephone
Funding Residential
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Monica Guillen $3,531.00 $o.00
Payment Recd Over/Under
Signature J4nlv�O'
NOTICE: Pursuant to Government Code Section 66020(d)(1), this will serve to notify you that the 90 -day approval period in which you may protest the fees or
other payment identified above will begin to run from the date on which the building or installation permit for this project is issued, or from the date on which
those amounts are paid to the District(s) or to another public entity authorized to collect them on the District('s) behalf, whichever is earlier.
NOTICE: This Document NOT VALID if Duplicated
Embossed Original - Building Department/Applicant Copy - Applicant/Receipt Copy - Accounting
Electrical Load Calculations
1650 @ 3w/SQ. FT =
4,950
2 Small appliance circuits (2xl500w)=
3,000
1 Laundry Circuit =
1,500
Range =
9,100
Dishwasher =
1,500
Garbage disposal =
1,500
SUB -TOTAL =
21,550w
IST. 10,000 W @ 100% =
10,000w
REM @ 40% =
11,550w
1-5 Ton A/C @ 2016w/ton = 4,620w
Service 26,170w/240v = 109.04AMPS
Use 200 AMP Service
Custom Residence for Frank Greco
8
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 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
FAX: 60) 777-7011
OWNER'S IGNATURE/DATE
-52-n2 AVEN (IMA M l-:NIDDzA
PROPERTY ADDRESS
PERMIT NUMBER(s)
CITY OF LA QUINTA SUB -CONTRACTOR LIST
JOB ADDRESS ` /✓�� Dr -7- A. PERMIT NUMBER OWNER BUILDER J, (4 i;_ l LE -2
This form shall be posted 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
of building permit. For each applicable trade, all information requested below must be completed by applicant. "On File" is not an acceptable response.
Trade / Classification
Contractor
State Contractor's License
Workers Compensation Insurance "
City Business License
Company Name
Classification
(e.g. A, B, C-8)
License Number
(xxxxxx)
Exp. Date
(xx/xx/xx)
Carrier Name
Ie.g. State Fund, CalComp)
Policy Number
(Format Varies),
Exp. Date
(xx/xx/xx)
License Number
(xxxx)
Exp. Date
(xx/xx/xx)
EARTHWORK (C-12)
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CONCRETE (C-8)
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FRAMING (C-5)
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LANDSCAPING (C-27)
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