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BLDG (9901-041)LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of 1-- Chapter 9 (commencing with Section 7000) of Division 3 of the Business and 04 LL . Professionals Code, and my License is in full force and effect. O 5 M License ## Lic. Class Exp. Date r- d LO r— LLJ r— oZ r-- Q to Signature of Contractor CD t J U CCD OWNER-BUILDER DECLARATION WaLU r— I hereby affirm under penalty of perjury that I am exempt from the Contractor's co License Law for the following reason: Z_ ( ) 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.LIDC. for this/season N Date Y �� r' Signature of Owner ' f O rn CL Q WORKER'S COMPENSATION DECLARATION p 2 Z I hereby affirm under penalty of perjury one of the following declarations: O () 1 have and will maintain a certificate of consent to self insure for workers' X W Y= compensation, as provided for by Section 3700 of the Labor Code, for the O J Q performance of the work for which this permit is issued. m Q U ( ) I have and will maintain workers' compensation insurance, as required by O (J Q Section 3700 of the Labor Code, for the performance of the work for which this 0 Z permit is issued. My workers' compensation insurance carrier & policy no. are: Carrier Policy No. cb =) r` O Q (This section need not be completed if the permit valuation is for $100.00 or less). J (,)SI 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, Section 3700 of the Labor Code, I shall forthwith comply with those. provisions. Date: 'a /L pplicant {+ i 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 author ie representatives of this City to enter upon the above-mentioned property fog inspection purposes. ;(g/nature (Owner/Agent) Date f j �+ tom+........ BUILDING PERMIT PERMIT# DATE int/39 VALUATION S8,51g.00 LOT TRACT JOB SITE ADDRESS 52-379 AVEN.IDA MIZINI"A APN - OWNER CONTRACTOR / DESIGNER / ENGINEER R1,0I1I'RT D ArtDIi SON OWNERItlUrIMIM 52-379 AVENIDA MENDOZA LA QUINTA. CA 02253 t 1 - C111.4 USE OF PERMIT 0RNRK.AL I.I(A ,MNU tWIX to 0 & 10417 @ N & 100LF 41 GARDEN IiT.CiCK WALL. WiPLAt.;H tX1,4f11NO QV`Ii14*,A1) eAXCI'H1CAL. :KVICdti W11'.tt 4tWAMI, 8FRV1d:"1 UNJA-: i. QW -A NI) C I'� A . WALL I900) LF S FT. W&A. trJ0.00 i.f' 4 V1'. WALI. 11A) ()0 l..F flail lMIX11 11) CYST OF CONS' TZ.1.1 t 1i?t\ x,515. 0 PERPAiT FEE:rUiktrtittARV fiL1w1;MJCAL FFki tOt-M-420-000 S.J3.4c.+ rY}NS'TR1fC T10N 1-47l? 110141(18-1194)()6 %I08(m Y'4 tl 1R=1Y-YrA.I. CONS1'RI_ 71'10N ANLL) MAN C11FCK -M41 -A r LESS 11RE •I'AIF FEES $0.00 `t999 1 -M -Al, !=ExNOT FERS OVE NOW S141.'Kf1 RECEIPKT DATE FINALED INSPECTOR g INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE I INSPECTOR ' BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade Return Air Steel Combustion Air Roof Deck Exhaust Fans OX to Wrap F.A.U. Framing Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans 8 Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath Final Final BLOCKWALL APPROVALS Steel POOLS - SPAS Set Backs Electric Bond Footings Main Drain Bond Beam Q 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: >....... of La uinta City Q Building 8i Safety tY DI islon n e P.O. Box 1504 k:,::::::.;:.;;.;:.;:.;:...... -49 Call Tam ico 78 5 e P La Q uinta CA 92253 Building Permit Applicationapd Tracking et Project Address: Owner's Name:rZ2 A. P. Number: Address: S� 3' �7vt Legal Description: F City,ST, Zip: ontracto . T le'h ne: " e o P U Address: Project Description: City,ST, Zip: lr h ne: Teleph p State Lic. # : City Lica#:.... Arch., Engr., Designer: Address: ;�� • City, ST: Zip: Telephone:hone: Construction Type: Occupancy: State Lic. #: Project type circle one): New Ad 'n Alter Repair Demo Name of Contact Person: Sq. Ft.: # Stories: # Units: Telephone # of Contact Person: Estimated Value of Project: 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 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 F�`.'1 60)x'777 011 OWNER'S SIGNA RE/DATE ue j, a PROPERTY A DRESS PERMIT NUMBER(s) r9Vc;2r7) Y Sa 3 79 P.O. BOX 1504jj 1 ` N o . 114 81 Building r B D02� 7&105 CALLE ESTADO ( I1 Address LA QUINTA, CALIFORNIA 92253 l In Owner � r( / CELESTE SHEATE Address 21338 LA PLAS ROAD WOODLAND HILLizi91364 Contractor STEFFEN PLUMBING Address P 0 BOX 612 BUILDING: TYPE CONST. C OCC: GRP. 7 A.P. Number_ el. 818-703-1799 Legal Descript Zip I Tel.: State Lia I City & Classif. C -3C 565175 Lic. # 1 i Arch., Engr., Designer Address Tel. CityI Zip I State I Lic. # LICENSED CONTRACTOR'S DECLARATION 1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 70 OO) of Division 3 of the Business and Professions Code, and my license is in full force and effect. SIGNATURE 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 rive 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 of completion, the owner -builder will have the burden of proving that he did not build or improve for the purpose of sale.) . 0 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.) O 1 am exempt under Sec. B. & P.C. for this reason Date Owner 1 tj ) WORKERS' COMPENSA`fION-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. ❑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 thg work for which this permit is issued, I shall not employ anyperson 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 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.) 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 Project Description SEWER HOOKUP Sq. Ft. Size . No. No. Dw. Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation 1,$00 PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing 30.0 S.M.I. Grading Driveway Enc. Infrastructure TOTAL V • U 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: +"1 CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES"'" 1ST FL SO. FT. $ 2ND FL SO. FT. POR. SO. FT. ® GAR. SO, FT, ® CAR P. SD. FT. WALL SO. FT. ® SO, FT ® ESTIMATED CONSTRUCTION VALUATION $ UNITS MOBILEHOME SVC. POWER OUTLET YARD SPKLR SYSTEM BAR SINK ROOF DRAINS DRAINAGE PIPING DRINKING FOUNTAIN. URINAL WATER PIPING NOTE: Not to be used as property tax valuation BONDING FLOOR DRAIN MECHANICAL FEES FORMS WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GAS (ROUGH) GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED OTHER APPJEOUIP. LAUNDRYTRAY AIR HANDLING UNIT CFM TEMP. POLE 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 FINAL INSP. SO. FT. ® c WATER HEATER MAX HEATER OUTPUT, B.T.U. SO. FT. RESID ® 1% c SEWAGE DISPOSAL SO.FT.GAR ® 3Ac HOUSE SEWER VENTILATION GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PLCK.FEE CONST. FEE ELECT. FEE SMI FEE PLUMB. FEE STRUCTURE PLUMBING ELECTRICAL HEATING & AIR CO!ND. SOLAR SETBACK GROUND PLUMBING UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE ROUGH PLUMB" BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWE ROUGH WIRING. DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEOUIP. 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 REMARKS: VENTILATION FIRE ZONE ROOFING: FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTIO CERT. OCC. FENCE FINAL INSPECTORS SIGNATUREWINITIALS GARDEN WALL FINAL Received Address: Accountl' Service Ai ❑ Meter(s) ❑ Service(s) O Backflow(s) ❑ House Lateral(s) ❑ DetectorCheck(s) ❑ Meter Surcharge C-- Sanitation Capacity Charge ❑ W.S.B.F.C. ❑ Temporary Construction Meter ❑ Turn on Charge ❑ Uncollected Account - Name ❑ Inspection Fee - Tract - Fee - ❑ Plan Check Fees Water / Sewer - Tract - ❑ Bond Payment - A.D. - Bond COACHELLA VALLEY WATER DISTRICT CASH RFCFIpr nFTAit ut . Ant�f ❑ Customer Deposit ❑ Other Remarks: 2 n ;�,1/�' 1 / • /* ,. TOTAL ❑Copy to: Cash ;_ =l Water Service Check Money Order / Cashier 2 } C 438(11/89)