BLDG (0203-145)LICENSED CONTRACTOR, DECLARATION
I hereby affirm under penalty of perjury that CONTRACTOR,
licensed under provisions of
Chapter 3;(commepcing with Se6tion 7000) of Division 3 of the Business and
Professionals Code, and my License is infullforce and effect.
License # i 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, asp 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.C. for this reason
Date ' Signature of Ower %. ,P r
WORKER'S COMPENSATION DECLARA ION,
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 Ishould become
subject to the workers' compensation provisions Of Section 37000 the Labpr
Code, I sh ll fort .with comply with thos'e'provisions.
A",'
Date:Applicant�- �- _ _ v - ,d'
Warning Failure to secure Workers' ompensation coverage is unla 'rand
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 Ouinta, 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 ooffrth s` City to enter upon
the above-mentioned propertyfor inspection purposes.
i
Si nature (Owner/Ag ne t) � � ��--�•''"�' j'" � ate �t ,
s
`BUILDING PERMIT y — PERMIT#, -
DATE / `�?� ✓gTlOf�. LOT f-1445 TRACT
JOB SITE i _
ADDRESS ,51-•.'93.4 , AV04 MA NKVA.R:RO
APN
V3,183-4025
OWNER
CONTRACTOR / DESIGNER / EN INEER
VARP 4a,,I'f )T, M11W, 8: DAVM
OWNER Bt.TUM't
LA 1QTJIWfA, CSA 922531*
`s
USE OF PERMIT
4�1 X IV f,ru'WUR.0014 HE WITH NEW 6- X 12e
X I ,BK5 ,_ ONLY.
VALUATKYN la.ao
ESTS10".1c"IDST OF CORG-CRUCTION
3,710
FES )VER MO.t ARM
PLO cncr, Fu 101-090-439-338..
COU'VeRI:JGtow PUP, 3 o'1-000-418-000) ISAD
t.
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VIAR 13 2002
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RECEIPT
DATE
BY
DA FIN D
INSPEC
r Y...`�.. f _.....
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
hasulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath .
_
Final
— —
BLOCKWALL APPROVALS
Final
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
PI`mbing Top Out
Equipment Enclosure
Sr4 wwer Pans
O.K. for Finish Plaster
Sewer Lateral
Saver Connection
Pool Cover
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:
4: i_- .. i
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 Quint$,. 92253
(760) 777-70101 2
FAX (7li9j")'i 77-7011
OWNER'S SIGr�A!TUR'E/DATE
33
PROPERTY ADDRESS
4=3 - d6
PERMIT NUMBER(s)
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Submittal
Req'd
Recd
City Of La Quints
PERMIT FEES
Builtffng S Safe Division
ry
P.O. Box 1504, 78-495 Calle Tampico
Pem* #
Plan Check submitted
La Quinta, CA 922S3 - (760) 777-7012
Item
Amount
Building Permit Application and Tracking Sheet
ProjectAddrcss: 5 J c7 33
ven w a r o OWner'sName: Zvi-��m4�� t
pro
A. P. Number.
A
Address: SIS 33
vee 1` c(c_ c.<. Ve— r r 0
Legal Description:
City, ST, Zip: (—� e, CA 5 5 3
Contractor. S�
Telephone: ')ice —S(oy —CIS
Address:
Project Description: °
Plan Check Balance
evv�o 2,
City. ST, Zip:
Title 2.t Calcs.
� ` �� Civ C� CJ
Telephone:
Plans picked up
�0 2 �� t C'1 vl.
State Lic. # :
Citv_ Lic. #:
Arch.. Engr.. Designer rSto k�
-
C- e- o0 1t- � 5
Address:
Plans resubmitted
Mechanical
Electrical
City. ST. Zip: a�
9 aa%
Telephone: _
Construction ct1
on Type: >P Occupancy:
State Lic. #:
'' Project type (circle one): NeW Add'n Alter Repair emo
Name of Contact Person: � ,
�� Sq. Ft.: �o0 # Stories: / # Units:
1
N
., /
Telephone # of Contact Percnn-
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' APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Coles.
Reviewed. readv for corrections
Plan Check Deposit
Truss Coles.
Called Contact Person
Plan Check Balance
Title 2.t Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Electrical
Grading plan
2" Review, ready for corrections/issue
Subeontaetor List
Called Contact Person
Plumbing
S I 1
Grant Deed
Plans picked up
H.O.A. Approval
Plans resubmitted
Grading
Developer Impact Fee
IN HOUSE:-
''' Review, ready for corrections/issue
Planning Approval
Called Contact Person
A. 1. P P
Pub. Wks. Appr
Date of permit issue
School Fees
oAy
—
'k
Total Permit Fees
D Vk
t
Bin. . 016
City of La Quinta
Building 8r Safety Division
P.O. Box 1504, 78-495 Calle Tampico ., -
La Quinta, CA 92253 - (760) 777-701.1t2
Building Permit Application and Trac ing Sheet
Permit#
Project Adds� s: (i 33lqvey%�&O_ Mok-Ntc,(-C(D
Owner'sName:
A. P. Number:
Address: az H, ckc'
Legal Description:
City, ST, Zip:
Contractor:
Telephone:io
?
Address:
PTject.,E6crioion:
City, ST, Zip:
............ ......
Telephone:_ -RLI <' . . ....
...............
.............
State Lic. # : City Lic. \ I
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
..........
... ......
...
............. . .........
............... ... ..
Con struction Type: Occupancy:
State Lic. #:
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person: la
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person: +
Estimated Value of Project:
APP ANT: 13LO T WRITE BELOW THIS LINE
N
Submittal
Req!d
Rec'd
\TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted\
Item
Amount
Structural Cales.
Reviewed, ready for come V
re -
\ ons
Plan Check Deposit
Truss CaIcs.
Called Contact Person
_21an Check Balance
Title 24 CaIcs.
Plans picked up
4/f/04'
-construction
Flood plain plan
Plans resubmitted
A/�1S
Mechanical
Grading plan
2 "d Review, ready for corrections/issue
IQ(
Electrical
Subcontactor List
Called Contact Person
of
Plumbing
Grant Deed f.
Plans picked up
V-9/01
S.M.I.
H.O.A. App/?"al
Plans resubmitted
Grading
IN Hou
Review, ready for corrections/issue
Developer Impact Fee
Plan/.� Approval
Called Contact Person
\A\. 1. P. P.
b,,Wks. App.r
Date of permit issue
§chool Fees
Total Permit Fee\
City of La Quinta -
Plan Check Correction List.-,,
-Date: June 4, 2001 `
Project Address: 51-933 Avenida Navarro 4
Project Description: Remodel with beam_ replacement 4"
Status: First Review -
Plan Checked by: Greg Butler, (760) 777-7015 r
Due to the minimal of information in this submittal, this is a cursory review. A
comprehensive plan check (structural and non-structural) will be performed,at the
next submittal.:
Respond in writing to all corrections requested below, noting specifically where
correction can be found. Return *this list and all red -marked plans with next submittal.
Revise plans and/or calculations as necessary, reprint and resubmit two complete sets
of plans and/or calculations, wet -signed by the person who prepared them. If that
person is a licensed engineer or architect, the documents must also bear his/her stamp:
1. From the information submitted, it is not possible to determine whether the proposed
beams meet the requirements of the 1998 California Building Code. All existing
members must be identified in order to check the adequacy of ,the new beams.
Provide a complete Roof Framing Plan and details as required for the area involved.
2. At the proposed wood beam, clarify the existence of any tributary loads to the' left of
the beam (second page of talc package).
3. From the information submitted, it is not possible to determine whether adequate
footings are provided or proposed. Provide a Foundation Plan and details as
required for -all existing and proposed footing conditions.
4. Page four of -structural calculations indicates that the proposed `steel beam is
inadequate• unless �a wall is built beneath it. More information about the Master
Bedroom area is required before this can, be approved. The new wall appears to `
create a separate room, approximately 6' wide by 18' long. Provide a detailed,
dimensioned Floor Plan and Electrical Plan, showing. all existing and proposed
doors, windows, and electrical devices. Identify the proposed use of the new, narrow
room. ,
As information is provided and reviewed, additional corrections may be required.
END CORRECTION LIST
Page 1 of 1 r " ,
City bf La :Quints : r
Plan Check .Corrections
Date: September 6, 2001
Project Address: 51-933 Avenida,Navarro
Project Description: Residential Remodel / /Addition
Status: Second Review
Plan Checked by: Greg Butler (760) 777-7015
The current submittal, in addition to being a substantially different scope of work than the
original, is primarily incomplete.- Consequently, once again, this is a cursory review. A
comprehensive plan check will be performed only after a complete submittal is provided.'
Please see the attached "Residential Plan Submittal Requirements" document for4he basic
information necessary to perform a plan check onr this Remodel / Addition. <
In addition to the attached general list, be sure to address the following specific
deficiencies:
1. Provide an "Existing Floor Plan" denoting which walls are to remain and which are to be r
removed.
2. Provide a Roof Framing Plan.
3. Provide a dimensioned Revised Foundation Plan.
4. Provide Foundation and Framing Details as necessary to demonstrate compliance with the
applicable provisions of the 1998 California Building Code (CBC).
5. Portions of this structure may qualify to be constructed under -the provisions of CBC §2320
for conventional light -frame construction. However, the carport -like structure in front of the
garage does not comply. Provide a design by a ,licensed architect 'or engineer in accordance t
with CBC §1605, including vertical and lateral calculations for the entire project or those
portions that cannot be made to comply with CBC §2320.
6. Provide information on Plans as necessary to demonstrate compliance with CBC §2320 with
regard,to braced wall panels in all required locations. '
7. Provide Truss Calculations; with layout plan, for this project. ,
8. -Provide Energy Calculations (Title 24 Report). ,
9. Provide a Revised Electrical Plan.
10: As further information is provided and reviewed, additional corrections may -be required.
END CORRECTION LIST
Page 1 of 1