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11664 (RPL)11664 Building P.O. BOX 1504 { \� No. _ 78-105 CALLE ESTADO AddresS V Address LA QUINTA, CALIFORNIA 92253 C!P Owner Bob A�.cal.a Mailing BUILDING: TYPE CONST. OCC: GRP. Address - aMp A.P. Number Cityip Tel. La Quanta, CAT 92253 Legal Description ContractorProject Description P001. 3' &" setback, anrIrny,,-f5 Owner/Bu3..Ider Address __. by planning. ity State Lic. & Classif. Arch., Engr., Designer Zip j Tel.: City Lic. # Sq. Ft. No. Size Stories - New ❑ Add ❑ Alter ❑ No. Dw Units Repair ❑ Demolition ❑ Address Tel. City Zip State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 70 130) of Division 3 of the Business and Professions Code, and my license is in full force and effect. -9GNATl1RE DATE OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License taw for the following reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a permit to construct, after, improve, demolish, or repair any structure, prior to Its issuance also requires the applicant for such permit to file 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] 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.) &< 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.) - 0•1 am exempt under Sec. B. & P.C. for this reason Estimated Valuation 8 {� rj • 00 PERMIT AMOUNT . .Plan Chk. De oti Plan Chk. Bal. Const. y Mech. Z4 • UU Electrical 45 e U U Plumbing x S.M.I. • 8 U •Grading Driveway Enc. Data/-'-2—Owner .`ti.t,tr�-�-`� 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.Comp'any ❑ Copy is filed with the city. f Certified copy is hereby furnished. - TOTAL zoD • [.2 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 employany parson 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 It 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 ateMailing Address City, State, zip REMARKS q-1 t t: .':'< $ # : _. A—.0 r r) Lit"ut'arl 1•.ItSfh1, t f.L•L..1.! 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: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES, 1ST FL. SQ. FT. ® $ UNITS COLL. AREA SLAB GRADE YARD SPKLR SYSTEM 2ND FL. - SO. FT. HEATING (ROUGH) STORAGE TANK FORMS MOBILEHOME SVC. BAR SINK POR. SQ. FT. ® DUCT WORK ROCK STORAGE GAR. SQ. FT. ® POWER OUTLET ROOF DRAINS METER LOOP HEATING (FINAL) DRAINAGE PIPING CAR P. I SO. FT. ® GAS (FINAL) WALL SQ. FT. DRINKING FOUNTAIN. SQ FT ® URINAL ESTIMATED CONSTRUCTION VALUATION $ FINAL INSP. WATER PIPING NOTE: Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES GRADING cu. yd. $ plus x$ WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER ROOFING GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRY TRAY AIR HANDLING UNIT CFM VENTILATION 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 SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 11/. c SEWAGE DISPOSAL SO.FT.GAR ® 3/ic HOUSE SEWER MESH 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 47UNDERGROUND) 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 APPJEOUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM FINAL INS �� GRADING cu. yd. $ plus x$ =$ LUMBER GR. FRAMING FINAL INSP. 3 ROOFING . (-, /,2/ CIA C 1 '�✓ J q/ REMARKS: VENTILATION FIRE ZONE ROOFING: FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING NSPECTION FINAL INSPECTION- CERT. CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESJINITIALS GARDEN WALL FINAL :d �LE ESTADO — LA QUINTA, CALIFORNIA 92253 (619) 564-2246 CASE NO: CITY OF LA QUINTA FE .:: $100.00 TING & DEVELOPMENT DEPARTMENT :CATION FOR SETBACK ADJUSTMENT form with two copies of a scaled site plan, (.i,00 ct the nature of the request. A nonrefundable .,�;,.�;•,..;;; ,; ;; hen the Application is submitted. Check must be J'0Tr;l... ;.f) of La Quinta" . the owner of the property, a letter must be ithorizing the Applicant to execute this document PLEASE PRINT OR TYPE APPLICANT/CONTRACTOR: /�Oa.% L c A L A DATE �.Z�/ 2— CONTACT PERSON (I F DIFFERENT) PHONE 3 67 MAILING ADDRESS: 5/-'4-7Z) ,Ao: Ou,00TA CA '122,5 3 (Address) (City) (State) (Zip) OWNER'S NAME: 'sp0-t PHONE MAILING ADDRESS: SA "O (Address) (City) (State) (Zip) STREET ADDRESS OF PROPERTY: .SAr�-tom' LEGAL DESCRIPTION OF PROPERTY: LOT # TRACT 7 ASSESSOR'S PARCEL NUMBER: "`:.t:: .i "'Ci.=; i•T-' 1 ADJUSTMENT REQUESTED: "1 REASON FOR REQUEST: 4fr To Co •-572U c j �oo c_ 1 -o -F/ -' /,) c(412-1) JUSTIFICATION: No request for a Setback Adjustment shall be granted unless it is determined that it is consistent with the intend and purpose of this Ordinance; that there are special circumstances applicable to the property, including such factors as size, shape, topography, location or surroundings that justify the approval of the adjustment of the setback requirement, and that the adjustment will not be detrimental to the health, safety, and general welfare of the community or be detrimental to property in the area of the parcel for which the adjustment is requested. FORM.013/CS Z :t.4 c� oma. 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 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 wilth 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 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 workers' compensation insurance. ... 16 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 3132 Bradshaw Road, Sacramento, California, Mailing Address: P. O. Box 26000, Sacramento, California 95826. 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. o Very truly yours. CITY OF LA QUINTA BUILDING AND SAFETY DEPARTMENT IM V •c Z ro of n+� OWNER -BUILDER VERIFICATION Attention -Property Owner: An owner -builder permit has been applied for in your name and bearing your signature. Please complete and return this information 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 anSkmaterials for construction of the proposed property improvement yes' r no) 2. I av*haVe not). k w—e_ signed an application for a building for the proposed work. 3. I.have contracted with the following person (firm) to provide the proposed construction: Name 1 Address City Phone 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 V) A Address City Phone Contractors License No. 5. I will provide some of the work but I have contracted (hired) the following persons to provide the work.indicated: (see attached) RPT1 OWNER -BUILDER SIGNATURE TAT 4 P.O. Sox IN4 7b 105 CALLE ESTADO LA OUINTA. CALIFORNIA 92253 Contractor Owner cu no S- C Address Job Address 5 — Ln 0 C,4 e_to.,1 2,4 La Quinta City License No.: Expires: Bldg. Permit No.: L2. L3. L4. L5. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. Plastering { HVAC This, form shall be posted on the job with the Building Inspection Card and it Electrical 'br's shall be the duty of the General Contractor or if Owner -Builder Permit, the owner NPVY- to see that all sub -contractors sign this card, giving his City of La Quinta �Dvjyw Business License Number, Contractors License Number and a current certificate Of Workman's Compensation Insurance Certificate when he starts the job. Failure o U"^4�. to comply may cause Building Inspectors to stop work, or complaints to be filed SGwW ('M 4 _ against such contractors or owners. bt"111— Til e CITY CONT. SUB -CONTRACTORS NAME LIC. NO. EXPIRES LIC. NO. EXPIRE: I. Grade i Excavate Fences/Blockwalls 2. Pipelines 11 3. Cement -Foundations (�Lp1Y%^Vl 4. Cement Walks i Drives ��%V) 5. Asphalt Paving U4y-k 6. Framing 7. Steel Structural ll 8. Masonry h Q 9. Plumbing �1���✓ L0.' Lathing D Ur►"`r L1. Drywall L2. L3. L4. L5. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. Plastering { HVAC A 61 W ewyK ar- Electrical 'br's r I2C gd-_ Roofing NPVY- Sheet Metal �Dvjyw Floors -All Types Glass - Glazing o U"^4�. Insulation/WeatherstriOG-L �yiY,il��i1r�15 Sewage Disposal SGwW ('M 4 _ Painting/Decorating bt"111— Til e ( 1, Cabinets -Installations w �►IY�Vy/� w Ornamental Metal VAA, Fences/Blockwalls •VA -v - Landscaping Others f DO NOT REMOVE THIS CARD Before Final Building Inspection Will Be Made This Form Must Be Completed and Filed With Title 24 Calcs and Plans Tilf 4 4 QuW0 P.O. sox 1504 78,105 CALLE ESTADO LA OUINTA. CALIFORNIA 92257 Contractor Owner 0)z b C� Address Job Address e.G',tyU\-2A, La Quinta City License No.: Expires: Bldg. Permit No.: This form shall be posted on the job with the Building Inspection Card and it shall be the duty of the General Contractor or if Owner -Builder Permit, the owner to see that all sub -contractors sign this card, giving his City of La Quinta Business License Number, Contractors License Number and a current certificate of Workman's Compensation Insurance Certificate when he starts the job. Failure to comply may cause Building Inspectors to stop work, or complaints to be filed against such contractors or owners. CITY CONT. SUB -CONTRACTORS NAME LIC. NO. EXPIRES LIC. NO. EXPIRE: 1 . Grade & Excavate 2. Pipelines 3. n Cement -Foundations CrR U1l In 2161 4. Cement Walks i Drives 5. 6. 7. 8. 9. 10.' L1. 12. L3. 14. 15. L6. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. Asphalt Paving Framing ✓ Steel Structural Masonry Plumbing ?4Dk Adl. 71aM%� Lathing l Drywall Plastering Lr, Mt( HVAC 6 d� t't X16 o,654( /,? e,-3 Electrical 12oa5,&_ Q(e bo 510 m Roofing Sheet Metal f� Floors -All Types Glass - Glazing Insulation/Weatherstrip Sewage Disposal -� Painting/Decorating Tilef�c1Z �`�j"1R�- 1��3 Cabinets -Installations -�`- Ornamental Metal ✓ Fences/Blockwalls Landscaping f Others �41 % �� �� _� 3(0 l �Z t ;ZK iso/ y tl DO NOT REMOVE THIS CARD Before Final Building Inspection Will Be Made Thi C C .� �.�. M . � c t O o /' n...... 1 � � o A � n r1 C : 1 0 .i •.? i � L, rn : � 1 � "1 , r. � 1 ,... _ _..? ^ 1 .. ..