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0104-141 (BLCK)V/ .�- W, O ch -r- (Y'LC) W oKZ r CID W W I— a Z co LO N ON U °) 3 LICENSED CONTRACTOR DECLARATION 1-hereby.affirm under penalty of perjury that I am licensed under provisions of H 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& \for this reason Date P I «U li Signature of Owner -7). -7) -= , ---""""`-- -WORKER'S COMPENSATION DECLARATION F 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 with those provisions. Date: Applicant - ••.�-'r %'� . _, �"'"'.� —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-mentioned property for inspection purposes. Signature (Owner/Agent)t��� Date BUILDING PERMIT PERMIT# DATE VALUATION"' LOTTRACT / JOB SITE Y' ADDRESS }\ APN 51-60.AVEMAi CAJ~- . 714 - - OWNER CONTRACTOR / DESIGNER / ENGINEER j 5161 AIIENMA CARM147A -w� Q m rA CSA. 9225 USE OF PERMIT 0 SVT,, WALL LF N ARY Pe�i411 7.'�)FRy91,73A+�by`y�� YC�ryq�R FRE D a � APR 1 8 2001 CITY OF LA QUINTA FINANCE DEPT SUR'I`�-.�X)TAY CONenRI-MMON fNI,% KAN UIU . T0TAL :P'13WI +EMS DUE NOW q&5Iepi RECEIPT DATE % / BY DAT INALED INSPE OR INSPECTION RECORD OPERATION ]7776ATE 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 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 Final BLOCKWALL APPROVALS POOLS - SPAS Steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Final Underground Plbg. Test 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: 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. ti �. 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 >�OZER'S SIGN RE/DATE PROPERTY ADDRESS (D / G) / Y/ _ PERMIT NUMBER(s) Building�/ 6 O S Address G A OwnerS�����f Address �� City 1-4 Contractor Address P.O. BOX 1504 APPLICATION ONLY 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 BUILDING: TYPE CONST. OCC. GRP. A.P. Number % -73 Zip y Tel. 6, 7/v 91�.ZS 3 57,/ a SS/ ;-/IV Legal Description Project Description S r� City IZip I Tel.. State Lic.I City & Classif. Lic. # Arch., Engr., I Designer Address Tel. City IZip . I State Lic. # LICENSED CONTRACTOR'S DECLARATION affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of bnnsion 3 of the Business and Professions Code, and my license is in full force and effecL SIGNATURE DATE OWNER -BUILDER DECLARATION 1 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 pem*.to construct, alter, improve, demolish, or repair any structure, prior to its issuance also requires Me appfcant 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 ONWon 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis for the merged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the appicant to a civil penalty of not more than two hundred dollars ($500). ❑ 1, as owner of the property, or my employees with wages as their sole compensation, will do the wort, 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 buids 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 w8hrn one year of completion. the owner -builder will have thi burden Of pmvf g that he did not build or improve for the purpose of sale.) ❑ 1, as owner of the property, am exclusively contracting with licensed contractors to con- struct the project (Sec. 7044, Business and Professions Code: The Contractors 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 1 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 Jess-) 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: ff, after makhg this Certificate of Exemption you should become subject to the workers' Compensation provisions of the Labor Code, you must forthwith coney will 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 wok for which this permit is issued. (Sec. 3097, Choi Code.) Lenders Name Lenders Address This is abuilding 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. 1 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, Slate. Zip BUILDING DIVISION Sq. Ft. No. Size Stories No. Dw. Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation i PERMIT Plan Chk. Dep. 2 S Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure / /ham -7— 2_,3(/ ,3(/ TOTAL —z--7 U.a o v AMOUNT REMARKS1 v "S: v rx� x. y?75,00 4 r) rA.RI4 i THTAI i 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 GROUND PLUMBING NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. v Sp. FT.®1,44W.Ifp. SLAB GRADE UNITS BONDING HEATING (ROUGH) STORAGE TANK FORMS YARD SPKLR SYS,I"EM 2ND FL. Sp. FT. @ DUCT WORK ROCK STORAGE FOUND. REINF. 3 to METER LOOP MOBILEHOME SVC. BAR SINK POR. SO. FT. ® GAS (FINAL) TEMP. POLE T 1:7Sp. GROUT POWER OUTLET ROOF.DRAINS GAR. FT. ® eta BOND BEAM WATER SYSTEM GRADING CU. yd. $ plus x$ =$ DRAINAGE PIPING CAR P. SO. FT. @ FINAL INSP. FRAMING FINAL INSP. ROOFING DRINKING FOUNTAIN WALL Sp. FT. REMARKS: VENTILATION URINAL SO. FT. ® FIREPLACE ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING NOTE: Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES LATHING WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER INSULATION/SOUND GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED FINISH GRADING LAUNDRY TRAY AIR HANDLING UNIT CFM FINAL INSPECTION KITCHEN SINK ABSORPTION SYSTEM B.T.U. CERT. OCC. 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 SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/. c SEWAGE DISPOSAL SO.FT.GAR ® 3/ac 3y HOUSE SEWER 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 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 INSULATION/SOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL HAMMER PUMPING INC.. JOB INVOICE P.O. Box 2448 CATHEDRAL CITY, CALIFORNIA 92235-2448 17Qn1 Alan _ 7AAR DANT. - 6-0-1 -�� i7,6 -0-i3-2- 760) 321-7,44-8 PRICE CUSTOMER'S ORDER NO. DATE ORDERED Gallons / . _ _ oy � �p ORDER TAKEN BY DATE PROMISED 0 A.M. Dumping Fee per 1000 gal. ❑ P.M. BILL TO PHONE D � Out of Area Fee I ADDRESS MEAN , IC A4 A CITY HE PER JOB�E NDLOMAT ON J �` lVl ` L n 7„ -AY WORK DESCRIPTION OF WORK ❑ CONTRACT j 0 EXTRA ! c L A SERVICE CHARGE OF $20 WILL BE DUE ON ALL RETURNED CHECKS. 18% PER YEAR WILL BE CHARGED ON PAST DUE ACCOUNTS OVER 30 DAYS. DANT. DESCRIPTION OF MATERIAL USED PRICE AMOUNT 0()o Gallons ,)o U Pumping Fee per 1000 gal. � �p Dumping Fee per 1000 gal. Out of Area Fee I Locating / Opening Fee (per hour) Size System: A SERVICE CHARGE OF $20 WILL BE DUE ON ALL RETURNED CHECKS. 18% PER YEAR WILL BE CHARGED ON PAST DUE ACCOUNTS OVER 30 DAYS. HOURS LABOR AMOUNT TOTAL MATERIALS MECHANICS Q HELPERS Q TOTAL LABOR I hereby acknowledge the satisfactory TOTAL LABOR completion of the above described work: TAX IG ATURE _l_ DATE COMPLETED tJ�1 TOTAL �� 9A 15�� max. wai 146 ?A- 2 :ww VA ?.1?7 a lov cr ass,—, /00 �� �� t oubp Ca lcS b y CARO —R—ii x =' Si-. Uc . * ,q9(og13 73 o c.,Y,.F �T , Y;