9703-106 (RER)LICENSED CONTRACTOR DECLARATION '
U) I hereby affirm under penalty of perjury that I am licensed under provisions of
F- Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
fV W �. Pro'essionals Code, and my License is in full force'and effect.
O`D A ' % 'License # Lic. Class Exp. Date
r- Cr ,
Zr- Date Signature of Contractor
r
(O ~ OWNER -BUILDER DECLARATION
W d I hereby affirm under penalty of perjury that I am exempt from the Cont Actors
License Law for the following reason:
Z_ ( ) I, as owner of the property, or my employees with wages as thei sole
compensation, will do the work, and.the structure is not intended or offer d 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 & Profess nals
Code). +`
C () I am exempt under Section B&P.C. for this reason
C\; Date Signature of Owner t
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 insurance1 as required by`.
Section 3700 of the Labor Code, for the performance of the work for which this
perrniit 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
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
Ahe above-mentioned property for inspection purposes.
Signature (Owner/Agent) Date
T - - PERMIT# •� , , CONTROL#
~ -BUILDING PERMIT
4887
lVALUATION S: 1•�!l LOT - TRACT
DATE, 31V/97i
e
JOB SITE ,
ADDRESS 5,x,.111`.+ AV.ENI DA C:ARRANZA
APN
1
OWNER+•
CONTRACTOR / DESIGNER / ENGINEER
t t r
t-°'hilCJU(iLC-If3Nili7.,
BUILDE::t
21.105 AVENIDA CARP ANZA
,
1 A fit AWA CA 92M
USE OF PERMIT
t2ISMf:yl i
OW0 iN'14500R WmA, rkNi7+. LOttlii' t
' t
05•l•UNtNVED COPT cat^ (70INS't'IMC!'ION
3tt3E.itfl
Pf.AN C1IE K FF:F? Io1-000-1:` 4.31 9
fi0I1ff"f'U11C70tlpf17W 1014*04IR-OM
IiLI i'I ft tr1S1riz1 f i1E-iK}0 • IkC 0(3(} $15 (fil
�• S1`4140Tf>if
$19 15
LESS PRE -PAID FEES
TOTAL PERMIT F F..'S DUE N0W
$39.75
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
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
OX 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
POOLS - SPAS
kocKWALL :APPROVALS
3•..=:- _
steel
Set Backs .-
Electric Bond
Footings r
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. 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
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
,:Smoke Detectors
Temp. Use of Power
Final
t'Utility Notice (Perm)
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CITY OF LAW
NTA
w _ 'QDON-t.AUs.11Ly,
QLY]u
` iN� SAFETY
® 0�RTMENT-,
i-� �' -
CONDM®NALLY�-ACCEPTED FORZONST
-.--
RUCTION
wRe ,3r 1\it9k! r -
SUBJECT TO INSTALLATION AS PER 1
AND ALL APPLICABLE CODES
THE fsrote 6E.7DR+�^'\ • 15 - -
2 �] BY We 4o�.
s)
•
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.
F,or 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
78-105 Calle Estado
La Quinta,. CA 92253
(619) 564-2246
FARC: (619) 564-5617
!! im, a -71v
OWNER'S SIGNATURfUDATE
elf rra- to 2!4 M7A_U11,174
PROPERTY ADDRESS
PERMIT NUMBER(s)
I
78-495 CALLE TAMPICO — LA QUINTA, CALIFORNIA 92253 - (760) 777-7000
FAX (760) 777-7101
TDD (760) 777-1227
December 10, 1997
Miguel Gomez
52-105 Avenida Carranza
La Quinta, CA., 92253
RE: Remodel Permit #9703-106
.Dear Mr. Gomez
The purpose of this letter is to inform you that your Remodel Permit #9703-106, for the project
at 52-105 Avenida Carranza, has expired. In accordance with 1994 UBC section 106.4.4, no
further work may be performed until a new permit has been issued.
Please contact Daniel P. Crawford Jr., Building Inspector I, at (760) 777-7012 to obtain any
information you need regarding a new permit and/or any required inspections. Should you
choose not to complete the project, we would then have to pursue any or all of the following
actions:
1) Abatement of the project through the City Attorney's Office and Code Compliance Division.
2) Notice of non-confonning structure placed upon property profile.
3) Action filed with Contractor State License Board. Optional if Owner/Builder.
Please contact us at your earliest convenience prior to 10 working days to resolve this issue, and
for any questions you may have.
Sincerely,
Mark Harold
Build' g & Safet/y Mana er
Daniel P. Craw f rd r.
Building Inspector I
cc: file
dpc
MAILING ADDRESS ' - P.O. BOX 1504 - LA QUINTA, CALIFORNIA 92253
r K f US Postal Service 't
Receipt for Certified Mail
No Insurance Coverage Provided.
` Do not use for International Mail (See reverse)
`::� . a
f4livz "r
.0. BOX 1504 - LA QUINTA, CALIFORNIA 92253
"rk:V!11"GI 1V, 1// r
Miguel Gomez
52-105 Avenida Carranza
La Quinta, CA., 92253
SenttoMiguel Gomez
"'t`"a'I'b'105 Ave. Carranz
Post Office, State, & ZIP Code
Postage $
CeAfied Fee
1.35
Special Delivery Fee
Restricted Delivery Fee
Return Receipt Slowing to
Whom & Date Delivered
1.10
Return Receipt Showing to Whom,
Date. & Addressee's Address
TOTAL Postage & Fees 1
$ 2.77
Postmark or Date
P 277 543 739
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