9803-068 (AR)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
`CYFar,';er 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).
(� am exempt under Section , B&P.C. for this reason
,Date`r _e Signature of Owner
.., %4t—
WORKER'S
4t
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 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
Cyade, I shallforthwith comply with those provisions.
V te: ,r ,-; 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) r-� c� Date ./5'
PERMIT # CONTROL #
BUILDING PERMIT�;,,,�,,
DATE 3mon; VALUATION
x7,iio(i 00 LOT TRACT iNJC O
JOB SITE
ADDRESS 5645 i�6�iiUM C^ARRANZA APN 773-285.020
OWNER CONTRACTOR / DESIGNER / ENGINEER
52645 AVENIM CARRAN7A.
L.tt, QUINTA L_A �>i215z
USE OF PERMIT
fA FAM
ADD l I I S.F. %'JUS -IN C:LOSRr
VALUATION
CITY
F•+f AN 0+Citi IrFE
SifF'l-'['('Y 1lI,(,CJN�I'iZC1C'T40tJ
I0l-"-43Q-3t8
Cr?NnTR17r'rto7N ii:vu*
101 -000 -1i'18 -M)
V11i 06
I i L Ur "Lt IIt-'AL Flit"
101-` ID -420-000
315, *
STR6►t O niOVON 1;M - RE SID
lilt -OW -241.000
S.75
AND PLAN
;I;SS PRE—PAID I tai:,,
(JIU1
13 1998
LA QUINTA
7..W.00
RECEIPT I DATE I BY t/ I DATE FINALED I INSPECTOR
�t7V 10
00
$17911111
li!
INSPECTION RECORD
y 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
0. K. to Wrap
F.A.U.
Framing y
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
steel
POOLS - SPAS
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
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
r�-
Flinal
Utility Notice (Perm)
COMMENTS-
Desert Sands Unified School District
Notice: 82-879 Highway 111
01
922
Document Cannot Be Duplicated 619-77Indio, C5-3500 AA 922
CERTIFICATE OF COMPLIANCE
Date 3/13/98
No. 16736 Jurisdiction La Quinta
Owner NameDemetrio Colin
No. 52-645 Street Avenida Carranza
City. La Quinta zip 92253
APN # 773-285-020
Tract #
Type of Development
Comments a -in
Lot #
Permit #
Log #
Study Area
Square Footage 117
Residential Addition No. of Units 1
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, cov-.ied
patios/walkways, residential additions under 500 square feet, detached accessory structures or, replacement mrobilehoes.
It has been determined the above-named owner is exempt from paying school fees at this time due to tl'le following
reason:
EXEMPT
This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of
0.00 X 117 or $ 0.00 the property listed above and that building
permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued
Fees Paid By N/A Telephone 564-3424
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Rosita Jones Exempt
Check No. N/A
Signature
NOTICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified
above will begin to run from the date on which the building or installation permit for this project is sssued or on which they are paid to the District(s) or to another public entity authorized to
collect them on the District('s)(s') behalf, whichever is earlier.
Collector: Attach a copy of county or city plan check application form to district copy for all waivers.
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting
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 Out 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
(760) 777-7012
FAX ,(� 777-701 Li
OWNER'S SIGNATURE/DATE
X52 =Co ��_ _yE►�ti ►�� C Z�-�
PROPERTY ADDRESS ____
PERMIT NUMBER(s)
Wal
in
City f La u to
C o
tYQ
Building 8t Safety 'n f Division
h
P.O. -Box 1504
78-495 Calle Tampico
LaQ uinta CA 92253
n Tracking Sheet
B n Permit Application a d
ulldig
Project Address: S 2- (� (/ �- c�-e-�L tZ�
Owner's Name: �/, j�
Legal Description:
City,ST,
Contractor:
T le hone: /
Address: ✓ 9.,9 p , ,� n/ -t 2
Project Description:14
City.ST, Zip:
Telephone: a�
S
State Lic. # :
City Lic. #:
Arch.. Engr., Designer:
Address:
— 1
City. ST, Zip:
Telephone:
Construction Type: Occupancy:
YP Y anc :
State Lic.. #:
Project type circle one): New Add'n Alter Repair Demo
Name of Contact Person:--T#—stories:11, 1 o ��
/
Sq. Ft.: // %
Units:
Id
Telephone # of Contact Person' S �C./ (/� �.
o O
Estimated Value of Project: 7.
M
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
N0. PLUM91NG FEES
IST FL. 50 FT .`,. S
UNITS
SLAB GRADE
ROUGH PLUMB,
BONDING
YARD SPKLR SYSTEM
2ND FL. SO. FT. ,$
FORMS
SEWER OR SEPTIC TANK
`•
MOBILEHOME SVC.
BAR SINK
POR SO FT iii
GAS (ROUGH)
METER LOOP
GAR. SD FT ,Y
POWER OUTLET
ROOF DRAINS
CAR P SO, FT 4
TEMP. POLE
DRAINAGE PIPING
WALL SO FT .Z
GROUT
DRINKING FOUNTAIN '
SO cT. g
FINAL INSP.
URINAL
ESTIMATED CONSTRUCTION VALUATION S
WATER SYSTEM
WATER PIPING
NOTE: Not to ba used as pro0erty :as +aluathon
e$
FLOOR DRAIN
MECHANICAL FEES
FINAL INSP.
WATER SOFTENER
VENT SYSTEM FAN EVARCOOL HOOD
SIGN
WASH ER(AUTONDISHI
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
I TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE. TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT.•g. c
BATH TUB
GAR. FIREWALL
SO. FT. 0 c
WATER HEATER
MAX. HEATER OUTPUT. B.T.U.
SU. FT. RESID rli l±a c
SEWAGE DISPOSAL
SO.FT.GAR a 4c
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERM iT 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 A AlR 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 APP/EQUIP.
REINF. STEEL
GAS (FINAL) ,1 t
TEMP. POLE
GROUT
WATER HEATER !' ,
SERVICE
FINAL INSP.
BOND BEAM a
WATER SYSTEM
GRADING
cu. yd.
= Plug xf
e$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
Y
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
ccure eru•i
SIGNATURESRNITIALS
GARDEN WALL FINAL
T4t!t 4 4 Qumm
78-495 CALLE TAMPICO — LA GIUINTA, CALIFORNIA 92253 – (760) 777-7000
FAX (760) 777-7101
TDD (760) 777-1227
February 3, 1998
Dawson Sandra/Astleford Jane Z Trustees
52-645 Avenida Carrahza
La Quinta, CA., 92253
RE: 52-645 Avenida Carranza
_Dear Home Owner,
It has come to the attention of the Building Official that a un -permitted addition/remodel is in
progress at 52-645 Avenida Carranza. Please stop all work on site until plans are submitted and
a building permit has been issued.
If you have any questions please feel free to contact me at (760) 777-7027.
Yaniel
y,
.
Cra ord Jr.
Building Inspector I
cc file
dpc
MAILING ADDRESS P.O. BOX 1504 LA QUINTA, CALIFORNIA 92253