0004-053 (AR)` �� LICENSED CONTRACTOR DECLARATION
1 hereby alirm undee penalty of perjury that I am licensed under provisions of
Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
Professionals Code, and my License is iii full force and effect.
License # . . Lic. Class Exp: Date
.J.%ill�l
Date Signature of Contractor
- f
OWNER -BUILDER DECLARATION r
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
(k/ 1, 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). , r
O I am exempt under Section , B&P.C. for this•reason
(Date !Z Signature of Owner �i✓'�r� _.
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 STATE FUND Policy No. 229-00 001921'
.(,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 37.00 of the.Labor
:Code, I shay fort .with comply with those,provisions:,.+' --
L,b e: L ! _
Warning: Failure to secure Workers' Compensation 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 representativ_es'of-this.,City"'to enter upon
the above-mentioned property for ins�pe,ctib'mpu poses. -�
nature (Owner/Agent) � -��'"� Date
BUILDING PERMIT PERMIT#
DATE �" VALUATION LOT O%4" 53 TRACT
$27,041.40
JORSITE y
ADDRESS 54_225 AVLp=A R*U910
APN
774-201.-62.
OWNER
CONTRACTOR / DESIGNER / EN (NEER
RAY JUAREZ
OWNERM'UI DER
54.125 AVEM- DARUBIO
54-125 AV.FIUDARUBIO
LA QUJ.tNTA CA 92253
I.JA QUINTA CA 9225 t
w.549rAf.
USE OF PERMIT
XMI•iF3.1 IAL RMODM.
`-I-'
REMOOR1,655 S.F. ROOM ADDITION KITCHEN REMODEL
y�
VALUATION 490.00 3F
r+
.a
LL
'
ESMIA711M COST OF CONSTRITCTION
27,441.40
PERMU 14TE SuAMARY
1V RCH, M0,Ab FEE 101w000-423-000-; $19,30
ELECTRICAL PEE 101-000-420.000 $35:10
-
*.
PLUMBING FEE 101.000.419.000 $21.00
STRONG MOTION F110, - RLI.SID 101-000-241.00LI $2:76
}
GRADING "1 101-000.423.000 $20,00
PLAN CHECK FRF 101-000-439-318 $176.49
CONSTRUCTIt3N r ? 101.000.419.000 $271.50
�i
4AM-MAL C0NS 1'RUCI101•d A.WD Pr-" CBEM
$546.34
LES$-1RR�PAM FMS
$0.00
1 "A"
r• TOM PERMAT T+' S VVE 1'?'OW
J
RECEIPT
DATEBY
DATE FINALED
INSPECTOR
V
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings
_
`
Underground Ducts
Ducts
Slab Grade
_J _
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
A
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
—/ • p79
Drywall - Int. Lath
.— O
Final
Final
POOLS - SPAS
BLOCKWALL
APPROVALS
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
Water Piping
Ov
Heater Final
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
6�
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 '
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
T
Bin
City of La Quinta
Building BE Safety Division
P.O. Box 1504
Permit #
78-495 Calle Tampico
La QuinEa, CA 92253
Building Permit Application and Tracking Sheet
�roject Address:
—0;;We-rs`Name: No kr,5. J—UaA,�P— Z—
A. P. Number: J? L Aj"7
ffd—dr—ess7-6/4-Ia,5jSubl'o
Leg alDescripti on:
rC—ity---iT--Zi—PDtA au IYT�� 0 qa&5 3
IContractor,l-
Xei �hone.
Address:
Project Description:
Cir% -.ST. Zip: 1-14
IFZ06:7
Telephone:
State Lic.
Citv Lic.
MO.. Engnesistner-
n
Address:
C it%-.IST.Oz ip:
A
I on
Telephone:
TeleR,
Constru ction Type: Occupancy:
StateLicl=:
-X::.: X T ...
Project type (circle one New Add'n Alter Repair Demo
PTO'
-?'ante of -C6-n--tkf'Pe-rsort:
# Stories:
# Units:
Telephone —=of Contact Person:-) 0
/Estimated Value of Project
........
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Ag. ApprovalPa
Desert Sands Unified School District
47-950 Dune Palms Road
Notice: La Quinta, CA 92253
Document Cannot Be Duplicated 760-771-8515
Date 4/18/00
No. 20307
Owner NameRandy Juarez
No. 54-125
City La Quinta
CERTIFICATE OF COMPLIANCE
APN # 774-201-019
Jurisdiction La Quinta
Street Avenida Rubio
zip 92253
Permit #0004-053
Log #
Study Area
Tract # Lot # Square Footage 498
Type of Development Residential Addition No. of Units 1
Comments
498 sq. ft. Kitchen remodel.
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered
patios/walkways, residential additions under 500 square feet, detached accessory structures or replacement mobilehomes. It
has been determined the above-named owner is exempt from paying school fees at this time due to the following reason:
Residential Addition 500 Sq Feet or Less
EXEMPT
This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of
0.00 X 498 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 - Randy Juarez Telephone'
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by' Mary Ann L. Boda Exempt $0.00
JJCheck No. N/A
Signature ,
NOTICE: Pursuant of Assembi`y 61113081 (CHAP 549, STATS. 1998) this will serve to notify you that the 90tlay 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 Dlstrictfs)(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 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, the; 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' ot'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.
w
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 (760) 77
OWNER'S SIGNATURE/DATE
PROPERTY ADDRESS
PERMIT NUMBER(s)