08117 (RPL)Buildin
Address 49 -WS Salad& Cf.
Mailing
Address
414
P.O. BOX 1504
78 105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
__71BUILDING: TYPE CONST._
City Zip Tel.
La Qainta 92253 327-7066
Contractor
s by Camin;e
Address
ity
State Lic: _ City-
& Classif. 52M2 Lic. # 13N
Arch., Engr.,
Designer
Address Tel.
CityI Zip I State
Lic. #
LICENSED CONTRACTOR'S.DECLARATION
Section
7000)rofyy Division 3 of the Busrm that I am iness and Prrunder ofessi' rtqCo/ ehrovisi(ofa od/my license se iiss in ffuullcommecintforce and
effect. �./t%
SIGNATURC
6WNER-4 ILffER DECLARATION
I 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
permit to construct, alter, 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, 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
orimprovement 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.)
0 I, 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.)
O 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
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. .Company
O Copy is filed with the city. O 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 ($100) valuation
or less.)
I certify that in the performance of lhg work for which this permit is issued, I shall not
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I certify that I have read this application and state that the above information is correct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives of this city to enter the above-
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
A.P. Number
No. 08117
_OCC. GRP.
Pare La Quintet
Legal Description Cat 24 TR 21555-5
Project Description Pool & Spa
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
93.60 ..
Const.
1".00
Mech.
39.00
Electrical
Plumbing
42
S.M.I.
.91
Grading
Driveway Enc.
Infrastructure
TOTAL
1364,51
REMARKS
'ir
b v 3rRiQ r �
yy'at4,uA
LV s f T.i t
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date 5/20/9 Permit
Validated by:
Validation: s
City, State, Zip
IYr
- �',$.'�.�:^�: !�t1"`ir _. ��. ::t,�.{ t� ,'.L ��i�.2Yd7' •'rzr��X:Y � .
. ,
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SO. FT.
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
GAS (ROUGH)
METER LOOP
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. I SO. FT.
GROUT
WATER HEATER
WALL SO. FT.
FINAL INSP.
DRINKING FOUNTAIN.
SO FT ®
WATER SYSTEM
URINAL
ESTIMATED CONSTRUCTION VALUATION $
_$
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.0OOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
VENTILATION
LAUNDRYTRAY
AIR HANDLING UNIT CFM
FIRE ZONE ROOFING
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.
SO. FT. ®c
BATH TUB
LATHING
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/. c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/<c
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 APPJEGUIP.
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
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL
Date
3/14/14
No.
32019
Owner
Gipson
Address
49010 Balada Ct
City
La Quinta Zip
Tract #
Type
Residential Addition
Lot # No. Street
Unit 1 49010 Balada Ct
Unit 2
Unit 3
Unit 4
Unit 5
Comments
CERTIFICATE OF COMPLIANCE
Desert Sands Unified School District
47950 Dune Palms Road
La Quinta, CA 92253
(760) 771-8515
S.F.
45 Unit 6
Unit 7
Unit 8
Unit 9
Unit 10
BERMUDA DUNES
rn RANCHO MIRAGE
INDIAN WELLS
�.� PALM DESERT ,y
LA QUINTA
QINDIO y�
O
APN # 646-290-058
Jurisdiction La Quinta
Permit #
No. of Units 1
Lot # No. Street
�M
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 (spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation) or replacement mobile
homes. It has been determined that 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
Education Code Section 17620 and Government Code 65995 Et Seq.
in the amount of $0.00 X 45 S.F. or $0.00 have been paid for the property listed above and that
building permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued.
Fees Paid By Exempt - Wendy Gipson Check No.
Bank Name/Recipient of Certificate Telephone 505-515-5151
Funding Exempt
By Dr. Gary Rutherford
Superintendent
Fee collected /exem fed b . S f n M IIVt Payment Recd gO.Or p
y
i�er/Under�
Signature
NOTICE: Pursuant to Government Code Sect n 66020(d)(1), this W4,1seV to notify you that the 90 -day approval period in which you may protest the fees
or other payment identified above will begin to from the date on whit the building or installation permit for this project is issued, or from the date on
which those amounts are paid to the District(s) or to another public entity authorized to collect them on the District('s) behalf, whichever is earlier.
NOTICE: This Document NOT VALID without embossed seal
Embossed Original - Building Department Applicant Copy - Applicant/Receipt Copy - Accounting
P.O. BOX 1504
LA QUINTA, CALIFORNIA 92247-1504
7$-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
e
BUILDING & SAFETY DEPARTMENT
PROPERTY OWNER'S PACKAGE
(760) 777-7012
FAX (760) 777-7011
Disclosures & Forms for Owner -Builders Applying for Construction Permits
1II�� _0RT /YTt NOTICE TO gRQPERTYOWNER
Dear Property Owner.
An. application for a building permit has submitted in your name listing yourself as the builder of the property
impmvemeats specified at q Q fU G-1 e— A r^ C-1: LaQ y; N-(-_ /L
We are providing you with an Owner -Builder Acknowledgment and Information V � Fon make you aware of your
responsibilities and possible risk you may incur by having this -permit issued in your name as the
Owner -Builder. We will not issue a buildingpermit until you have react, initialed your understanding of each provision,
signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this -notice
unless you, the property owner, obtain the prior approval of the permitting authority.
OVA'S ACI EDIT ANDNEIMCATION OF II f9MJ&nON
MREt:TIOM. Read and initial C=h statement below to signify you understand or verify this information.
1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder"
building permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as
an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person
and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those
injuries. I am willfully acting as an Owner -Builder and am aware of the limits of my insurance -coverage for injuries to workers
on my property-
Ob
2. I understand building permits are not required to be signed by property owners unless they are responsible for the
construction and are not hiring a licensed Contractor to assume this responsibility.
t�_3. I understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may protect
myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her naive instead of my
own.
t__ 4. I understand Contractors are required by taw to be licensed and bonded in California and to list their license numbers on
permits and contracts.
�. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value
of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer"
under state and federal law.
10-&Z 6. I understand if I am considered an "employer" under state and federal taw, I must register with the state and federal
government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment
compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial
risk
�7. I understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential
structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed
subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed
under contract with a licensed general building Contractor.
property permit is issued, I may be he'd liable, for any
�8. I understand as an Owner -Builder if I sell thefor which this
financial or personal. injuries sustainedby any subsequent owner(s) that result from any latent construction defects in the
worlananship or matedils.
f9. I understand I may obtain more information regarding my obligations as an "employer" from the Internal Itevenue
Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California
Division of Industrial Accidents. i also understand I may contact the California Contractors' State License Board (CS .LB) at 1-
800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors.
�(7_10. I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the
Party le ally and financially responsible . for proposed construction activity at the following address:
91 _
_V(oo,l L I agree that, as the party legally and ftn ucially responsible for this proposed construction activity, I will abide by all
applicable laws and requirements that govern Owner -Builders as well as employers.
.�t 12. I agree to notify the issuer of this form immediately of any additions; deletions, or chimes to any of the information I
have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with
someone who doesnot have a license,. fire Contractors' State License Board :may be unable to .0441, Roy finanew loss
you may sustain as a result of a complaint Your only remedy against unlicensed Contractors may be in civil court. It is also
important for you tounderstand that if an unlicensed Contractor or employee of that individual or firm is injured while working
on your property; You may be heldliable for damages. If you obtain a permit as Owner -Builder and wish to hire Contractors,
You will be .responsible for verifying wheEhm or not those Contractors are properly licensed and the status of their workers'
coon insuranoe coverage.
Before a building permit can be issued, this form must be completed and signed by the property owner and returned to
the agency responsible for issuing. &e..perm..Note. A copy of tkeproperty owner's driver's l of form nota its or
other verrjrcatiox acceptable to the agency isrequired to be prosersted when the permit is issrrtd to verify the property
owner's signature.
Signature of property owner �� cam• Date: �r !
Note: The following Authorization Form is required to be completed by the property owner only when designating
an agent of the property owner to apply for a construction permit for the Owner -Builder.
AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF
Excluding the Notice to Property Owner, the execution of which I understandis my personal responsibility, I hereby authorize
the fallowing persons) to act as. my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner -Builder
Permit for my project
Scope of Construction Project (or Description of Work):
Project Location or Address:
Name of Authorized Agent:
Address of Authorized Agent:
Tel No
I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above
information and certify its accuracy. Rote --'A copy of the owner's driver's license, form notarization, or other verification
acceptable to the agency is required Co be presented when the permit is issued to verify the property owner's signature.
Property Owner's Signature: Date:
s
CALIFORNI .' -_GR�V l
_[�r ! I % i � ♦ r it ', ��c`_-:.:.i:
y DLl C099
EXP 02/0612017 �` ENo NONE
l LN-GIPSON
FN ROBERT WAYNE
° ,49010 BALADA CT
LA QUINTA,.CA. 92259 - r
.6/b6`02106/196 4
TR ORR LENS 02061964 --
SEX w,_
= HAIRN� VEXES BRN.
HGT-6'-02 WGT _2]Sib
SS
2
♦ \ �i✓1 UD 20268C27AAf01t7 101261201
1012 61 1 7 2