0008-154 (SFD)LICENSED CONTRACTOR DECLARATION
1 heeeby affirm under 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 in full force and effect.
License # Lic. Class Exp. Date
7 1834 }3 1-9-C� � � - 07/31 /2(
Dat / Signatu"re 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&P.C. for this reason
Date Signature of Owner
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 EX"PT Policy No.
(This section need not be completed if the permit valuation is for $100.00 or less).
((,)/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/provisionsof-Section 3700 of the Labor
Code, I,s all to hwith comply with those"p�ov�sions.
Date: R Applicant
i
Warning: Faure 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 setforth 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
fo
the above-mentioned property -r inspection..purposes.
_ bJ
Signature (Owner/Agent> Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT ON8,454 TRACT
08d i OC ,3 31.1(1 12 k3Lr i7
JOB SITE
APN
ADDRESS 52—lr'Y
2W A��A L 4MDZ eQ
77-x-222--1011
OWNER
CONTRACTOR / DESIGNER / ENGINEER
M1M PX%AUCXWA 14
T3rk .UaW NN INC
PO DOX 517
PO BOX 517
1A Q-UJN CA CA 92253
LA QT DMk CA 92233
(760)409-5422 =.4f
USE OF PERMIT
SPD•PERI4IIT DOn NOT INCLUDE BLOCKWALIZ OR POOL
'1'I3ACT CONSTRUCTION 1,409.00 SF
i. 7A.I1,AGiICARPORT (SI) 10,173.40
5 Fr. WOOD FENCE 200.00 L,F
X88,381.10
Fn=XFM) COST OF C014A-,M2T3C1101V
PL�F:I T M '4ilA"AW
CON#RUCTION FEE 101.000--418-000 $500,00
PLAN CHECK FEE 101.000-439-318 01+95.21
MECHANICAL FEE 101.000.421-000 $53.50
ELECTRICAL FFE 101-000-420-000 $129.20
PLUMBINO FEE 101.000119.000 $110.73
STRONCf'AAOTION FEE - RESID 101-000-241-000 - $3.84
QRADINO RM 101-000-423-000 $20.011
1DLVELOPILER IMPACT FEE a $1,907.00
PRECISE PLAN 101.000.441-345 $100.00
FRY, DEPOSIT 101-000-439-31€5 4250.00
,L
hp
MM-WrAl.. CONMUCTTON AND P.LA1+T C1IFC`X
$3,41E4,50
LESS PRE-PASD ".ES
42ZO0
AUG5 Lw� `J'O'1'AL 1�_.. .�1' 1f' 'S DUE NOW
*,164M.
• "
aj Y Ji- i a i,. !,J�,
d
'RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
a
t
u
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
. MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
O
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
(. Ott '['
F.A.U.
Framing
Ig,. ( ,map —
Compressor
Insulation
–vo
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 d
BLOCKWALL AP ROVALS
POOLS -SPAS'
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
_
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
4090 1
Encapsulation
Gas Piping
Gas Test
, –O
Appliances
Final
Final
Utility Notice (Gas)
a
ELECTRICAL APPROVALS
Temp. Power Pole i
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) p
COMMENTS:
v 6
coo 17 y
wilding �
idress �-lJ/1O - �'\ AW j a
Mailing r�
Address Y, .0 1,
City
Ca ✓ /v► �l
Contractor
;� Y ALX-r-
Addre
, v .,,- 7
City, .1
State Lic. j
& Classif.
Arch.; Engr:
Designer I:Gt r
1.
v �r - P.0, BOX 1504
78-495 CALLE TAMPICO .
�. LA OUINTA; CAUFORNIA 92253
,`oG FP
Foie
APPLICATIOR ONLY
r
0
BUILDING: TYPE'CONST. OCC. GRP.
A.P. Number 7%3 :2_z z ..O t I
Tel:
ZZJi6p 4-I0.9.)r112Z Legal Description L -of iZ atoc-.L 7-7 ,:-r• ;r�1
Project Description ��'� 1�''• E
G� 1
(t51��
Tel.
76.0
City b
Lic. a 023 O 7 S . t. .� LI C) 1 . Stories.. No. Dw.
New Add. ❑ Alter.`❑r e❑� D olition O
Tel V2 I
City Zip State
G
of a CIZZ.S.3 . a N .
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section .
7000) of Division 3 of the.Business and Professions Code, and.my.license Is In full force and,
effect.
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that l,am exempt from. the Contractor's. License Law for the following
reason: (Sec. 7031.5,SusMess ant! Professions Code: Any city' or county which requires a
permit to construct, alter. Improve, demolish. or repair any structure; prior to;fttissuance also.
requlres the applicant for such permit to rilee signed statement that "he is licehsed pursuant to
the provisions of'the Contractor's License Law, Chapter. 9. (cotmrrenchlg,. with: Section 7000) of
Division 3 of the Business and Professions Code. -.Or that. he is eiaapt 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 Ove hundred dollars ($500).
I, as owner of the property, or.my employees with wages awtheir 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.1himse/f-or through his own employees.
provided that such improvements are not intended or offered for sale. i ll, however, the building
or improvement is sold within one year of completion, the owner -bulkier. will have the burden
of proving that he did not build or knprove'for the purpose of safe.)
F1, as owner of the property, am exclusively' contracting' with licensed contractors to cam
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 whocontracts .for
such projects with a contractors) licensed pursuant to the Contractor's License Law:)
i 1 1 am exempt under Sec. B. 8 P.C. for this reason
Data-
-!r. Owner' i _ — �'�--.'
WORKERS' COMPENSATION DECLARATION
1 hereby affirm that'1 have a certificate of conientto seltoinsure, or a certificate of
Workers Compensation Insurance, or a certified copy thereof. (Sec` 3800, Labor Code.)
Policy No. Company
n Copy is filed with the city. ❑ Certified copy Is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completedO Ilis-00rmii 1s rot one hundred dollars ($100) valuation
or less.)
I certifythat in a performanc it ieh'this permit -is Issued, I shall not'.
employ any perso i�any mann o: subject to the Workers' Compensation
Laws' o '
ri
Date Owner
NOTI E T A LICANT: It, a g this Certificate o/ Exemption you should. become
subject t fh Workers' Compensation. Droyhions- of the Labor •Coos, you must forthwith -
comply I s h provisions or this perm/f shall be deemed revoked.
CONSTRUCTION .LEN DINQ'AdFNCY
I hereby affirm that there is a construction lending.agehcy, for the performance of the
work for which this permit is issued. (Sec. 3097, CMI Code.) "
Lender's Name—
Lender's
ame Lender's 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. ' .1 a -
I certify that I have read this application and state that the above information is comfit.
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 igepection pure" .
Signature of a0plican -""��� J Date ~ ` 1 tt"fir
Mailing Address
City, Stale, Zip
t�
stimated;'Valuatjonj�
.
PERMIT AMOUNT `'
Plan Chk: Dep.
Plan Chk. Bal.
COrISt. '
Mach.
Electrical
Plumbing
S:M.I
.Grading
DrNeway Eric.
Infrastructure
"TOTAL
'REMARKS.
1,411 L 1 A i i
ZONE: BY:
Minimum Setback Distances:
- Front'Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback.from Center Li
Side Setback from Property Li
FINAL DATE INSPECT ((�� i V
Issued by: Datee?fnit
Validated by:
Validation: J�
WHITE _ FINANCE YELLOW = APPLICANT, PINK = BUILDING DIVISION.
'Desert Sands�iJiiffied School District
47=95Q.Vune.Pa1 is Road
Notice:
� ' "' La Quwta,, .CA��92253
Document Cannot Be Duplicated 760=771-8515
s
CERTIFICATE OF COMPLIANCE
Date 8/25/00 APN # 773-222-011
No. 20933
.Turisdiction La Q.umta
Owner Name" Brauckmann' Permit #0008-154
No. 52-200 street.; Avenida Ramirez, }Log #
City La;Quinta zip 92253 Study'Area
Tract # 'Lot # Square Footage 1409
Type of Development Single Family Residence: ; s No. of Units 1
Comments
At the present time, the Desert Sands:,,Unified School District does-. not, collect fees on garages/carports, covered
patios/walkways,.residential additions, under'500;squaie, feet; &ta lied 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:
*�
EXE,MPTI0N N0T APPLICABLE, 3
This certifies that school facility feesimposed pursuant to ` Government Code 53080 in the amount of
2.05 X 1,409 or $. 2,888.45 the property listed above anddthatbuilding
permits and/or Certificates of Occupar►cy for this square footage'in this proposed project may noi0e issued
Fees Paid By CC / Wells Fargo & Co. [Mike Brauckman Telephone 760-409-5422
Naine'on the c6eck
By Dr. Doris -Wilson
Superintendent
Fee collected /exem ted by Annette 1313 xlow Payment, Received $2,888.45
Check No.,, 7377001.711
Signature x;
[.b."e
OTICE: Pursuant of Assembty.B1113081 (CFIAP S! STATS: 199!) this'wfll serve"to noLfy.you thafthe: '0-day'approv.1 period In which;you may pmtestthe fees or other payment identified
will begin to run from the date on which'the tiwlding or:instellationpermit for this project Is,asauad or on which they are pa!T to the Distrfot(s) or to eno8ier public entity authortzed to,
ollect them on the Distfict(%Xs') behalf, whichever' is earhe { :..
Vr y.
Collector: Attac6_a copy_ of county or Ian chock application -form to district copy for all waivers:
Embossed Original -`.'Building Dept./Applicant Copy Applicant/Receipt Copy -,Accounting,.•'
I
4.
RC -DISTRICT - PLANNING REVIEW. FORM
This form is: to. be used by CDD, staff forreview of single family dwellings in -the RC (Cove Residential)
District, in order to determine the applicability',of compatibility issues.or need to require the filing of Master
Design Guideline's by the -applicant. It shall be*.transmitted; 'to the Building 'an&.Saf0Y Department as your
44-*_
correction list. Please attach additional explanations as-�he6essary.
APPLICANT BRAUCKMANN INC. ,
SITE ADDRESS 52-200 Avenida Ramirez
APN 773 222- 011 BW NO.: CASE NO.: 2000-289
LEGAL: LOT 1'2 BLOCK 77- UNIT 10 S.C.@V.L.Q.
CHECKED BY: Greg Trous.dell. DATE:
Inform the assigned Building plan checker upon your assignment ignment to this case. The CDD .Executive
Secretary maintains a log book to track applications and assign case numbers.
REQUIRED ITEM
Y
N
COMMENT/CORRECTION
Compatibility Review
Case logged and number. assigned,
Verify legal and APN information
*Consistent with MDG on file (as.applicable
MDG filing required (5 filings sifice. 9%3/98)
Y
Consistency with&e surro"un'ding area:
Colors,
0 Materials
Architecture
tN4 V
r
g`1
\�:
Other Requirements:
<!15, "I
X
Certificate of Occupancy
Cit. of La uin ta
Bulldin and Safet: De a=rtrn:en:�,� ofti°V�7
g Y p
This Certificate issued:pursuant to. the requirements ,of Section 109 :of the Uniform .Bui/ding: Code,
certifying Ghat, at the time of"issuance; this structure was -in compliance with the. various ordinances
of the tCity regulating building. construction -or use. For the following:'
BUILDING ADDRESS: .52-200 AVENIDA..RAM.IREZ.
bse Classification SFD 81dg. Permit No.: 0008-154
Occupancy Group: R,3 Type of Construction: VN Land.;Use Zone: RC
Owner..of. Building: M?M BRAUCKMANN Addre s: m P.O. 9OX.517
City: LA aUINTA; CA 92253
By; STEVE'TRAXEL
Date: 04=04-07
Building Official
POST IN A CONSPICUOUS PLACE
rF