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0008-176 (BLCK)_ .. LICENSED CONTRACTOR DECLARATION llli'��hereby 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:. 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 a their sole compensation, will do the work, and the structure is not intended o offered for se. sale (Sec. 7044, Business & Professionals Code). ( ) I, as owner of the property, am exclusively contracting wit�fi' licensed' contractors to construct the project (Sec. 7044, Business'& Prpfessionals. Code). �' O I am exempt under Section B&P.G°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 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 ^,&'"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) `' Date' BUILDING PERMIT PERMIT# DATE VALUATION LOT -1�fT TRACT JOB SITE ADDRESS M AVMIDA R REZ APN _ OWNER.. _. CONTRACTOR / DESIGNER / EN (NEER J'AVI1 U1 LG" LLCM CMXE%B'lILD S4 �£�5 AVE�IDA. I3f�:l� rJ1 i� CA 92253 CBIS! USE OF PERMIT -.:.t omDTJXDD4 "'`, ,UOL„FA'H &I OL F. 3'H & 10 L.19WH CIARDEN 'thl'ALL ONLY e CITY ETFAIi17APD b FT. WALL 1*10. 00 LF 5 FT. WALL 10.00 LF ; 4 FT. WALL, 10.00 LF e R ESMAKrED COS'r OF LO�i�'.&�U d'CON rt PK S� 't CONSTRUCTION FEE 101.0020-�1'&-00tl t AUG 0 7 2000 �. ATT OF L" G UINT SUS 'T01 At C%I'MR UMON AND PLAN CIV OK x'54,00 Ims M^PAM ITERS $0.00 TO OfA-L S! YMUT FFA ]f IM VOW RECEIPT DATE BY . y 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 O.K 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 BLOCKWALL APPROVALS POOLS -SPAS Steel Set Backs . (G -rx s 7 Electric Bond Footings Bond Beam �7 l of UQ 57 3 ' D~ Main Drain 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 Final Utility Notice (Perm) COMMENTS: ' s OWNER1,BUIL.DER" 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 be4ware that as ;';Owner/Builder" you are the.responsible.party of record on such a permit. Building; permits are not.required;to be -signed by'properry owners unless they.,ar'e`personally performing their own work. If your work isbeing by'someone,other than yourself, you may protect yourself from possible liability if that person applies,for; the propevpermtt in his, or her name. , Contractors are requiredby,la,w 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 infom'ation for your benefit and protection: If you employ or otherwise engage any personsother iha i)our immediate family, and'the work (including materials and other costs)'; is .$200.o0•:or: more :for the 'entire -project, and, such persons are -not licensed as contractors or subcontractors,'then`you may bean employer: If you are an employer, you must register with4the-State and Federal Gove'rnmentas,anemployer.and you are subject to several obligation's including State and, Federal 4ncome tax withholding,. federal ,social security taxes, worker's compensation insurance,'4isability 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 und11 er Federal Law, contact Internal °Revenue Service (and, if you wish, the U.S. ;Small Business Adminsiration) For more specific informaiion,about your obligations under State Law, contact the Department of Benefi� Payments and the Division,of.Industrial Accidents. If -the structure is intended for sale, property,ownersIwho'are not., licensed'contractors are allowed to perform their work personally outhiough their own employees,,without-a licensed contractor or.subcontractor, only under limited conditions. A frequent, practice of unlicensed: personi.professing�.to be contractorsis to secure an "Owner /.Builder" building permit, erroneously implying that. the -property owner is providing iis`oi`her ow,n 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 t community or at 1020-N. Stree,' Sacramento, California 95814. Please complete and return,, the.enclosed owner- builder •verifrcation form so that we can confirm that you are aware of these matters. The building permit wti;rill 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. . (760) 777-7011 �! WNER'S"SIGNA /-DATE PROPERTY -ADDRESS PERMIT WMBER(s)