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-*% _ � - LICENSED CONTRACTOR DECLARATION
hereli,° affirm that hen licensed under provisions of Chapter g (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' Signatureof Contractor t
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Low 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
I/,. , . _ V
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).
(1 l 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: , 41 1, 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 application agrees to, & shall, indemnify
& hold harmless the City of Indian Wells, 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/Ager Dat, .f , Y
ALC0
�0"ILDING
PERMIT
PERMITIoz-oso
DATE ryr:aip
VALUATION
LOT
TRACT
JOB SITE ADDRESS 54.024
APN 7^14-225-016
OWNER
CONTRACTOR
OWNI IRIB%JILDER
/
P..t 1-Ep,'r r &.wfylntm mvm
5,!024 AVk.N111ABERMUDAS
LA QUINTA. CA 5275-1
(140
(
DESIGNER/ENGINEER
t. O .•v
USE OF PERM_5ii 13MOT-4
iU)IJV.I10N T0 HX1,14TINK3 BA1.'I-I21.(j AvI
FEE DESCRIPTION
FEES
TR ACf tMQNS':t kLICtTLON 124.00 SI~
*a
.
•cam
ESTtlytATED COSH' OF CONSTRUCT (ON
6,73:).2{1
ITFOX, SUMMARY
PIS RINTUP-KFFIE,
PLA I 101.000.439 319 %58.30
ONSTRU FIONFEE 101-000-418-M $90.00
MECHANICAL F03 101-000-421-000 $15.00
LL W-f'.FtICAI FEE 101 -000 -420 -OW SI9,34
f.. FLUNISING T1?E 10lJJ(I 410.()00 $27.00
STONIG MOTION FEF - RESID 101-000.241-000 11.67
C UC'1 ION AND PLAN CHEC' ;.
FF�
$210.61
LESS PRE -PAID FIDES”
$0.00
�y 81996
T A L PVRINI'T 1±E S 1)1JEN OW
�2�fl.51
RECEIPT
DATE f
BY,
DATE RNALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
et Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
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
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVA S
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
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: -
o ll�"tf
7a �BeOLT /�wD�/
Notice:
'Document Cannot Be Duplicated
"' Date 1/30/96
No. 14089
Owner Name Poppy Owen
No. 54024
City La Quinta
Tract #
Desert Sands Unified School District
82-879 Highway 111
Indio, CA 92201
619-775-3500
CERTIFICATE OF COMPLIANCE
Street Ave. Bermudas
Lot #
Type of Development Residential Addition
Comments
iddition to existing bathroom
APN # 774-225-016
Jurisdiction La Quinta
Permit #
Log #
Zip 92253 Study Area
Square Footage 124
No. of Units 1
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 124 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
Name on the check
By Dolores A. Ballesteros
Superintendent
Fee collected /exempted by Pauline Pearson Exempt
Signature 9 9 Of AA 0 \ i 0 qi A a1 eyy-
Telephone
• '� JT
L
$0.00
Check No. N/A
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
:Iiirica►e of Comeliancs: Residential (Page I of 9) CF -1 R
�c�Y�IP circ - I'1t•3 �.IJ. � ^ ;L
oject Title Date
oject Address \ Building Permits
- LVA 6.1 ��^cq )�2k=" Plan ChecK/ Date
:3cumentallon Author Telephone
ti C Li ('-%v r Field Check / Date
_:impliance Method (Package, Point System or Computer) Climate Zone Enforcement Agency use Only
3ENERAL INFORMATION
otal Conditioned Floor Area:
3uilding Type:
:neck one or more)
=ront Orientation:
dumber of Dwelling Units:
=1oor Construction Type:
ft2
Single Family x Addition
Mufti -Family Existing -Plus -Addition
North / East / South-;i�ft / All Orientations
(Input orientation in degrees and circle one.)
(05 / Raised floor (circle one or both)
30ILDING SHELL INSULATION
Construction
component Insulation Assembly LocatiorvComments
'rype R -Value LI -Value (attic, to garage, typical, etc.) .
Wall .............. _
Wall ..............
Root .............
Root .............
Floor .............
Floor .............
Slab Edge ....
FENESTRATION Shading Devices
Fenestration
Area
Fenestration Interior . . Exterior
Overhang
Framing Type
Orientation
(Sf)
U -Value (roller blind. etc.) (shadescreen, etc.)
!Yes/(1o)
(metal/wood/vinyl)
Front..... (%J)
IN�a�
Front..... ( )
Left.......
Lett.......
( )
Rear .....
Rear ..... ( )
Right..... (S)
1'a.S
,'lam 1i t
ti
tt
Right..... ( )
Skylight
C-1,
Skylight .......
THERMAL MASS
Type/Covering Area Thickness
aILv_
Certificate of Compliance: Residential
roject Title
(Page 2 of 2) CF -1 R
Date
. HVAC SYSTEMS
Note: Input hyaronic or comoinea hydronic data under Water Heating Systems. except Design Heating Load.
Distribution
Heating Equipment Minimum Type and Duct or
Type (furnace, heat Efficiency Location Piping Thermostat
urno. etc.) (AFUE/HSPFI lducts/anic, e1c.1 R -Value Type
r2 -x
Cooling Equipment Minimum Duct
Type (air conditioner, Efficiency Location "Duct Thermostat Configuration
heat oumo: evao. coclinal (SEER) (attic. etc.) R -Value Type (split or Dackage
t,x I
WATER HEATING SYSTEMS
Energy, Extemal
Rated' Tank Factor or Tank
Water Heater Distribution Number Input (kW Capacity Recovery. Standbys Insulation
Type Type in Svstem -or Btu/hr) (oallons) Efficiency Loss I%) R -Value
1. For small gas storage (rated input!S 75.000 Btu/hr), electric resistance and heat pump water heaters. list Energy Factor.
For large gas storage water heaters Irated input 2 75.000 8ttuhr), list Rated Input. RecoveryEtfioency and Standby Loss.
For Instantaneous gas water heaters. list Rated Input and Recovery Efficiency.
SPECIAL FEATURES/REMARKS (Add extra sheets if necessary)
COMPLIANCE STATEMENT
This certificate of compliance lists the building features and performance specifications needed to comply mth Title 24. Parts 1 and 6, of
the California Code of Regulations, and the administrative regulations to implement them. This certificate has been signed by the
individual with overall design resoonslbility. When this certificate of compliance is submitted for a single building plan to be built in multiple
orientations. any shading feature that is varied is indicated in the Special FeaturestRemartcs Becton.
Designer or Owner (per eusinesa 6 Professions Code) Documentation Author
Name:
TideJFirm: mp
Address: tJ 6
Telephone: 1! >j
Iic. a:
(signature) (da0e)
Enforcement Agency
Name:
Title:
Agency:
Telephone:
(signature/stamp) (ddOB)
Name:
Tide/Firm:
Address:
Telephone:
'(signature) (date)
-,'M vah�..�^F7.:� f`f.�'���YK"!++�{.�S}4✓iFr+^�rf�.r".�.,r•,�..M7NN'�4'/�y;�1�"e"�^4i�f���►�wK�f!T!�"jf"�,(�'�"s� INC �-_.. � si-ii".'G,- '-"Y"f' , t
(-
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.
.r
If you plan to do your own work, with the exception of.variuus 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 verificatiori is returned.
Very truly yours,
CITY OF LA QUINTA
DEPT. OF BUILDING AND SAFETY
78-105 Calle Estado
La Quinta,. CA 92253
FAX: (619) 564-5617
OXVNER:§`§l*G'N'lATUA /DATE
/
PROPERTY ADDRESS
—�
�
PERMIT NUMBER(s)
i
4
78-495 CALLE TAMPICO — LA QUINTA, CALIFORNIA 92253 - (619) 777-7000
FAX (619) 777-7101
September 19, 1996
Mr. Robert J & Mrs. Yvonne Owen
54-024 Avenida Bermudas
La Quinta, CA., 92253
RE: Addition to Existing Bathroom Permit# 9602-050
Dear Mr. & Mrs. Owen
The purpose of this letter is to inform you that your addition Permit#9602-050, for the project at
54-024 Avenida Bermudas, has expired. In accordance with 1994 UBC section 106.4.4, no
further work may be performed until a new permit has been issued.
Please contact Daniel P. Crawford Jr. at (619) 777-7027 to obtain any information you need
regarding a new permit and/or.any required inspections. Should you choose not to complete the
project, we would then have to pursue any or all of the following actions:
1) Abatement of the project through the City Attorney's Office and Code Compliance
Division.
2) Notice of Non -Conforming structure placed upon property profile.
-3) Action filed with Contractor State License Board. Optional if Owner/Builder.
Please contact us at your earliest convenience prior to 30 Days to resolve this'issue, and for any
questions you may have.
Sincerely,
Mark Harold
Buildi &• Safety Manager
iel r or�
Building Inspector I
cc: file
dpc
MAILING ADDRESS -.P.O. BOX " 1504 - LA QUINTA, CALIFORNIA 92253