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9809-084 (BLCK)- LICENSED CONTRACTOR DECLARATION U) ) I hereby affirm under penalty of perjury that I am licensed under provisions of ".dZ'pter 9 (commencing with Section,7000) of Division 3 of the Business and c,4 W Professionals Code, and my License is in full force and effect. O :) M License # Lic. Class Exp. Date d LO 0t8 Z r� rho H( J D LU a co Z M In N ON U °) La C:, Z ��cc O X W'LL co Q Q boLO C Z ob 5 C) Q J Date Signature of Contractor OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contraclur'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). Y\1 .I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business & Professionals Code),- ( ) ode)-() °yam a empt under Section B&P.C, for this reason Wgiate / % Signature of Owner J 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). (Yj 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 subjeect'to the workers' compensation provisions of Section 3700 of the Labor C de, I shall forthyvith comply with those/ provisions gate: ./ ! `, � YApplicant �"`-"' Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,0001.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 representatives of this City to enter upon the/above-mentioned property for inspection purposes. ' /Signature (Owner/Agent) �'[ Date PERMIT # CONTROL # BUILDING PERMIT 9X09.094 DATE Q 1 VALUATION $;s,y,1 LOT TRACT 8191 1 1 C`�f � ADDRESS 73,25"8RADFORD C:;R'C.UE JOB SITE APN Y 604.-M-040 OWNER CONTRACTOR / DESIGNER / ENGINEER H M AN R & MNLI11 N MON' W E OWNER I BUItI DER 78.5:40 8RADI..-'0k7 C'SR. LA (;)CTINTA. C, A ►2233 {)- MR USE OF PERMIT GENERAL.31�1LDING 3RD CAR GARikGE CC? E'SION TO BONUS ROOM AND RE -LOCATE W,1f A HEATER. -257 S.F. VALUATION tl.4+iu.flif LS TIAV11,TZ11) COST Uri CONS TRUCTIC'N 3,S''moo ,PF.R'MYC PE,]rK i; UATIV3ARY PLAN (W.I FC~K .VFE 30.1-M114P-31€3 C°ONSI'1111 Y "I ON FEE. 101-000-418-000 S10,00 Mi✓C� dLU41CAL FM, 101.000-4421-000 $26.00 ELEC'MIC AL :I' 48 101 -ON -420-000 $24.00 PLLIi<illl:ING 101-000-417-000 $40_5.6 S'f`l2owi mO'I'ION Fm -1'C smo 101-(1013-241-4)00 S.89 GIM)I;tG F116 #° 101 -000423-000 i oil JAL COMMUIC11011 AND .PLAN CHECK pgq. 59 LESS PRE -PAID REES $0,00 SEP 21 1998 �d�t x1 �»�y �c+pyp py p¢ B y; 1! DUE # OTATIP.FIRN�.��Y 7)JIES �JiJ9`.�e l�O to �Zfiy.�7 ^t� �ry ! Y F U 11x I r v ,A 9 EB �± 'RECEIPT _ DATE BY A . D I AL INSPECTOR i �J I l pr A�• 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 Wali Firewall Exterior Lath _ -- Drywall - Int. Lath Final Final —'? b' BLOCKWALL APPROVALS POOLS - SPAS steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover —ZqaipTffent 1ion Underground Electric Underground Plbg. Test Final Gas Piping PLl"MBING APPROVALS Gas T Electric Final Waste Lines Heater Final Water Piping _ Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Piaster Sewer Lateral Sewer Connection _ --�� 11--t Pool Cover 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 c. Final (Utility Notice (Penn) COMMENTS: 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, 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 verification is returned. Very truly yours, CITY OF LA QUINTA DEPT. OF BUILDING AND SAFETY 78495 Calle Tampico La Quinta, CA 92253 (760)777-7012 FAX (760) 777-7011 OWNER'S SIGNATURE/DATE i� S y o &r roz-o LC> . 6j4 ct2 z 53 PROPERTY ADDRESS Rsoq - n6t PERMIT NUMBER(s) CITY OF LA QUINTA ' SUB -CONTRACTOR LIST SB ADDRESS PERMIT NUMBER OWNER nBUILDER !IjJQfm_ihall be posted on the job with the Building Inspection Card at all times in a conspicuous place. Only persons appearing on this list or their employees are authorized to work ii this job. Any changes to this list must be approved by the Building Division prior to commencement of work. Failure to comply will result in a stoppage of work and/or the voidance I building permit. For each applicable trade, all information requested below must be completed by applicant. "On File" is not an acceptable response. Trade I Classification Contractor State Contractor's License Workers Compensation Insurance Cit Business License Company Name Classification le.g. A. B. C-8) License Number (xxxxxx) Exp. Date (xxlxxlxxl Carrier Name (e.g. State Fund, CalComp) Policy Number (Format.Varies) Exp. Date (xxlxxlxxl License Number Ixxxx) Exp. Date Ixxlxxlxxl EARTHWORK IC -12) CONCRETE (C-8) FRAMING IC -5) a Ft, Ar�p M IAYI cC e _� �- I � 'i � 15 1 e 1 l i � r� 1..1 11 .li � t'� 1 0 L 2 L; I �i STRUCT. STEEL (C-51) _qn ' I MASONRY (C-29) PLUMBING (C-36) .- / .,& (� L ���o Z ✓7A LATH, PLASTER (C-35 -f)H) PLASGR C 35 3/ P �/31 ,1 101'311,17, ft � .T 5. WAJI4S7�_&5 o 9�6 .9 1 0 (Z $ DRYWALL (C-91 Jot=-(eq-wAga CC) CPO (e /:�)r/io HVAC (C-201 ELECTRICAL (C-10) r oC /ZQ /� �LE��`� lb . % Z.5 7 Zo 6 0 CAI— / ,� CAL CO � � NS . I p ^� G W 9 O (1 30-1 0 W9181130%0 1 & 1 7 q c7 G / / ROOFING IC -391 i SHEET METAL (C-43) FLOORING (C-15) . Q 061) lJ (71 (Z GLAZING (C-17) INSULATION (C-21 d aVJ N SEWAGE DISP. (C-421 PAINTING (C-33) 0 %1. G-7 .- CERAMIC TILE IC -54) CABINETS IC -61 d p e vT FENCING IC -13) LANDSCAPING IC -27) POOL (C-53) )9- IT fool U) �sV Wig' �._-CYc:4�e__L+1s✓_��.NS..: ---��-^ .SUITS .f�-'� .:'_::-_-----_------ • 7R , m CODY & BRADY ARCHITECTS 75-750 Altamira Drive INDIAN,WELLS, CALIFORNIA 92210 Notice: Document Cannot Be Duplicated Desert Sands Unified School District 47-950 Dune Palms Road La Quinta, CA 92253 760-771-8515 CERTIFICATE OF COMPLIANCE Date 9/17/98 No. 17771 owner NameBrian R. & Malia N. Monroe No. 78-590 City La Quinta Tract # street Bradford Circle Lot # Type of Development Residential Addition Comments APN # 604-223-040 Jurisdiction La Quinta Permit # Log # Zip 92253 Study Area Square Footage 257 3rd car garage coversion to bonus room and re -locate water heater. 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 257 or S 0.00 the property listed above acrd that building _ L ' permits and/or Certificates of Occupancy for this square footage in this proposed projq& may 6w be issued; t Fees Paid By N/A - Malia N. Monroe R p Tele hose Name on the check y t. t By Dr. Doris Wilson ri Superintendent Fee collected /exempted by Juanita Green Signature Exempt Check No. N/A $0.00 (NOTICE: Pursuant ot Asseo#ly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 91) -day approval period in which you may protest the fees or other payment identified above will begin to run frorrYPe 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 Dislrid(bb)(s') behalf, whichever is earlier. 3 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