0304-369 (AR)U)
F -
CV
�w -
o=)cM
C) Lf)
LLJe-
C6 Z l�
CZOOO
W W CSD
F- d
N
Z
M
LID
N
ON
U °)
d Q
Z
LO
Q 0
X W �
mUU
O
rnH
't Z
co 5
�O
J
LICENSED, CONTRACTOR DECLARATION
I hereby affirm under penaly 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 ylsc /( > 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 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 his reason
'Date Signature of Owner :-f-- i '-i"
17,
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 provissiori's. i
/Date: 1174 : L' % Applicant—
Warning:
pplicant 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 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
0 ' PERMIT #
BUILDING PERMIT
p4
DATE VALUATION LOT TRACT
18 Q. 0 1 243334 7
JOB SITE
APN
ADDRESS ��- ►� r�1>c�.aWi� l�>�.> z 1'!►l21f'
767-330-440
OWNER
CONTRACTOR / DESIGNER / ENGINEER
RICHMd) & %iANI; H ATON
OWNM - BUNTim
81.645 MUW14 DP.LR rARX
Ell -645 DROWN DEER PAI hK
LA QURrrA CA 92233
1.A Q13tNTA CA 92253
( i - CBM
USE OF PERMIT
Ras. DDM•
CONVERT3RD CAR 0ARAOfr TO L1VABIZ ARF -A. (t3AMr, ROOM),
CUSTOM A0NU3 ROOM CONVE) 323.00 SF
Rf>;'1'[MA'J7W CC�SC Olt (,10N9rRJ7Cn7£arJ
18AN)90
PERM" FRIT SUMMARY
PLAN CHECK i7F.E 101.000.439.318 1128,70
CONSTRUCTION rEX 101-000-418-000
ELECTRICAL, FELE 101.000.420.003 114.34
-
:IT1LC,llaMOTION FEY -RLSID 101-000-2A1-000
' • •. 'T' ' ^ UMON JOID rI./�l'3 CIMCK
$348.08
DJX321l IW. -PAM) F1, 3
$0.00
APR 3 0 JV0?1Vi V YKX8 DDE NOW
t2003P"
04MOO
CITY OF LA QUINTA
FINANCE DEPT.
RECEIPT
DATE
By
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Duds
Forms & Footings
Duds
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
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final I I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping -
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
0. 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 fJ
Low Voltage Wiring
Fixtures
Main Service
Sub Panels -
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
r•�
A
Bin #
City of La Quinta
Building 81 Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit # /
���(�
Project Address: _ �� f,�
Owner's Name:
A. P. Number: T % 'r� �i%�Y
Address:
Legal Description: ? 6 �� .►
Cite. ST. Zip: .,L S e2LI
Contractor; L5'v.t.� V t (C%h
Address:
Uelephone:._ ,�,—
Project Description: eZ)" Oj fir, 3 pzD
Cite. ST. Zip:
Telephone:
C �&O
State Lic. # : Citv Lic. #:
Arch.. Engr.. Designer:
Address:
City. ST. Zip:
SCr 323 X 8.30
Telephone:
Construction Type: Occupancy:
State Lic. #:
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person: ,::>` CkSq.
Ft.:
# Stories:
Units:
Telephone # of Contact Person: 7 ,—
Estimated Value of Project: 930, c7
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cales.
Called Contact Person
Plan Check Balance •
Energy Calts.
Plans picked up
Construction 41
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2nd Review. ready for correctio slissue
Electrical 0
Subcontaetor List
Called Contact Person G
t�U
Plumbing
Grant Deed
Plans picked up
S.M.I. •
H.O.A. Approval
Plans resubmitted
Grading
P,V HOUSE:-
3' Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
-tb =$v6 (�
#-5&A-ml,Ar
1&0 GfJ,
Total Permit Fees
LvA'k
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 employt.r, you rhust 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.
f
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 Stare
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
78-495 Calle Tampico
La Quinta, CA 92253
(760) 777-7012
AX: (760) 777-7011
Jn 2 &
OWNER'S SIGNATURE/ DATE
�v .-Qs�
g ► -lo45
PROPERTY ADDRESS
D3o4. -33,_5
PERMIT NUMBER(s)
__..__..._._,_...___._........................,
rI
ZU0100 ". `
W~
1 Y
6� >�
�1
:5<cc
0
L�..�
a a-0 �-
LL.CLCr
ui
r
V.
SF
•sEc� r-Gos�ug ��
4
IV
t
�sk.,,
_.
__..__..._._,_...___._........................,
rI
ZU0100 ". `
W~
1 Y
6� >�
�1
:5<cc
0
L�..�
a a-0 �-
LL.CLCr
ui
r
V.
SF
•sEc� r-Gos�ug ��
4
IV
APR -27-03 05:35 AM RICHARD
April 25, 2003
31784205
To: La Quinta Building Department
Please allow Dick Reynen, my agent, to pull a building permit on my home at 81-645
Brown Deer Park, in La QuiAta, It is a permit to add electrical hook ups and a I hour fire
door, in what used to be the golf can garage, in order to make that area livable
yi
Thank you for your assistance on this matter.
Sin'Y'
Eaton
Owner
CITY OF LA QUINTA SUB -CONT CTOR LIST
JOB ADDRESS B/- ��S ?.a4y PERMIT NUMBER p�,L4/ . 3 (o5 :OWNER BUILDER
This form shall 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
on 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
of building permit. For each applicable trade, all information requested below must be completed by applicant. "On File" is not an acceptable response.
Trade /Classification
Contractor
State Contractor's License
Workers.Compensation Insurance
City Business License
Company Name
Classification
(e.g. A, B, C-8)
License Number
(xxxxxx)
Exp. Date
(xx/xx/xx)
Carrier Name
(e.g. State Fund, CalComp)
Policy Number
(Format Varies)
Exp. Date
(xx/xx/xx)
License Number
(xxxx)
Exp. Date
(xx/xx/xx)
EARTHWORK (C-12)
CONCRETE (C-8)
�AM�11fG IC 5)
'.9)LIP'd � D
?,FN `M
y2 Z9-7
8'23
� .�.u�rQ-
O4l6o.? /oa
-/-osl
O/Dld
23.03
STRUCT. STEEL (C-51)
MASONRY (C-29)
PLUMBING (C-36)
LATH, PLASTER (C-35)
DRYWALL (C-9)
HVAC (C-20)'
'
ELECTRICAL (C- 10)
/e L
C io
X95903
/o -�o
73
ROOFING (C-39) :1
SHEET METAL (C-43)
FLOORING (C-15)
GLAZING (C-17)::;
INSULATION (C-2)
SEWAGE DISP. (C=42)
PAINTING (C-33)'::.
CERAMIC TILE (C-54)
CABINETS (C-6):.
FENCING id -13) '
LANDSCAPING (C-27) ::..
POOL
POOL (C-531