0012-140 (RER)a LICENSED CONTRACTOR DECLARATION
I h?reby affirm under penalty of perjury that I am licensed under provisions of
vhoter er(co Tmencing with Section 7000) of Division 3 of the Business and
Pr f6.1 i dls 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 emplcy,ees,with •wages as their sole
compensation, will do the work, and'lhq structure•,is not intended.br. offered.for
sale (Sec. 7044, Business & Professionals Code).: s..
( ) I, as owner of the property,. am' ekclusively contracting with licensed
contractors to construct the project. (Seca 7044; Business & Professionals
Code� .
D)I da ;,exempt �{,nder SA fi rn B&P.C. for this reason
Date,'� Ver
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,$i 00.00 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 Sectio'' 3700. of the Labor
Code, I•shfall forthwith comply withtthbse provislotlsi
Date 4��i Applicant 'N) 1 Yt'` 1 ��
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 i spectionfpurposes:
r
,Signature (Owner/Agent) -� w Dati
i
BUILDING PERMIT PERMIT#
DATE VALUATION LOT TRACT
JOB SITE
APN '
ADDRESS
49-695 C'OEtC MLA DRIVE
OWNER
CONTRACTOR / DESIGNER / ENGINEER
DaMRT lilt, Irl WC:
C)"UV�iXs�1�3iILL�?��
49-095 CO-ACHEMADME
LA. Q'UINITA CA 92254
USE OF PERMIT
46 LIQ 6' OAi bYN )7VA1I,
MMODEf.. Ptf..TFi.ROO7ul14ta,UN#3RY A8 ;i'.FRAPPRO +D 111 AX5 ONLY
VALUATION W
6 r r. WALL 46.00 LY
E0111 3iWILM COS'' OF C0NFERUC`I'tON
P RhM FPS 9UR+6Aef ARY F
PLAN C:11KCK PIER 101 X000. *39-318 $46.80
CONSTRUCTION ME I01-000-418-000 02.00
STRON. MOTION ITT- RESID 101 DO.241.000 $tip
SUB-T(7'fAL t":Oe3&;< UC.'�C>~Y1+I'.P.WD PLAW C'MCI' `.
$119.30
IMS PRE;PAW FLMS
$0.00
RECEIPT
DA EBYE.
DA FIN
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Sit Backs
Underground Ducts
NF.-jrms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to WrapiNA
C
F.A.U.
Framing
V
Compressor
Insulation
Vents
Fireplace P.L.
Grills j
Fireplace T.O.
Fans 6 Controls I j
Party Wall Insulation
Condensate Lines I
Party Wall Firewall
Exterior Lath
_
Drywall - Int. Lath
Final
jay
Final
POOLS - SPAS
BLOCKWALL APPROVALS
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
t //
Pool Cover
Sewer Connection
K\
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
_
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
I
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
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
78-495 Calle Tampico
La Quinta, CA 92253
(760) 777-7012
FAX: ,(760) 777-7Rl ( 1
v u � � �ai..-:� a•. -.ter �a� �.��
OWNERSi RE/DATE
(:MAXQDZ1'0A.,
PROPERTY ADDRESS
z - 4�
PERMIT NUMBER(s) 9
a
T �
04/16/2001 09:47 7605644892 TRIAD2 PAGE 01
=SZ.A1�dDS HOI�OWNERS ASSOC=ATYON NO. 1
P. 0. Sox 1271 La Quint2 CA 92253 ;
April 16, 2001
Planning Department
CITY OF LA WINTA
P. O. Box 1804
La Quints CA 92253
RE: Construction
49-•859 Coachel l a
Gent iomen:
The Architectural Committee of Islands kkneowners No. 1 has reviewed the
proposed changes to above referenced residence of Robert and Jeanne Hart and
find them to sleet 0 l' criteria of our CCBRs.
Approval has also been obtained from their adjoining neighbor, Richard Tyrone.
If you have any questions, please contact the Association office at
780/_584-2177 .
Yours truly,
Anne Tuttle
Association Manager
V, - - •':,
04/16/2001 09;47 7605644882 TRIAD2 PAGE 02
1.
=SLA1'D8 HOMEOWNERq ASSOC2AXXON NO. 1
.......................... ,•
P. 0. Box 1271 .,La ' .•
QuintaCA 92253
MR. RICHARD TYRONE
Apartment 118
77 South Ogden Street
Denver 00 80209
Dear Mr. Tyrone:
It is the understanding of the Board of Directors that you have approved
changes being made in the residence of Robert and Jeanne Hart located at
49-659 Coachella that adjoins your unit.
We would appreciate you signing a copy of this letter, acknowledging this
approval and return in the envelope provided.
Your prompt attention to this matter will be greatly appreciated.
Yours truly,
THE BOARD OF DIRECTRS :
Anne Tuttle
Association Manager
Yes, I acknowledge approval of the construction changes being made at 49-659
Coachella in Islands Homeowners Association No. 1.
Date: ! �`i/o Signature: r