0308-276 (RER)Date
LICENSED CONTRACTOR DECLARATION
rm under penalty of perjury that I am licensed under prpvi i f of
;ommencing with Section 7000) of Division 3 of the Business and
s Code, and my License is in full force and effect.
Lic. Class Exp. 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:
(�')f 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).
( ) lam exempt underSection B&PC. for this reason
Date /0 ? Signature of Own '
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:
Cartier 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 .3,700 of the Labor
Code!I hall forthwith comply with those provisions'
Date: .., / : ' 7% Applicant
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines upkto $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, insp'ec�ttion purposes'- )
y ,.
Signature (Owrier/Agent) /_ �— cr Date 1'!'
BUILDING PERMIT- - PERMIT#
DATE VALUATION LOT TRACT .
i; $2,100.00 66 -;;0Ep 8 _ 27559
JOB SITE
ADDRESS 79•-38D rIASEq O DEL RrKY
APN
-Oif1Y-
OWNER
CONTRACTOR/ DESIGNER / EN INEER
KEVIN DARCY
0VV'NF-K BLTL. DER
79.380 M9EO DF, REY
LA Qi7L1.3' -A CA 92253
() - CB100
USE OF PERMIT
"IMENT A RIWODEE,
REMOVE S1191,FWALL Lk EXISTINO FiRLPtAWREPLACE WITH 149W'
3 -WAY MREPLAt E FtMOCATE 91ACTRIC,A UCABLE. Ql TLETS.a001 CBC.
VA.LIfA'1'1ON 4100.00 LS
119111WAnM COST OF CONS7t UCITON
21106.)
ITZ SUMMAR-Y
PLAN CHRCK FfJ � 101-000-439-318 $35.10
.
CONS TRUCTIOW MW 101-000-418-000 $54.00
j�
AUG 2 21003 �p
CITY OF LA QUINTA
FINANCE
DEPT.
STIR -TOTAL C(..)t xJrRUCTION Alan PI,At,r C9M
$80.10
A LESS PMPAM MN
$0,00
RECEIPT
DATE
BY
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 8 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
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
OX 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
aJnderground Conduit
Rough Wiring
Itow Voltage Wiring
Fixtures
Main Service
Sub Panels.
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
e f . II1u.•■ H �� ��lOh.� EL
� H 3L �.
A
LLL�j1 ■■■���
Pian 5 5X
.. .... ....... ..
,r�GF_ ,
CITY OF LA QuINTA 1
BUILDING & SAFETY! DEP .
APPROVED Optional Pool and Spa
FOR CONSTRUCTION t a
DATE g L/ BY 1Z t: �'.• Li c „I
Zoo Gac r L� i., --t 9- 3 Q d pa-
Family l qb�eivin
tv, g
6- ke-, ;eXitik UAS :.:, Master Suite
�. e�� l.iHE ,! r •
Master
Bath
closet _
.. IIIIIIIIIII(I% ,
Uv,Ae,\ SiJ.�C.iq
a
Morning ' {)ptirmsil
Rooth ...
bedroom
Entry..
• J v --
.whl
S ;rvtce i:'::::: :. - l 13ath 2
Kitchen _
wish
dr 'i ii II
VIII
I'I.I
:-..
Bedroom 2
-
��
;Optionfll. Cliiest
�'uife I Home QFtice ., .
Ceiling
Ch►tle
10/10 'd ZI£9 ZH O9L 'ON XdA ONIM 3IN311VO dfl0V Wd O9:1O.1nHi £OOZ-i mfld
T P Hi
.-AE"' LADELPHIA
Plan 5, 5- X
Optional Pool and Spa
Family
ZF y 13 4.1
v Ixg IlLk-
Living
7G A-16\ t
media
. 1�141
BUILDING
C CITY OF. LA QUNTA
BU I ILDING& SAFE-fY IDEPT.
'T r
y OF LA 0 UN NTN
& )L T.
BU D NG FET:�
PP
D
-1 -D
APPI 0VE-
CO�J� _
0 C �Cj"j
TION
FOR CONS RUC
Y�_
D,4,TE BY
j
Master Suite
Master
Bath
walk' -in
closet
J/ Gates
ize Permits
............ ........
Optional
Bedroom
en
>
Bath 2
LBedroom 2
+ Ceiling I
Outlet
c;I/ Gates
Size Permits
I�Famil
Y
Morning
Room
MLADELPHIA
Plan 5, 5X
Optional Pool and Spa
Living
antry Dining
Wh
Service .......
Kitchen
........... ........... ...........
0 0 ref.
;:was
0 OT sp�e: ly li:
d
.. .............
........... ...
.......................... L
..........
.......... ...............
...............
2. or 3
Car Garage Suite Optional Guest
/,Home Office
CITY OF LA OUI
.BUILDING & SAFETY DEPT.
k- I
APPRO�ilr-
FORGO i*�,'�---Rlj,,:,
DATE
BY-
Master Suite
Optional
Bedroom
.... 1.Ijjjjjj
...,`1 Bath 2
IIIIIIIiII �}, ...:�
Bedroom 2
+ Ceiling'.
OUtle
LAD
EJL
Plan 5"5X
. .............. .
Optional :Pool and SiaCITY OF LA N TA
C'
J.
B u i L
J.
Q r-,
AJ
F �0)'jj -,j C 0: Q 71' -.Tlu ON4
DATE
I I — . BY
tW
hamily iving
Master Suite
Master
Bath
walk-in
-cl6set
Z)
4
Morning
lig
Rom . 11
01)(lon'll
Bedroom
Bath'2
II I� i 11� r� �� ,
Bedroom 2
+ Ceiling I :
outlel
CIPT.-MIV.-O.
Framing Specifications
Note: Framing dimensions are calculated for a
re depth Af,IA"-
Typlcallrabllation
91menslonsJor
:. Five Type; -
Ce111og Operiing
A 8.
FTF B Vertical at 2"
16-1/2' 16.1/2"
F1F 8 Offset it 2" .
16-12" 27"
i
i
i
Fmm6g Dlme6lons for -Rout
PRO'
C .' '` '• ` D.
0/12
16.172" 16-1/2'
W12
16=1/2"- IV.
1Z/1
16-1/2" 23.1%2"
II Pmpendkvlar rod ridpa
� Ytew.
I�Ih�itfwNfYMw
' 4 s 4 header
214
hwlf
(optional)
4T
S_SPOW CPF3a
23-15nr
,aS,
,
.
r min
Framing
' 4 s 4 header
214
hwlf
(optional)
4T
S_SPOW CPF3a
4"r
y
CP F-38�.
Appliance Specfications
�I_ ifi --rl
,39`1W
Left From View:
sane•
0 0 mfr
an line
eo ng"Mr r CNU
r31-7
of-]11 a. nr fig- o
!3-15116'
End View
Top>Yiew
Fireplace::.Finishes -
IMaiiels and Trim Health fiensions & Wall Shields
Combustible mantels and trim may be installed :Combustible materials niay.project _beyond the -A-,hearth extension must be installed with all
12" above the fireplace opening as per. NFPA sides':of the fireplace operiing,as long;as they fireplaces. its purpose is twofold. It protects a
211, Section 7-3.3.3. and the mantel,limitations : aye kept within: the shaded areas illustrated in combustible floor in front of the fireplace from
diagram. If a mantel is of a non-combustible ,the diagram below:. ' both radiant heat and sparks and it dis6n-
material, it is exempt.from'-these requlrements guislies the prescribed hearth extension area
as long as It does not interfere with the instal- from other non -protected surfaces.
lation or operation of glass doors. _
�r
malr. — +.
spacer
False
header
6wsLwtlhH
erarrtel
fid trim �:•
MIN.
flrrizhed erall
Fireplace epemop
U.S. Mantel Limitations
(See Installation Manual for
Canadian Installation)
Combustible
CPF-3111
.ntandals allowed
16"
B
to ehaled area
C
8"
1'
e -
minima m distance
to:>tlde welt
Vertical Surround Limitations
Side won
8' mia.
to fireplace opening
Opo"
e.a "nh*
neaM
evewoe
�e � A
Hearth Extensions & Wall Shields
:Hearth Extension Dimension
Opening
Width
CPF-3111
A
16"
B
K-1/2"
C
8"
S_Spm CPF-3e
P�V
1.
. .. ... ....
P�V
CPF-38 peninsula, shown with I
rior's multiview -wood -burning fireplaces
tifully enhance the ambiance of any home.
come in three configurations:
rner (right or left).
. . . . . . . .
. .
r
insula (3 -sided),
.--Through
sider thepeninsula for an island'installation at
nd of a wall, the see-through for a room divider
corner unit for a quite retreat. These models CST -38 see-through, shown with
to a dramatic focal point and are the best choice ^Nf
nstallation versatility.
leg
E� A
1
!:
io' k
IKV.
CPF-38 peninsula, shown with I
rior's multiview -wood -burning fireplaces
tifully enhance the ambiance of any home.
come in three configurations:
rner (right or left).
. . . . . . . .
. .
r
insula (3 -sided),
.--Through
sider thepeninsula for an island'installation at
nd of a wall, the see-through for a room divider
corner unit for a quite retreat. These models CST -38 see-through, shown with
to a dramatic focal point and are the best choice ^Nf
nstallation versatility.
Y+ a H l 71 1 b (rl
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, yowmay 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. . J
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 person's other than: your immediate family, and the work (including materials
and other costs) is $200;00 or moie' 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 GovernmentL as an employer,and you are subject
to several obligations inclu'ding'State and Federal income tax.'withh'ol'ding,,.federal social security taxes, worker's
compensation insurance, disability insurance costs and'unemjploymenrcompensacion-contributions"
There maybe financial risks for you if you do not carryout tese obligations, and these risks are especially serious with
respect to worker's compensation insurance.
0
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)''Forrhoie specific information about your obligations under Stair
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 thatthe property owner .is providing his or,her own labor; and material personally.
Building permits are not required to be signed b-u
property owners Mess 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 ILA QUINTA
DEPT. OF BUILDING AND SAFETY
78-495 Calle Tampico
La Quinta, CA 92253
(760)777-7012
F 6 -7 11
OWNER'S NATURE/DATE
380
PROPERTY ADDRESS
r7 6
PERMIT NUMBER(s)