9905-317 (AR)LICENSED CONTRACTOR DECLARATION
I%hereby affirm under penalty 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 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:
( R) 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 a nf'' exempt under Section , B&RC. for this reason f -
Wate i ~13 "-`' 7r Signature, of Owner -,?t
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:
Carver 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 provisions:
;Date: •K - our 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 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- i
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. f
_ f
VSignature (Owner/Agent) Date '
BUILDING PERMIT PERMIT#.
DATE #a ( VALUATION i�,r8 LOT TRACT
ss.g7%
JOB SITE
ADDRESS 484 Z3 PASO T W EA Q'!
OWNER
CONTRACTOR/DESIGNER/ENGINEER
11-1 41L1:tD & BONNIE YVOIIEP
OWN 1<PiDulLDER
48-1.25 PM -A 1'1ENAK)
;
L.tic?t!.{NTA CA +r.)253
Cal
USE O���F))
��PER�7M(IjT //�� 77
S1..F±S1 BNTFIJCAIJ A../I� 1'itif l
ES .1MA7`ds .1.s C09T OF MNS7FtU M0N
6a976,M)
PERMITFEC SUMMARY
PLAN 01hT,,XliXty 1014XV-104.31S�
';f??S`MIJK"11'10!4 FEE I8313M
iY�a�:F3Yfiy�Cc►�11t11C:{AI.YI�TI �dO-rR{i••i $�'�}�33()
7l.R�y.f,1ip�
Wf'R01,10,MOTION tiles, - RP,810 101.000 -241 -Mi
CONK—IR13CfION AND VIT.Af{Nyy��("If1i ck:
PUTS
��fyytre��
$0
TOTAL PERMIT YUMS DUCNOW
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
• OPERATION
DATE
I INSPECTOR
OPERATION
DATE
I INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
0. 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
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
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
/
�l U
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)
Notice: ,
Document Cannot Be Duplicated
Date 8/9/99
Desert Sands Unified School District
47-950 Dune Palms Road
La Quinta, CA 92253
760-771-8515
CERTIFICATE OF COMPLIANCE
No. 19156 Jurisdiction
Owner NameRichard & Bonnie Witter
No. 48-125 Street Paso Tiempo
City La Quinta zip 92253
APN # 646-360-001
La Quinta
Permit #9905-317
Lag #
Study Area
Tract # Lot # Square Footage 108
Type of Development ' Residential Addition
Comments
08 sq. ft. enclose patio off den
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 tie amount of
0.00 X 108 or $ 0.00 the property listed above and that-tuildinwg%
,. '
permits and/or Certificates of Occupancy for this square footage in this proposed project 1nay rioN- h_'`e issued
Fees Paid By N/A Telephone ?71 49'81
Z
Name on the check
?'
By Dr. Doris Wilson
Superintendent NA
Fee collected /exempted by Juanita Green Exempt $0.00
�n Check No. N/A
Signature
lm
NOTICE: Pursuant of ssebly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90 -day approval period in which you may proles` the fees or other payment identfied
above will begin to run/fromthe date on which the building or installation permit for this project is sssued or on which they are paid to the District(s) or to another public entity authorizedto
's)(s') behalf, whichever is earlier.
Collector: Attach a copy of county or city plan check application form to district copy for all waivers.
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting
07/30/99 ' FRI 08:53 FAX .. 002
art -
CL ,
\a UN.P41 Ill
July 29, 1999
Mr. and Mrs. Richard Witter
- 48125 Paso Tiempo Lane
La Quinta, CA 92253 "
Dear Mr. and Mrs. Witter,
The Architectural Committee for Rancho La Quinta has reviewed and approved your recent
submittal of drawings fur a proposed room addition to your home subject to the following
comments:
4
1. The new door and window shall match the existing finishes, design style a$d details as
existing.
2. The new walls shall match the existing plaster in texture and color.
s w
We are in receipt of the grading and drainage form, signed construction" regulations and all fees
for review of plans and deposits. Thank you for your patience in our review of your plans. I
,look forward to working with you further on this improvement to your home.
Sincerely,
Mindy Gutierrez, Property Manager
Master Association for Rancho La Quinta
Professional Community Management I Desert Resort Management
4 Post Office Box 4772 • Palm Desert, CA 92261-4772
73-550 Alessandro, Suite 5 • Palm Desert, California • (760) 346-1161 FAX (7-50) 346-9918
Vid! 1.0/ VV PrIv VU;ov rAA
MASTER ASSOCIATION FOR RANCAO LA QUINT A
. ARCEMCTURAL COMAErffEE,
SUM&TTAL OF PLANTS FOR BUILDING/STRLTMWS/LANDSCAp]NG
Name of Applicant . \A/1 if VQ Phone -760-72L,49V
Address of Applicant -494215, VM0 --OL; moo
Person or Agent to be c9ntacted for additional infbnnation;
_6I
We propose to construct a
on
Proposed Start Date
— I Aq -------
Approximate Completion Date
Name, address and telephone numbers of profbssionals involved. (Attach proof of insurance and
COPY Of California license number to ap 1i anon)
30-sulte ly Ar=—.DAr-1 Pic 3'K-(7—?$01 /0222W IM6
The following documents are provided herewith in triplicate as required by On Arebitechiral
Committee for Rancho La Quinti.
Full construction drawings -_-_Specifications/Dimensions
Site Plan Drainage plan A
Landscape plans _ztElevations
NOTE, 4f you feel there are any unusual items that require specific attention, pleas--. Est below:
(we) agree to construct the structure(s) and all other *rovernents in strict accordance with
these plans. I (we) agree that no changes" will be rinadc in the plans without first submitting and
receiving approval of such changes. D'OT to commen"MEnt Of cOnstmotion I will submit a copy
n
of my completion bond in the amount of $2,500.00. In addition, I (we) agree io forward a copy
of the BWWW Permit issued by the City of Lar QuirAa to the Arch"cnu-9 Com-nittee prior to
construction-
Aoplicant )ate
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 "perso-nally-performing their
own work. If your work is being performed by"someone other than yourself, you may protect wourself 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 1 -ave 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 ooligations 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),70 11
OWNER'S SIGNATURE/DATE D
PROPERTY ADDRESS
3)7j7
PERMIT NUMBER(s)
to
. it _ �. _♦ '
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ell
EX6SflNHi%pEr,
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-
- --
-
- -
-- — No` .CHAIJG��
�(=1v10�
To -- c2r-fTE LAV,gb('.Room.
}
Av v 6WI PATIO
i I �•
BREAKFAST/
t I FAMILY ROOM
F..UV�+cY I
•� I o
���i�rn l_IV}NG ROOM o
I I
PATIO KITCHEV
I
1 NVI Y
I I I
DEN/OFFICE/ I I I r I r. DINING RCOM
• BEDROOM 3 J
I f
— — — -- '— wol Oa. t.
IL:.Y� I , ......
Laundr,I i I
lzi Room
L
I. mll MASTER BEDROOM SUITE
O
I t3alleria v-.ua
1 � Rac�m
C1uw1
Lm
qu
Entry
BELROOM 2MAster Bath
Clu.0t
w:u O
_ — 1 et
Gloeot
Entry Porch
Y
F
-• )lanky: Residentsal . (Pace � 01 2) �F-1 R
Irlificate 0i Coma
30 .4
))a
MOy te
Budmng Permit r
'o19C.11 Address 323.851 - 6 ( 3
—OAM M 'd0 NSSd N Plan Checx Date
xumenntation Author Tek""nO
p/�• K�� � 5 Field Checx /Date
cntorcement Agency ase Only
3mptiance Method (Package. Point System or Computer)
Climate Zone
1ENERAL INFORMATION _
'otal Conditioned Floor Area: L : 10 -
O
V Single Family Addition
;wilding Type: n9 Existing -Plus -Addition
:track one or more)
Mufti-Family
=ront Orientation: WlfSi North /East /South /Wes /All Orientations
wz
kn degrees and cmrcie one.►
Vumberof Owelling.Units:
=loor Construction Type: Floor (circa one or both)
3UILDING SHELL INSULATION
Construction
:,omponent Insulation Assembly LocatiorvComments
'rvoe `,R -Value t U Value (attic to garage. tyotcal• etc.)
Wall..............—LZIL -_
t _
Rau ..............
Root ............. ' •.
Root .............
Floor ............. S
Floor ............. ' -
Slab Edge ....
'T`1 eiCAIL
F.ENESTRATION.
Shading Devices
•- Fenestration
Area Fenestration
` U
Interior Exterior Overhang Framing Type
roller blind. etc.) (shadescreen, etc.) !ves/no) (metalMtood/vm q
L_orientation�
of \ -Value'
V�oob
Front..... (�)
Front..... ( )
Left ....... ( ).75
Left ....... ( )
Rear .....
Rear..... (. )
Right..... ( )
Right..... ( )
Skylight .......
Skylight .......
THERMAL MASS
Type/Covering Area Thickness'
slabiexoosed. tile, etc.) (st) (inches Location/Description kitchen, batn. etc.)
UWE -fll.E 109 3" fJEW ��u/ EXr(EOJtIDW
Certificate of Compliance: Residential(Page 2 of 2) CF -1 R
Project Title e IKOab 7 .1w
HVAC STEMS JU
Note: In t n K or aomotnad hydrome data under water HeauN Systems. e:ospt Oesgn Heating load.
Oistribution
Heating Equipment Minimum Type ana Duct or
Type (turnaca. heat Efficiency Location Piping Thermostat
pump. etc.) (AFUE/HSPF) (ducts/attic etc I R -Value TYpe
Cooling Equipment Minimum Duct
Type (air conditioner. Efficiency Location Duct Thermostat Configuration
heat puma. evao. cooling) (SEER) (attic etc I R Value Tvpe ' (sold or oackaae)
WATE EATING SYSTEMS.
Energy' Extemat
Rated' Tank Factor or Tank
Water Heater Distribution Number Input (kW Capacity Recovery StandbyInsulation
TYpe Type in System or Stu/Mr) (cations) Efficiency Loss ('/,) R Value
�For small pas etorape (rated input S 75.000 BtWhr), ebeWe reslaunoe and hew pump water heetars. list En
� v u ape wat« hsetses tratW a+out 2 75.000 Btt�. Inst Rated Input. Recovery EMiosnc�r and Standby ��
ewis pas water heetara. hat Rated Input and Recovery Etkisney.
SPECIAL FEATURES/REMARKS (Add extra sheets if necessary)
COMPLIANCE STATEMENT
This cendicate of compliance usts the Uding teattues and perfomw= speaticacons needed to comply vhth Tith 24. Parts t and 6. of
the Cakforrna Code of Regulations. and fhe.aamlrnstrative regulations M implement them. This cenih=e has been signed by the
individual with overall design resoonslotlity. When tins 6"atil ate of compllartca Is ttubrmtted for a single building plan to be txidt in mud*orientations. any shading texture that Is vaned Is Dated cit the Special Features/Remarks section.
Designer or Owner (per BuMness a Prereaatom fie)
Naim:
TidwFirm:
Address: - 12 �EMj� 0
RA 11V( udA
Telspharte: "7
lie. s:
(signature) (daft)
Enforcement Agency
Name:
Tide:
Agemy: .
Tebpt+ona:
(s+Onawmstamoi (date$
Documentation Author
Nam:. . C I
TiderFrm: CDIU OW?OTL
Address: 1a,7r. n,&k
TeMphane: 32 '1
(sou )lure
(dM)