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0106-373 (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. Uc*nse # Lie. Class Exp. Date 783503 B1 08/31/2( 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: O I; as owner of the property, or my employees with. wages as their sole compensation, wilr do the work, and the structure is not intended or offered for sale (Sec. 7044, Business & Professionals Code). ( ) t, as owner of .the property, am exclusively contracting with licensed, contractors to construct the project_ (Sec. 7044, Business &• Professionals Code). O I am.exempt under Section , B&P.C. for this reason Date Signature of Owner WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of pequryone.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 tabor 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 peAorrnance of the work for which this permit is issued. My workers' compensation insurance carrier &. policy no. are: (`,artier lOLEMPT Policy No... (This section need not be completed if the,permit valuation is for $100,00 a less). ( Y:.l certify. that in. the performance of the work for which this pennit.is issued, I shat( not employ any person in any manner so as to become subject to the workers', compensation laws, of: California, and agree that if 1, should become subject to the workers' compensation provisions of Section 3700.of the Labor Code,: 1, shalt forthwith comply with time provisions: Date: 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 nult 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. 1 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 BUILDING PERMIT PERM010&373 ' DATE VALUATION $43,627.80 LOT 58' TRACT 29147' 1/ J013 SITE ADDRESS 81-090 CHAfMCLXKR% APN 761-86"12 1. OWNER CONTRACTOR / DESIGNER /ENGINEER WEMOPF PARZNTW 1, I= KAHUIIIIA CONSTRUCTION INC '. 53.=161 SOUTHERNffiI.LS PO BOX 366.,:• %A;QLIiNTA . CA .92253 LAQUII�TA ..CA 92253 ('760)564-4832 CBIA 3237 y� USE OF PERMIT ltIMENIL4LA MON .c.. mr, UUEST71W. FEK710117PRM 10 -PLAN MUT 34 ` CUSTOM CONSTRUCTION" : " 5XIII0 SF "a/ea/e/ PORCH/PATIO 17600 SF X913DAMM C09r OF -CONS UIMON 1 43427.W CONSTRUCTION FE8 1%.6_ 18-OW. :. SM50 ': PLAN:CES iEl' 1Q3 fQ4(? 439-316 `_ ; (30212 . MCH;!! WAI:: Fitt :: 101-000-4216U00 " t39s0 ELZCTRIC.AL.F1Z : 101t0�20rOOO- 1 MBING,FE : .101.-000-$19=000 (3400 STRONG. MOTION FEE = RESW '- 101-000=241 'M0 t3RAIJ1N0 PEE.' 101-000-423.000 moo . SUB -7. 0TAL CONS'I8_ UCITON AND PIAN CAECR 5836.53 LW PRBrPAID F=39 $0.00 TOTAL PEIOW— FEES DUL NOW :5836 RECEIPT DATE BY DATE FINALED INSPECTOR P.O. BOX 1504 APPLICATION ONLY Building / 78-495 CALLE TAMPICO Address 5r% -0,q,0 /'slll� �/_r_FiIZ LA QUINTA, CALIFORNIA 92253 " '"" aing Addilress 55:�/& BUILDING: TYPE'CONST. A.P.Number Legal Description Zia Project Description OCC. GRP. 7- ST ©P -=me-^' 29%4- % A City Zip ip, Tel. y Contractor Address 10 . elrL City Zip z 2 5� Tel. �r/ 1/ 4- State ic. -7 & Classif. / 6- City Lic. #G0,L 32 3 Sq. Ft. Size No. No. Dw. Stories Units Arch., Engr., Designer _ A ,� ••.. New Add O �,� Alter O Repair ❑ Demolition ❑ Address Tel.:: City Zip State 0 LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000)of Division 3 of the Business and Professions Code, and my license is in full force and effect. SIGNATURE DATE OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish. or repair any structure, prior to its Issuance also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of Estimated Valuation PERMIT AMOUNT Division 3 of the Business and Professions Code, or thathe is exempt therefrom, and the basis for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (8500). I'll 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, Buisness and Code: The Contractor's License Law does not apply to an owner of property who Plan Chk. Dep. Plan Chk. Bal. Const. Mech. builds or improves thereon and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. 11, however, the building Electrical or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he did not build or improve for the purpose of sale.) Plumbing 111.as owner of the property, am exclusively contracting with licensed contractors to con- struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for S.M.M. such projects with a contractor($) licensed pursuant to the Contractor's License Law.) 17 I am exempt under Sec. B. 8 P.C. for this reason Grading Driveway Enc. Date owner Infrastructure WORKERS' COMPENSATION DECLARATION Ihereby affirm that 1 have a certificate of consent to self -insure, or a certificate of Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy No. Company n Copy is filed with the city. O Certified copy is hereby furnished. TOTAL CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE REMARKS (This section need not be completed it the permit is for one hundred dollars ($100) valuation or less.) I certify that in the performance of thg 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. Date Owner NOTICE TO APPLICANT., If, after making this Certificate of Exemption you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code.) Side Setback from Property Line Lender's Name FINAL DATE INSPECTOR Lenders Addre This is a buildin ermit when properly filled out, signed and validated, and is subject to expiration if work there der is suspended for 180 days. I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives -of this city to enter the above- mentioned property for inspection purposes. Issued by: Validated by: Date Permit Signature of affplicant —Date- ate Mailing Address Mailing Validation: •- �4 City, State, Zip WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION 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 11 al �e f31 �, f 41 /2{ !A Date /12.. 2 '1 `0 f Signature of Contractor t:�,' i 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 this reason Date Signature of Owner 11 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 *orkers' 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 LT.L?I1?fP^s, 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 Sectio 700 of the Labor Code, I shall forthwith comply with those Uovisions. Date: �'<� ° P Applicant .�+-!moi A Warning: Failure to secure Worker"s' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANTLApplication is hereby made to the Director of Building and Safety --for•*a•.permit subject to the conditions and restrictions set forth on his;. application. 1. Each person upon whose behalf this application is made & each person atf whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result`of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. •t I certify that I have read this application and state that the above information is correct. I agree} -to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for inspection'purpos'8s. Signature (Owner/Agent) `- ' -• / " _ . Dater 2- I �I • ,'.1 � BUILDING PERMIT PERMIT# 0106-373 DATE} VALUATION.�`.�y, LOT TRACT 29141.3 ADDRESS 81-• i /i} A �» � JOB SITE APN ^��►a 5� ^Cf �. OWNER CONTRACTOR / DESIGNER I EN INEER WMKOPF PARIWE" 1, :L= i:A3i7ZC.°IJA WXIS`3kUMOW INC .13••1.03 SGG"MON 1 -MILS PCS BOX 366 1A Ql:pi111 A CA 9225 y LA C, UIRTA CA, 9223.4 (7£,y0)564-4$:;2 c7au 3%37 USE OF PERMIT :�:iR .5tb`a Y:StIL•�it'•r°4titJ:S'K.�ti)"t;�f IC.rf�h? t'i�f.'. A2�'1'?l.C,�1�'h�3 !'X�cS?�I�idI.X71'�i� ._r CUMM CONSTRUCTION 53b:09 SF , 110R.gMPAT.IO 1-116.00 ST.' d j, ?~�.f�ik16!1'��`� ) COST OF C:O;°Alyd�'i"AIRU0:"3.7[f;?ly �*?��;�"a.�0 CONSTRUCTION FRIT 103-000-418-000 E3'951$0 .S3"�� l;++ 101-000-439-316 $Q40ga2, 12� Lr,�A/,lN d:6��q tl�:re�r pK iP o(�/�p.{�� �lfckuI.NItCALRX 101.000.421.000 639.40 %.!.•fv.:C`3'P,.O(;A1.,'ft 101-000--420-000 t 11.05 PLUMBIkdE3 MFI - 101.000-419.000 $54.00 S'.FRONG A9C3'.PION IORE • ,A..aA"11D 101-000-241-000 t .36 a'II3&DINO WE 101-000-42-3-000 $20.00 `R t '81 MM.-TOTAir, n..�6wy,nxt(.`1N't►,M PLAN M1VC ;'lw XHIS FRE -PAM IMS T, 836. S? $0,00 U OCT 2 5 2001e �j CITY WHY.C' 25DU.L NOW Upiea'A!.a RECEIPT DATE / :� BY AL NSPECTOR 1.3.1:;'• INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts — C Slab Grade Return Air Steel Combustion Air Roof Deck g Exhaust Fans O.K. to Wrap f OZ� pn�,� 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 L O 21 (� _ 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 a b_ C 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: 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) 1?'Vow 13tc!'a9i� 13Hz kn57; 72�-W ! CITY OF LA QUINTA SUB -CONTRACTOR LIST JOB ADDRESS PERMIT NUMBER OWNER i iE[,5KoF5 P,4KIVi59S Zf-L6 BUILDER l�iA14dfL1�4 a�clsrTVerl-Od de-. This form shall be posted on the job with the Building Inspection Card at all times in a conspicuous Ip ace. 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 a Contractor State Contractor's License Workers Compensation Insurance City Business License Company Name Classification le.g. A, B, C-8) License Number (xxxxxx) Exp. Date (xx/xx/xx) Carrier Name (e.g. State Fund, CalComp) Policy Number (Format Varies) AExp,.DateLicense Number Ixxxx) Exp.Date Ixx/xx/xx) EARTHWORK (C-12) j9. r ot04, &4t14A1 df � t!'I 1%1 C ('�- 161 �O$ i -31-63 �i4F� F 4'JO o��13- v 1 990497, CONCRETE (C-8) (-i AtJC6 Cd.JSMJGi�vU Ihk 6-$ �YA4 -1 u.i6'-03 5iATz f2c1p1p 1&1501 3 1.1"p2 03,517 - FRAMING (C-5) �SAK r�OhiS"l�rfG"j pnf �� 84010 1 71e4llf �1*�-d'Z 'Sim F4Av O�//�OI�IJtlaaa�Z i-I�O�' Gi�f'p7!/ j-Z7t1 STRUCT. STEEL (C-51) PA4M 6PF145 y t-21 � X23 -5'1 Aid 2fo�'✓ 1<P 1241 -oz- Si'413r dp /�j'7tp�t'p,>t� -ol /0-01.62 41 MASONRY (C-29) S413ot2 /KASGJ(L�l G- 2'P Lo�g4o6 ?.3i,o V'+4LA4�r (1�5 aAJa JJe - 12.511W5 -p j.p D(o21�{ 3 -22 -fl PLUMBING (C-36) aQ 1y(CLfiA i� tG1.1 L G- 3 �P �jgg 99 /0 -31-�! 'teozr � d�/0 Al WCd 16 ?Ia-� /2 -/S -a ( 61 /4z /-// -t�2 LATH, PLASTER (C-35) MA914A 129-144U_ a061M4 C- 3 72049l/ y3a-e� ���P 'jeo7�fSOd60 `.1-0-x ©,1v"y/ !Z'?/ -q DRYWALL (C-9) AA R(JA ,OR�/4.4(.L C 1 R1 t 4,$ '72,04- � 4%30.+02 �xrz rw4D �lG7Syc00 aj-/-oz 6,q 641 1Z-3/-ol HVAC IC -201 4-RA4�i aR4-/' c -2a 3IS46 3 /o. -3i-07 �OM F IJO /5•%40 -0/ 3 �-r z 03�I /0-21-oy ELECTRICAL (C-10) � e E,69ergrc c'^ /d 7A1$171 ,1_�-� /Ctrl a� &JIp/Z$5�ty=d 1 I - % -O v Do 2I S /o-�/-o ROOFING IC -39) �r'�c�1?ri�t7 1C61Gr1A /I�(G, 4 3Y 776'Alo j/.3o-vl 4% �� %yJ O 2�� � �`� /�4% l�h j-1= /2-2 01 SHEET METAL IC -431 Kc'f!M 1 r LA�$7/ C-'�° 3`62`/'6 3 /v• 3I• c>3�'1-�JjJ v7 /Sy 2�fo¢Q/ 3-1'SY'z cr> 3Gr7 /a -z7 FLOORING IC -15) C. V.�. C-iS 771v2R5 .3.,31.02. aPeK#.1tT{ 46, 14e4l II427»op St -1-D z. dSQ�it'P O-/-Xrc� GLAZING IC -17) 4dd,J TXY 446r WROW f iit "O e-1 7 77a6OCI Fr1/Jp 0,/tp - 0l /./- oZ 62239 3 -lx INSULATION (C-2) W'65'J-_,r4d 11J6',1"1_1,0A% C� -2- -714'/T 5- 3/'Q'J Ri4e-�IG4AI A&(,F /4%5 • 1/65 2 A142y/ 7- 3a -41L 'Otl35 2-Z(.47_ SEWAGE DISP. (C-42) hfAJAo--KL-or-oFTA �o,Fic rMP��4 t Co ScA 0 74623 3 +�� 1-Z-42 PAINTING IC -33) NfwMACK 10AW -4 IIJe. C^ 33374y9/ 3 j1-03 STfF /:: dr 1D 4�/(o/o3q/-01 (-/-oz- ©oy2� 3-3p.o CERAMIC TILE (C-54) G. Pa G. 77&2'16 3-31-62- I OCM1q tkSGao tU NM% I I f 27-� 2-1-oZ t:93�'2rorP Of- o CABINET$ IC -6) "�Ec!�4�Jr�C e451'ewt D__5q#J ok $6-S �`j2 /9� o3 -3I -o9 'VrTAiZZ f:iAWD 4:5)&199,961 .1-02 60170 I -13-o2 FENCING (C-13) rAea(Z fAA5o&]IZ71 14- 2-1 4-q f9m3 -31-oma V114AdevA t&dgs ka Qe4 -1-2-31Z77 d -2�2 LANDSCAPING (C-27) /1A-7,JRA4 6P`fa-:' 4-1-7 lo90377 3a c2 j� 1P 72�j o1 uo�Toa2�t c 7 -/-oz 07 2z.D orr23d POOL (C-53) A/4 -1-441Z41- e022F4 T'3 e-3-3 4,`/a 377 4 3 o 2- S%�� F,"1 V -A2�-0( a1�l�Tcb?oi 30 7-/-0�- p 7 2 249 5-23-6