0011-271 (DEMO)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:
( 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).
() m exempt under Section .k: ; B&P C. for this reason.
ate �/ Signature of --Owner
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of .the •following declarations.-
(
eclarations:(. ) 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
workersfcompensation laws of California, and agree that if I should become
subject to the workers' compensation, provisions of Section 3700 of the Labor
Cod , I shall forthwith comply with those provisions.—
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rovisionspplic
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and.civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's. fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person.at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construct on, Zand hereby authorize representatives of this City to enter upon
the abo
ve-mentioned property for inspection purposes
VSignature (Owner/Agenf) °--Y` - 'Date
BUILDING PERMIT PERMIT Jt
DATE VALUATION LOT 0011 -271, TRACT
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JOB SITE JAPN
ADDRESS
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79-750 ".6,�i',t IZO .Q:i$IVE
646-312-026
OWNER
CONTRACTOR / DESIGNER / ENGINEER
M14 &s J.:1�/Li' ).3F�, 14
OWNER,:03tSi2`d..,i M, .
784M OAGUARO
LA QVIILV rA CA 92253
l) m. ( SLA 2120
'
USE OF PERMIT
DEMOLISH L++2p�.e�"O'NIRY WALL AT NOR41 PROPEISRTY UNE
ZrhMWATM COUT OF (CO2WL INt7(.;° 1.001
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raw 1)%.79 iubM&
DEMOLITIUN FEE 000 Vs.,00
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RECEIPT
DATE I r
BY
DAT Fl NAILED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
I 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 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 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
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)
COMMENTS:
I,a>v OffzCgs of -
CR!$TE,. PIPPIN & GOLDS .
73-550,ALESSANDRO DRIVE l
ROBERT L. PIPPIN-ROBERTLPIPPIN®AOL.COM: ;SUI'TE 200. <TELEPHONE: (760) 862-1111
MICHAEL A. CRISTE PALM DESERT, CA 92260 :@ FACSIMILE: (760) 776-4197 .
IRWIN L. GOLDS E-MAIL: CPGCA@aol.com
JEFFREY S. FLASHMAN
July 5,, 2000
Mr. & Mrs. Jack.Nelson
78=707 Saguaro,Dr.
La Quinta, CA 92553
Re: Ms. Susan Jeffries
Dear Mr. & Mrs. Nelson:
I have. been retained by. Ms. Jeffries to respond to your letter of June, -26, 2000. In the first
instance, let me say, neither Ms. Jeffiri_es nor myself understand the natureof.your complaint against
her.
It appears that a:block wall was built on your:property by the prior owner of Ms. Jeffries'
property. The person who :built the wall "inay have trespassed upon your property, and, you may
indeed have some type of achoh-against,that person `. M§.`I ffri6s did not build. the .wall on your
property, did •not purchase`the. wall. when .she .purchased herproperty, and .neither the wall nor your
problem with the wall`is of any concern to her
Since the offending wall Is"on your property,.you are certainly atkliberty to remove the wall
at your convenience and at�your ex''brise..For her:part; Ms Jeffries.lias.no. objection to your removal
of the wall. Should you remove.thewall,, Ms Jeffries; may, as Is her legal right; build a new wall on
her property..
If you ' elect to remove •the wall, you .may .want to contact. me .to make appropriate
arrangements to come onto W. Jeffries' property to�facilrtate the,reinoval of the wall. Please lett me
know if that is your, intent.
Thank you for your, atterition:to this matter. If you would:like to discuss this matter further,
please feel free to contact' me k your convenience
;Vei ' ay Yo s�
obe of
Cri In &Golds
RLP/lcf
cc: Susan Jeffries
r1p2\jeffries.101.wpd
OWNER /.BUILDER INFORMATION,
Dear Property Owner:
An applicatiomfor 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.aie^ihe responsible party of record on such a
permit. Building permits are not ;req'uired to,be signed by,:property owners unl'ess'ahey,are `personally performing their
own work. If your'work is being performe& by someone other'than yourself, you may protect yourself from possible
liability if that person applies for the *proper permiC 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„aie-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 variuus 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 imniediate`family, and. the`work (including materials
and other costs) is $200.00 or-more.fdf 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: Siate 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 morespecific 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 coniraciors 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,o wn labor and material personally.
Building permits are not required to be signed :by. prop eriy 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 1020N. 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 issueduntil.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) 77 OI1�
6i qy
OWAR'S SIGNATURE/DAT-E
PROPERTY ADDRESS
PERMIT NUMBER(s)