9803-003 (BLCK)f LICENSED CONTRACTOR DECLARATION
f
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:
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
O I am exempt under Section B&PC:`for this/reasons'
Dates.Signature.of Owner 1.*
ra (f� r
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
( ) e 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.
.0 LE A PJB ., f v C. ra `
(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 forthwit comply with those' provisions.:
r
Date' . ,.,,=,1 Applicant^, dli.,'�•; f
...
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 s
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 inspecti6, pr r1.
l J,y�,
Signature (Owner/Agenfi/ A "• Date
VA
PERMIT # CONTROL #
BUILDING PERMIT,;,;.
DATE ! ,4s VALUATION $'➢�1�8.f€f3 LOT TRACT'
'
U oJOB
SITE
ADDRESS 48-721, S i�"9.l C N�.+C
APN C►/Sde^^�.�{�—��i�i
OWNER
CONTRACTOR/DESIGNER/ENGINEER
JOSEPH ASTER
Jura^3 :4t,f S1.7ILDr-k
48721 SA14 VJCV4NT ' .
LA c7f INTA. C; A 92253.
USE OF PERMIT
BUILDING
49 i;,.r,..4` Ci?tvii3 N—ATbN WVR,)13 Wail"i vROU 3 l 'iSt01' i, NCE.
xIqS"/ : R3 ".V : ' :3 '3 �� 6.'�DN_ :`i TR37CrIONi;�
e
t r�,;IYf—A:C, 4tAd"►'>'It1Ti 'f'TtN �iN't) .�L,�T C111(``ti.
1.(lf1
•
LESS 1'it.;-P�'.i:U. ZEriS
'r;/13
k)
RECEIPT1\ A
DATE
B� f ?
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 & 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 APPROVA S
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:
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
FGI
f Utility Notice (Perm)
;A, APPROVED BY
LA . QU=NTA. GOLF ESTA'PES
COMMUNT= ASSOCTA=ON
ARCH=TECTURAL COMP'I=.xTRiLv—
A
by ' .
� Cha man•
111 � •
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MAR. -02' 9 8 (MO.N) 12:36 WEST COAST TURF TEL: 760 360 5616
I P.002
030wt
WIN I
1Z/23/91
PRODUCER
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
PAN AM=cm UNDERIdsum, Ift.
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE.
T':
56-695 AVE 54, SUM G
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
j
COAMLLA CA gms
ALTER THE COVERAGE AFFORDED By THE POUCIgS BELOW,
LOW
740-399-0"1
COMPANIES AFFORDING COVERAGE
Caffwrda Ucense NO. 0132491
'COMPANY
-PAULA
A
INSURANCE COMPANYINSURED
-
WEST COAST TURF
COMPANY
PO BOX 4563
PALM DESERT CA 9=62
COMPANY
760-360-5464
C
COMPAW
......... ......
THIS is TO CERTIFY THAT THE POLICIES OF INSURANCE lJSTFA BELOW
NAVE BEEN ISSUED TO THE INSURED NAMED
ABOVE FOR THE POLICY PERIOD
INDICATED,OF ANY CONTRACT OR OTHER DOCUMENT' WITH RESPECT TO
WHICH THIS
CERTIFICATE' THE INSURANCE AFFORDED BY E POUCIES DESCRIBED HEREIN IS SUBJECT To
EXCLUSIO ALL THE TERMS.
HAVE BEEN REDUCED BY PAID CLAIMS.
DATE (YY/pQ
DATE SUL00MV)
LIN= •
GENERAL LIMUTV
G8481ALAGGREGATE
COMMUKI& Ge4ERAL uAeftjry
M
Pf=UCTS-WMP4PAaG 3
PERSONAL & ADV MAJOY s
CLAIMS MADE O=UR
OWNSM CONTRACTORS PMT
EAX-OCCURREWCE, S
FIRE DAMAGE (arty one fire) s
•
MED EXP !!�j =a parson)
AVTtMOBILE
LMBIUW
ANYALIM•
COMB NED'SiNaLrEumir
ALL OWNED AUTOS
S
SCHEDULED AUTW
j?Qjm
(Par
NON OWNEDAUT09
LSMS,
Pmawono
PRCWE3UV OAUAZ6
GARAQELLABILITY
AUTO ONLY - EA AC=ENr S.
ANY AUTO
-OTHER THAN AVro ONLY -
EACH ARDENT s
AGGREGATE $
O(CM
UABJLnY
EACH OCCURRENCE s
UMBFUR.LA R)MO
AGGASGA7E
OTHM THAN UMBRELLA Fo;VA
't
VIORKERS COWMISAman AND
WV.5TARJ-
17UW UMFM
EL EACH ACMDENT 1,000.000
_�LDGEASE-Pcucruwr
A
THE PnomeraRf INM
PUC 501-5053
OIL/01/99
101/01/99
PAWNERSOEXECLITIVE
RX
s 1,009,000
0MCEFGARE.- Excl.
aL 060SE - EA EMPLOVEE S 1,000,000
OTHER
DESMPItCm OF OPOtA'nOMSAjOCAnoustvL:mtcLe=pECIALlyEN3
.. ....
FPL LIMIT $250.000
20 -MY NOTICE OF CANCELLATION FOR NON_PAVKW.
KAI(m
a"O" ANY OF THE AR&JE DOWMDED POUCtES BE'CAkCElJUM BEFORE THE
-WEST COAST NkF FARMS
OPMATION CATETHEREaF. THE ISSUING COMPANY WILL ENDEAVOR To MAIL
nAvs wnrrmp NOTICE TO THE CEFMFWATE HOL'1�11EA MANED TO THE LUT,
BUT PAURE To KM aucgq fwTwe SHALL IMPOSE No CUUMATION OR UABMM
OV ANY MOND upais THE compAmy. rT5 AGENTS OR ftEPMMEwTAME&
OR= TA
r
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 r_..._
78-495 Calle Tampico
La ' ta' CA 92253
� 0) 7 7-7012
AX (70) 777 011
l . N,
O 'S S GNATURE/DATE
l c ,
'- )a-
PROPERTY ADDRESS
PERMIT NUMBER(s)
31x3 GbN��
NORTH
d'lf!'i'-G�r
.`�iC��,2e- ��r�c G�G�e�v 'Y
000,
CITY OF LA U. U 111 TA
Com munity Developrne'nt/Blldg. Dept.
CONDIT 101A3LY
ACCEPTED FOnz C 0, ri S, T P, U G 1! 0 N
SUBJEa TO INSTALLATION AS PER
AND LL APPLICABLE CODES
DATErrB
7F
Ll
/A
Ll
`TIIE MERAL CONTRACTOR HALL ''.V Fr.
C R's DIMENSIONS AND "SITS
s.
71,
CONDITIONS BEFORE STARTING WORK.".
MINH
SITE C WING 'AND'
CONTRACTOR' SHALL INVESTIGATE NJG
1,10 Plb Couptsrrs
EARTHWORK'. S',! FOR
'OPERATION FILLrD _EXCAVATIONS'_ -OR
STRUCTURES SUCH AS CESSPOOLS ONSp' 0
'CISTERNSO FOUNDATI &C
MANYSUCH.STRUCTURES ARE FOUND STRUCTURAL ENGINEER SHALL'
a.
'BE NOTIFIED IMEDIATELY.
4
CONSTRUCTION MATERIALS -SHALL'TE SPREAD .OUT::IF PLA CED N
' '
2
I�:? C -A L r i- -so,_i 1> LAr
s, WM
-5�rl
A
FRAMED FLOORS OR LOAD SHLL NOT EXCEED 'THE. DESIGN
L 40 t_M-4 M �TSFTT
LIVE LOAD PER SQUARE, FOOT.'.: PROVIDE ADEQUATE SHORING-ANDOR
Lie
/* ^v &T
BRACING NAS ATTAINED DESIGN STRENGTH.
+
WORK SHALL CONFORM TO THE 'MINIMUM StADARbS:OF.THE' 1982:
DE AND
EDITION .'OF THE UNIFOMI BUILDING '., CO �-ANY OTHER
..OVER ANY NG THE:
PORTION' 16F� THE VO lRdLUDI
REGULATIONS RK
7777,
Z
a
STATE OF CALIFORNIA "'DIVISION :OF .;INDUSTRIAL" - SAFETY, .-AND
THOSE LISTED 'IN THESE 'NOTES AND SPECIrrcAnoNs,
J
_rf
Ak
*4.
06
4F
IN 'L,M LL WIDE
_4
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SONRY
WALL, DETAI
its is
d'lf!'i'-G�r
.`�iC��,2e- ��r�c G�G�e�v 'Y
000,
CITY OF LA U. U 111 TA
Com munity Developrne'nt/Blldg. Dept.
CONDIT 101A3LY
ACCEPTED FOnz C 0, ri S, T P, U G 1! 0 N
SUBJEa TO INSTALLATION AS PER
AND LL APPLICABLE CODES
DATErrB
1 k
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i T -h'1,9 ,006,4, 66,910" 10 /A/ 7-EA4bEb FOR 00MR4RR r111471- Y ,C, E!/.EL
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2. 6ES1c/V A1,07- APPL,i' W11ER,6- EXPAA/s/V/E -40/1- GO/t/p/T/OrVS
.EX/sr.
3 r, E -RE SHALL BE NO (V e0UA/D WATER AT POoi- c4/TE.
4. POOL WALLS S'HALG BE /1/O CLOX619 THAN 055'-0" Td BU/LD/AILS, WALLS
FODT1/VMV. OR OTf1E,2 ST1eZ)arVR,6,9 WH/G'H MAY IMPOSE ,q cSUIPIC19Wk E
OX/ THE ,0004 W41-1-.
�-� 610/u/TE - MACH/iUE Mbr-c-b P/UEUMAT/,0A44Y PL.AG'ED, S SAG'K MIX,
2000 Pe /. 1N 28 pAYd', WATEe CURE 3 T/MES DA/[. Y, FOR 4,6q $ V.
6. EE/IVF. sTEE.� - oEFo,eMED BARs 1"7WRME6 G4. A.S. rM A/,5-31
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7 CONSreocr Poo4 FL.oe & wqus, ExoEPr 4,9 voreb, AGA/NST
NATURAL U/UD/STURBED S014.
8. PLUMB/NG R ELECTie/CAL 1N,STi9LLAT/Oi %9 TO COMCORM TO
LOCAL CODES
EFFLUENT /,VFC.UENT G'AUG'.E
GAUGE � s/GHT 6'GA�S'�S'
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tM= WO 3/Q'
CHEEK Sa p = 25 Ps 22 _ 1 .-.00C/ nP = .0,9
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FIG TER/NG SU,PFyC E AeE9
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APPRDY,gL- /S FOR. YrPV0TUR,,94 DESIGN
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..
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DATE €?Y
TY)OICRL PEGESL9
NO SG94.E.
G�o/ys-T,euc r/o/v
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,eEC/2CUL,AT/O�t/ pATA
PUMP MAKS' i
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MODEL
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i
NOTE
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