0108-250 (SPIN)LICENSED CONTRACTOR DECLARATION F
I hereby affirm under+ypenalty<of'perjury that I am'licensed under provisions of
Chapter 9 (commencIgxVri$h�,^S�ection 7000) of Division 3 of the,Business and
Professionals Code, and my License is in full force and effect.
r License #.- Lic. Class Exp. Date
"Date Signature of Cr ontractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason: 'c
( ) 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
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:
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
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: 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
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.
Signature (Owner/Agent) Date
' -"BUILDING PERMIT PERMT# a r
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RECEIPT
DATE
BY
DATE FINALED
IPECTOR
NS ,
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs l
Underground Ducts
Forms & Footings I
Ducts
Slab Grade I
Return Air
Steel ;
Combustion Air
Roof Deck 1
Exhaust Fans
O. K. to Wrap ]
F.A.U.
Framing
Compressor
Insulation }
Vents
Fireplace P.L. i
Grills
Fireplace T.O. I
Fans & Controls
Party Wall Insulation ]
Condensate Lines
Party Wall Firewall 1
Exterior Lath 5
Drywall - Int. Lath
't
i
Final
Final I
BLOCKWALL APPROVALS
POOLS - SPAS
steel
Set Backs f
Electric Bond
Footings I
Main Drain
Bond Beam I
Approval to Cover
I
Equipment Location
i
Underground Electric
}
Underground Plbg. Test
Final y
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines ]
Heater Final
Water Piping i
Plumbing Final
Plumbing Top Out !
Equipment Enclosure
Shower Pans {
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping 1
Gas Test
Appliances
1
Final
f
Final I
Utility Notice (Gas) 1
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit i
Rough Wiring
Low Voltage Wiring ]
Fixtures I
n Service 1
Pav,.els I
... ;nor Receptacles i
G. F.I. }
Smoke Detectnrs
Temp. Use of Flower
P ]
Y i
Final ]
Utility Notice (Perm) ]
COMMENTS:
J
i
August 31, 1999
Mr. Mark Harold,
-Building. 8.Safety Manager
City of La Quinta
78-495 Calle'Tampico
La Quinta, CA 92253
Dear Mr. Harold,
Thank you for.seeing me this morning to,review your needs for our Mariachi festival this week-
end. A recap of what P hale been able to accomplish since our nieeting this morning and what
you,can expect in.the next few days:
1 Please provide drawings for stades and. scaffolds.
x
I contacted "Mike. Brown Grandstands" in your, presence, and you spoke with their repre-
sentative.They promised.to Fed Ex a full blueprint for your review'next day air" tomorrow
morning. Your office should have this by Thursdayrafternoon.
2 Please provide a site plan which shows accessible path of travel per CBC.1114 B.1.2
(to public transportation, accessible. parking spaces public streets •and sidewalks).
We reviewed our maps of the areas and how the Riverside County Sheriff's Department
Deputies will direct traffic..on PGA West Blvd. Attendees may drop off at the PGA West
Fitness Center, General Admission Parking is oh, -the unpaved lot (used during the Bob
Hope Classic).
3 Please provide a description'of portable restrooms, number provided, accessible ele-
ments, etc.r
As we discussed, the proximity of handicapped,restro"oms:is equal to the distance of
port -a -potty restrooms.(but I'ocated within the Fitness.facility) as opposed7to the port -a -
potty's at the south end of the tennis.court. We will provide signs to clearly identify to
the disabled person where their restrooms are located..
4 Provide Riverside County Fire Marshal approval
After leaving :City. Hall.this morning, I drove to Indio to visit;and review our plan with
g
Walter Grandes, Fire Marshal. We reviewed 'a . c.
, copy oflast years plan, and he noted
no new;requirementssnd signed' off on the program.. He said both you and I should
receive a notice of. this meeting, in the mail by the end of the week.
5 Please provide plans/descriptions of electrical proposal for use.
I met with David Bricker, PGA West Director of Engineering to review these issues.
He notes the following information for your review, as was done last year:
49-499 Eisenhower Drive, Post Office Box 69, La Quinta. California 92253. Tel. 1760.564.4111, Far 760.564.7656
Mr. Mark Harold
Building & Safety Manager
Mariachi`Plan Check -Corrections
Tuesday, August 31, 1999
Page 2
Power'will be.from two sources:
First; using the Fitness Buildings Electrical Panel, it has, 200 Amps of 3 -Phase power.
This will,be,used -to light,the VIP Stands, Area-Lighting`on`:'North Side The wiring will
run exposed on the roof. Their are small distribution box
es;on the ground with 120 Volt
circuits for individual'use.
Second, an Electrical Generator which'will.feed the Audio Visual Program, lights, loud-
speakers, amplifiers, port -a -potty lights; beer.. truck (south-east side), and the "jump -box'
fans for children's play area.
Wiring from the generator will be covered and run along the sidewalk areas. The gen-
erator is•supplied by our Audio Visual' Company, and is expected;to'be an 1,800 Amp
Generator.
In the lighting features surrounding the tennis facility, there are. 20 -amp boxes for addi-
tional directional: lights.
6 Additional corrections may be requested upon further reviews...
7 Please note an estimated time. anticipated for City Inspection prior to the start of the
event.
David Bricker, the contact person for the. PGA West event would preferSunday morning,
but can make the push for Saturday afternoon if thatWbrksapetter for you (R. "Kirk" Kirk-
land). David can be reached at PGA'�West-by calling the hotel operator: 564-4111.
Mr. Harold it4is always a pleasure working with you and your staff. Please let me know if there
is anything 'else I can do for.you. Although we started earlier than last year,.1 notice we're still
at a "last minute" frenzy. [,know that the City of:La ,Quints has been very busyiwith growth this
year and I can only imagine how busy your office is, even though it's the summer.
As the program is relatively the same each"year; Tfhink, I'll start the permit process a .few months
earlier next year.
Mark, thanks again for your assistance!..
Sincerely,
Maury Mortensen
Director of Loss Prevention
cc: Dave Bricker; Director of Engineering;, PGA West
Rick Middleton, Director of Engineering, KSL Desert Resorts
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 we the.responsible party of record on such a
permit. Building permits are not required 6,be'signed ,by property owners-unless-the'y are -personally performing their
own work. If�work ork is being perfo med by someone oiherahan 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-ihe_State of California and to have a business license
from the City or County. They are also requiied by law`,to,put their license number on all permits for which they
apply.
If you.plan to do your own"work, with the. ex ception,of,:variuus..trad'es that.you plan to subcontract, you should be
aware of the followintinformaiion,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 •Admiristration)., 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 subconiiactor, 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 owtulabor and material personally.
Building permits are not required oto be signed by;'property owners unless .they are performing their own work
personally.
Information about. licensed contractors may be.obtairied' byrcontactin"g',the Contractors' State License Board in your
community or at. 1020 N. Street,:Sacramento California"93814.
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,
CITYOF LA•QUINTA '
DEPT. OF BUILDING AND SAFETY
78-495 Calle Tampico
La Quinta, CA 92253
(760)777-7012
FAX: (760) 777-7011 v
t
eWNER!S GNATURE / DATE:
PROPERTY ADDRESS
bIC? zsp
PERMIT NUMBER(s) -