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0112-062 (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: ( ); I; as owner of the property, or my employees with wages as their sole i;�npensation, 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). q () I am exempt un r Section B&P.C. for this reason Daie- 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. , . ( )til have and will maintain workers' compensation `insurance, as required by Section 3700 of the Labor, Code, for theperformance 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).. ( VI 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 forthw'th comply with os provi I ns. Date:,./ �C Applicant b Warning: Failure to secure Workers' Compensatio 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. t 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/Ager ���'��' ✓�"�te BUILDING PERMIT. PERMIT # DATE Z� ;� VALUATION LOT TRACT JOB SITE V ADDRESS APN• i,%y� OC(Y LO D.,,,ryy OWNER CONTRACTOR/DESIGNER/EN INEER i JA �0. X, C°.M U,aRYL WNM111TA.S>LC..g`!.ER 141095 000ULL0:1 R, 922.53 f: UGE OF PEnMIT 141 S. t719'gC?"f� 144.�3St �31`� .l=:.M (13- X FEE 1011-000-4X9-318 964,15 cpC1kJ�Sr3°I"n(�3tap."!'iv�Foi FEY., 1p01,­=1-41ry�y .8-�lC0 ' ��+ft14Ll3yQ A�f.FLV1r 1'�YLvat'a�� 4'iC L'o �'J A �'ii Vi/""CF.V"V'V?3 W ] Jr l�� STRONG M107 Oki IT -9. 9:ESID 101-000-2,43-000 SIA,{t(,t �3B,-*D `f A.L t' &M1 f&,' 110X .AH1.3 0lL A9 C�,,+"W e p RECEIPT fiE f�' �( BYC ± DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR' BUILDING APPROVALS MECHANICAL APPROVALS Set Backs /�, _ �g3 —v/ Underground Ducts Forms & Footings f _ g �./ . s Ducts —?_,:� L 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 Se'%Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Fnal 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 o 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,171 Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) Bin # City of La. Quinta Building ff Safety Division P.O. Box 1504, 78-495 Calle Tampico U Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # ©/i'2" 06 Project Address:* 44095 OCOTILLO DRIVE Owner's Name: y, JACK C. MALLORY A. P. Number: Qq 1$40-03( Address:Y. 44095 Ocotillo Dr L&gal Description: LOT 4 T(L "N-51 7 City, ST, Zip: y, La Quinta Contractor:x Owner Telephone: X 7 6 0 360-9224 ....... ... .......... ... .... ........ Address: Project Description: KCloset Addition to MBR City, ST, Zip: Y Telephone: X. ..................... ...... XX .................. State Lic. # Citv Lic. Arch., Engr- Designer: Owner Address: City, ST, Zip: Telephone: 01 State Lic.oc�V —bV \-0 , . 3 Name of Contact Person: �—i — .0 —.9,al—lory ..... Construction Type: Occupancy: Project type (circle one): New Add'n Alter Repair Demo •• Sq:. Ft.: IAIYOI # Stories: o Ai e. # Units: Telephone # of Contact Person: )C 360-9224 Estimated Value of Project: X 1 5 0 0. 0 0 /2//3 APPLICANT: DO NOT WRITE BELOW THIS LINE N Submittal Req'd Rec'd I TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural CaIcs. Reviewed, ready for corrections 7)Plan Check Deposit Truss CaIcs. Called Contact Person 41 �Plan Check Balance Title 24 CaIcs. Z Plans picked up Construction Flood plain plan Plans resubmitted IL Mecharical Grading plan 2"' Review, ready for corrections, rssue , Electri®I Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Gradin-, IN HOUSE:- Review, ready for corrections/issue' Develor.er Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees OcVva,, Total P:rmit Fees Desert Sands Unified School District ' 47-950 Dune Palms Road Notice: La Quinta, CA 92253 Document Cannot Be Duplicated 760-771-8515 CERTIFICATE OF COMPLIANCE ' Date 12/10/01 APN # 604-180-031 No., 22744 Jurisdiction La Quinta Owner NameJack C. Mallory Permit # 0112-062 -No, 44-095 street Ocotillo Drive Lag # City LaQuinta _ Zip 92253 Study Area Tract # Lot # Square Footage 144 Type of Development Residential Addition No. of Units 1 Comments Addition is a master bedroom closet of 144; sq.' ft. ' 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 th✓ amount of 0.00 X ,144 or $ 0.00 the property listed above and that budding. permits and/or Certificates of Occupancy for this square footage in this proposed project may now be•iissued , Fees Paid By EXEMPT - William Sumpter Telephone 760-831-6309 Name on the check By Dr. Doris Wilson `1 Superintendent Fee collected /exempted by Annette Barlow V02 Signature _ �%L Exempt $0.00 Check No. NOTICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90-day'approval period in which you may protest tie fees or other payment identified above will begin to run from the 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 aniother public entity authorized to collect them on the District('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 OWNER/BUILDER INFORMATION Dear Property Owner: An application for a building permit has been submitted in your name listing yourself as the b,.iilder 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 78-495 Calle Tampico La Quinta,CA 92253 (760)777-7012 FAX (769W7Z--7011 _ W, l � OWNER'S SIGNATURE/DATE PROPERTY A DRESS I12-�6z PERMIT NUMBER(s)