13907 (SFD)""f Ur aw K"Muj.`
P.O. BOX 1504 No. 33907
Building 53--230 Ave. Juarez LA QUINOTACCALIFORNIA92253
Address _
Owner lir•. & Mrs. John Palozzi
Mailing
BUILDING: TYPE CONST. OCC: GRP.,
Address Sable 774--041--011
A.P. Number
City Zip Tel.
Palm Desert, CA 92260
Contractor
Sean Rearneg/Desert Shmrock
Address
Box. 3123
9mlm Desert, 169' 3226() Te1.340-5088
State Lic.. B 6118947 City 3280
& Classif. Lic. #
----Arch.; Eng r.;
Designer
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
J hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
JD00) O�,Division 3 of the Business and Professions Code,, and my license is,inifull force and., r
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 rile a signed statement that he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code, or that. he 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 rive hundred dollars (8500).
O 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
Professions Code: The Contractor's License Law does not apply to an owner of property who
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. If, however, the building
or improvement is sold within one year or completion, the owner -builder will have the burden
of proving that he did not build or improve for the purpose or sale.)
O I, 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
such projects with a contractors) licensed pursuant to the Contractor's License Law.)
O 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby 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
O Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars (8100) valuation
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' Co pensation
+aws of lifor ia,
OTICE TO APPLICANT: If, afeY makin (firs Ce7lificate of Exem tion
tt9 p ' yothould become
subject to the Workers' ',Compinsatlon provisions 3f the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemeb revoked.
CONSTRUCTION LENDING AGENCY
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.)
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I certify that I have read this application and state that the above information is correct.
1 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.
Signature of applicant Date
Mailing Address
City, State, Zip
Legal Description
Project Description
Change of
Lot 14 Block 178
SFS
contractor see permit #12075.
Sq. Ft.
Size
No.
Stories
No. Dw.
Units
New ❑ Add ❑
Alter.❑
Repair ❑ Demolition ❑
Estimated Valuation
_0,_
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
.S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
..(jl..
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
}
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING(FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
t Fl
BONDING
YARD SPKLR SYSTEM
2ND FL. SO. FT. @
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
GAS (ROUGH)
METER LOOP
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. SO. FT.
GROUT
WATER HEATER
WALL SO. FT.
FINAL INSP.
DRINKING FOUNTAIN.
SO FT ®
WATER SYSTEM
URINAL
ESTIMATED CONSTRUCTION VALUATION $
=$
WATER PIPING
NOTE: Not to be used as property tax valuation .
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER. B.T.U.
SO. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
FINISH GRADING
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
// i? / 2
DQ_�4lJ L—Y
1
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS ,
GARDEN WALL FINAL
-
rte`
DE
Construction IK Management
Lic. # B618947
City of La Quinta
Building Department
78495 Calle Tampico
La Quinta, Ca. 92253
K
July 22, 1994
RE: Extension of Building Permit for 53230 Avenida Juarez
Dear Sir or Madame:
I have agreed with Mr. and Mrs. J. Palozzi, owners of 53230 Avenida Juarez, to supervise
the construction of their partially finished home. The home was originally started by
Synercon Construction and was foreclosed upon by Mr. and Mrs. Palozzi. As you are
aware, a lot of time has elapsed from the time that the original permits were issued.
The purpose of this letter is to request that the original permits be extended for a
sufficient period of time to complete construction. I expect that a request for Final
Inspection will be made around the end of September.
I will also need a copy of the Title 24 energy calculations in order to comply with the
heating and cooling requirements. I understand that there will be a charge for the
calculations.
Any other help that you can give me will be greatly appreciated. I look forward to
working with you.
Thank you for your time and consideration,
(�!q� tux-'�j
a Sean Kearney
New Construction • Post Office Box 3123 • Palm Desert, California 92261 • Phone/Fax (619) 340-5088 Pager (619) 568-7171 • Renovation
La 4'•c
� 9
0� •
F 2 • Q
V
y
OF TNS
Dear Business License Applicant:
Every contractor that applies for a city business license or renewal of a business license issued
pursuant to Section 37101 of the Government Code or Section 7284 of the Revenue and Taxation
Code shall complete and sign a declaration that states the following: .
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury, one of the following declarations:
I have and will provide a certificate of consent to self -insure for worker's
compensation, as provided by Section 3700, for the duration of any
business activities conducted for which this license is issued.
I have and will provide a worker's compensation insurance policy, with
The City of La Quinta listed a certificate holder, as required by Section
3700, for the duration of any business activities conducted for which this
license is issued. (See attached contractor record status)
I certify that in the performance of any business activities for which this
license is issued I shall not employ any person in any manner so as to
become subject to the worker's compensation laws of California.
Date: Z'Z- Applicant:
Business Name
Address City
-��.89Li
Contractors License Number
Classification
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS
UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES
AND CIVIC 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.