11094 (AR)P.O. BOX 1504 N o . 11094
Building 78-105 52-397 Velasco LA QUINTAC
Address CALIFORNIA 92253
Owner
ftxxVAxnnx Daniel Varner
Mailing
BUILDING: TYPE CONST. OCC: GRP.
Address same
A.P. Number
City Zip Tel.
. LaQuinta 92253 564-0745 Legal Description
Contractor Project Description
fawner /Bll] Zi��'�
Address $2flort Addition
City lZip, Tel.:
State Lic.I City
& Classif. Lic. #
Arcn.; Lngr.,
Designer
Address Tel.
City ( Zip ( State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
effect.
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the following
reason:. (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permit to construct, after, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to rife a signed statement that he is licensed pursuant to
1 the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) or
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'clvil penalty of not more than five hundred dodars.(E500).
Ni 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. ff, however, the building
or improvement is sold within one year of completion, the owner -budder will have the burden
of proving that he did not build or improve for the purpose of sale.)
❑ 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 contractor(s) licensed pursuant to the Contractor's License Law.). -
❑ 1 am exempfunder Sec. I B. & P.C. for this reason
�f{� fir- )g
Date V Ownei"'� f !%.v11 �.f 52-4-7 vox r• %J. 4
WORKERS' COMPENSATION DECLARATION
I hereby' affirm, that I 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
❑ Copy Is filed with. the city. . ❑ Certified copy is hereby fumished.. ,
CERTIFICATE OF EXEMPTION FROM
• WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
or less.)
I certify that in the performance of thg work for which this permit is issued, I shall not
employ any person in a anner.so'as to become subject to'the Workers' Compensation
Laws of California. /
'Date—'Owner .r�i' , .:w:"" i / !.✓" E? rr=3.. ..
NOTICE TOAPPLICANT: If„ after making this Certificate of Exemption you shouts become'"
subject to the Worker's Compensation provisions of the Labor Code, -you must forthwith
comply with such provisions or this permit shall be deemed 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.
I 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
Sq. Ft. 270 No. No. Dw.
Size -Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ .
15 W
:timated Valuation
13.905.00
PERMIT
AMOUNT ri
Plan Chk. Dep.
Plan Chk. Bal.
99.45.
Const.
144.00
Mech.
Electrical
Plumbing
S.M.I.
1.40
Grading
Driveway Enc.
Infrastructure
6142i AP
14
TOTAL
244. 5
`
REMARKS r
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
IST FL. SQ. FT. ® $
UNITS
SLAB GRADE
2ND FL. SQ. FT.
BONDING
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SQ. FT.
OTHER APPJEQUIP.
DRINKING FOUNTAIN.
SQ FT ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
t MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
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.
SQ. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
GAR. FIREWALL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
LATHING
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE ___JCONST.
FEE JELECT.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 APPJEQUIP.
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
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION -
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
jGARD,EN WALL FINAL
I
4 4.Q"
P.O. BOX 1504 N o . 11094
Building 78-105 52-397 Velasco LA QUINTACALLE
DO
Address CALIFORNIACAL FORN92253
Owner
RnHx51Hxnsx Daniel Varner
Mailing BUILDING: TYPE CONST. OCC: GRP.
Address same
A.P. Number
City Zip Tel.
LaQuinta 92253 554-0745 Legal Description
Contractor Project Description
Owner/Builder -
Address Room Addition
City Zip Tel.:
State Lic. City
& Classif. Lic. # Sq. Ft. 270 No. No. Dw.
Arch., Engr.,
Size Stories Units
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
effect.
SIGNATURE DATE
OWNER -BUILDER DECLARATION Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following 13,905.00
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permit to construct, atter, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to file a signed statement that he is licensed pursuant to PERMIT AMOUNT
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) or
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 Plan Chk. Dep.
sGbjects the applicant to a civil penalty or not more than rive hundred dollars ($500).
as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal. 99.45
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const. 144.00
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. Mech.
provided that such improvements are not intended or offered for sale. If, however, the building
or improvement is sold within one year of completion, the owner -builder, will have the burden Electrical
of proving that he did not build or improve for the purpose of sale.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing
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 S.M.1. 1 4n
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
❑ I am exempt under Sec. t B. 8 P.C. for this reason -
J Driveway Enc.
Date Owner //rn/1 / t� .`bs�� f) n /1 /% �1 Infrastructure
v
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I 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 'A0 C,
t`rk; ri`?
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished. 4
TOTAL 2441.18.5 -
CERTIFICATE
44, 8.5CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed If the permit is for one hundred dollars. ($100) valuation
or less.)
I certify that in the performance of the work for which this permit is issued, I shall not
employ anyperson in any manner so as to become subject tothe rah
Laws of California.
Date -
NOTICE
NOTICE TO APPLICANT)",
PPLICANalter making this Certificate or Exemption you should become ZONE: BY:
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith Minimum Setback Distances:
comply with such provisions or this permit shall be deemed revoked.
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line
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.) Side Setback from Property Line
Lender's Name
Lender's Address FINAL DATE INSPECTOR
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. Issued by: Date Permit
I 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. Validated by:
Signature of applicant Date
Mailing Address Validation:
City, State, Zip
APPLICANT
.,.w-.r........•�-••..-..���•,`..rr�9Kt� rr:�u � s.,��•-.aH�rv'��.. •.r�* s�,,,r.,�. �+•� r--••-;Y,.r-•F�y�.°.'�!'w-r'.r� »;+�t_ Y�,•Y•�ir:Y.:� r�r•;:y-c�,_-�';,.^,�v;�#
"" ri•� S' ,r .', M ,Ci .g attr^,. .VG`S.'., ..'tia .r,,•. F.i. j`a sg2a :As.}...; s - ♦- . s.'w
• ..
V
DE�1/LAN 3 "'iECK,RE
S
,
......................::::. ...............:.:.:..:
'
OF
Return check to requestor - Mail check -
4
' Name / Title of person requesting check
r Department individual is associated with: Y 4
Check Payable to:
Amount:
.a -e (Vendor NOT
� as-
-S 2 2 �% i/�l��,CLr� C�i Account Number: �=3 S�Ur� -.G �.�-- D9/,7
7�
• TAd re - ..,
.2 0 U
Check description and .invoice number: - • �„ ' -
. �,' {
.r .w
9VL % 9- 7�q G' o
`r, �• • �.' -� •.. •. ,,��,. ,- } fig tg.! � _.♦ • +{
- '
t
ce,ouolvz 4
78-105 CALLE ESTADO — LA QUINTA, CALIFORNIA 92253 - (619Y 564-2246
FAX .(619) 564-5617
May 26, 1993
Daniel Varner -
52 -391 Velasco
La Quintal CA 92253
Dear Mr. Varner:
It has come to the attention of the City of La Quinta Department 6f
Building and Safety that your building permit number 11094 at 52-
397 Velasco has expired..
According to the Uniform Building Code,.Section 303(d), no further
work shall -be performed on the above permitted job -site until anew
permit has been issued or an extension granted. An extension of
this permit can be requested. in writing within 14 -days of the date
of this letter.
If a final inspection has, not been requested due to ,an oversight by
either yourself or your contractor, please schedule that final
inspection within 14 -days to..resolve this matter. Failure to do so
will result in further action by the City.
Please contact me at your earliest convenience. We appreciate your
immediate attention to this matter.
Sincerely,
BUILDING AND SAFETY DEPARTMENT
Lonnie Day
Building Inspector
kt
Attachment
MAILING ADDRESS P.O. BOX 1504 LA QUINTA, CALIFORNIA 92253
T44f 4 4a QUM&
78-105 CALLE ESTADO — LA QUINTA, CALIFORNIA 92253 - (619) 564-2246
FAX (619) 564-5617
August 8, 1992
Mr. Daniel Varner
52-397 Avenida_ Velasco
La Quinta, CA 92253
RE: Check 12912
52-397 Avenida Velasco
.Building permit #11094 - room addition
Dear Mr. Varner:
Enclosed is a check for the reimbursement of the building permit
fee that was voided. The amount equals 80% of the permit fee..
Thank you.
BUILDING AND SAFETY DEPARTMENT
�
Mark HVarold
Building Inspector II
Enclosure: Check
MH: es
LTRMH01
MAILING ADDRESS - P.O. BOX 1504 - LA QUINTA, CALIFORNIA 92253