9802-126 (AR)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury, that I am licensed under provisions of
Chapt- 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
-1�"iG� 33 - t►i3t1��i+
Signature of Contractor`
OWNER -BUILDER DELLARATION
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
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.
I WA11n.103 OrN FILE
(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 shalVforthwith.comply with those provisions.
(Date: �' Applicant f_ ` �✓�
Warn!g: Failure to secure Workers' Compens titin 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 ofIsuch
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,4
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.
VSsignature (Owner/Agent) � � /�✓� Date'O' X ”
BUILDING PERMIT PERMIT, CONTROL#,
11402-126
DATE 1" VALUATION 1;3,261 90 LOT TRACTQ.8 9
68
Q
ADDRESS JOB SITE
APN 646-:110-037
OWNER
CONTRACTOR / DESIGNER / ENGINEER
1,() 11AR J Mikl,Jt VA81 KAY
#8141..(:' 1A,1r 8EKJ ,NAS
I `J210 I''k1:iRON1114% ,t W1.
j 9y
LA Q111MA
` n 9Wq
USE OF PERMIT
PAT O L'f4iCLOSijkk� ADDING 1.7,4 0L.1't'RN0 t Rrii,
BONIXY, ROOM SIF
V-STVAIA'.1 ED COSIT OF CIONNXMI CT TON
PLAN 47HO-7.E; FEE, 101 (1iJ(�-�1�41-:(!� `!♦4U.�`�
00iVRTIfJFa'•i'1;O,14 rW- l0i-INNS-41Q.d )n 11AI0i
NIX"'(1fVI€CAL UFT, 101-000-421.000 1, i9
S7RONQ MOTPON JiFEo' - RES.lu 101-000-241-000 �.
sa
1J
> Ss.
J-11 )1f;A1,�'IQMIZilJK11"1f?N1.A NIF) MAN(IRT"C11K
}}' ��� {gypp P�yy �{{ f[
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�p /y{�
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{ f°�'J,:
.
TOTAL P>;.;RMU Vi4 E -S OUR, NOW
®nt � g, r
TY Orr I.r�
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings a'
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
BLOCKWALL APPROVALS
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain -
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
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
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground- Conduit
Rough Wiring
Low Voltage: Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
t
Final
K H14 Notice (Perm)
COMMENTS:
LICENSED CONTRACTOR DECLARATION
1.,,I.horeby 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
424048 B 6/30/98
Date Signature of Contractor
OWNER -BUILDER DECLARATION
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
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
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 N, Policy No.
E} DAPTION ON FILE
(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, indemnity
& 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
i
r1 Le
BPERMITq CONTROL#
BUILDING PERMIT -
9802-126
^
DATE 2/25/98 VALUATION S3,261 go LOT TRACT 6 89
8
V V
JOB SITE
ADDRESS 48-141 CALLE SERANAS
APN 646-110-037
OWNER
CONTRACTOR/DESIGNER/ENGINEER
LOTHAR & MARN VASHOLZ
LARRY GUMTZ CONSTRUCTION
48141 CALLE SERANAS
15320 PATRONELA AVE.
LA QUINTA CA 92253
GARDENA CA 90249
(310)679-7113 CBL# 2789
USE OF PERMIT
ADDN
PATIO ENCLOSURE, ADDING 94 S.F. OF LIVING AREA.
BONUS ROOM 94.00 SF
ESTIMATED COST OF CONSTRUCTION
3,261.80
PERMIT FEE SUMMARY
PLAN CHECK FEE 101-000-439-318.' $40.95
CONSTRUCTION FEE 101-000-418-000 $63.00
MECHANICAL FEE 101-000-421-000 $21.50
ELECTRICAL FEE 101-000-420-000 $18.29
STRONG MOTION FEE - RESID 101-000-241-000 $.50
SUB -TOTAL CONSTRUCTION AND PLAN CHECK
$144.24
LESS PRE -PAID FEES
$0.00
TOTAL PERMIT FEES DUE NOW
$144.24
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
Desert" Sands Unified School District
Notice: - ,82-879 Highway 111
Document Cannot Be Duplicated Indio, CA 92201
619-775-3500
CERTIFICATE OF COMPLIANCE
Date 2/25/98 " APN # 646-110-037
No. 16673 Jurisdiction La Quinta
Owner NameLothar and Maj1 Vasholz Permit #9802-126
No. 48141, Street Calle Seranas Log #
City LaQuinta zip 92253 Study Area
Tract # Lot # Square Footage 94
Type of Development Residential Addition
yp p No. of Units 1
Comments
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 the amount of
0.00 X 94 or $ 0.00 the property listed above and that building
permits and/or. Certificates of Occupancy for this square footage in this proposed project may now be. issued '
Fees Paid By. N/ATelephone 31'0-679-7113
Name on the check
By Dr. Doris Wilson
Superintendent `
Fee collected /ex pted by Ellen Patino Exempt $0.00
Check No. N/A
Signature
OTICE: 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 the fees or other payment identified
bove 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 another public entity authorized to
3Ilect 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
CITY OF LA UINTA
BUILDING & SAFETY DEPARTMENT
CONDITIONALLY
ACCEPTED FOR CONSTRUCTION
SUBJECT TO INSTALLATION AS PER
AND ALL APPL{CABLE CODES
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TOP OF UPPER
}
TOP PLATE
P
BRACED
WALL PANEL, TYPICAL
TIE -DOWN DEVICE
WITH AN APPROVED
UPLIFT CAPACITY OF
1,800 POUNDS
TYPICAL AT EACH
OPENING'
END OF EACH PANEL '
X
U
I
,
----
BOTTOM OF MINIMUM
SILL PLATE TYPICAL
9l INCH -THICK (MIN.) WOOD STRUCTURAL PANEL
SHEATHING NAILED WITH 8d COMMON OR GALVANIZED
BOX NAILS NAILED IN ACCORDANCE WITH TABLE 231-0
TWO ANCHOR BOLTS, ONE AT EACH PANEL
AND ALL PANEL EDGES TO BE BLOCKED, TYPICAL EACH
QUARTER POINT, INSTALLED IN ACCORDANCE
BRACED WALL PANEL'.
WITH SECTION 1806.6, TYPICAL EACH BRACED '
WALL'PANEL
ONE-STORY BUILDINGS
For SI: • 1 inch= 25.4 mm, 1 foot= 304.8 mm, i pound =4.45 N.
''•
ALTERNATE BRACED WALL PANELS
Fwlie 2326.19
(Figure continues on page 325:)
=4
run caze of compliance: Residential
oject
t
oiect ,
L/
(Daae I Or 2) CF -1 R
Date
rte. I Building Permit s
G% Z - Plan ChecK/ Gate
Telephone
Fieid Check / Date
�mpt epee Method 1 Pa ge. Point System or Computer)
Clltnate Zone Enforcement agency use Only
!ENERAL INFORMATION
q�otal Conditioned Floor Area:/
ft2
'uilding Type:/ Single Family Addition
;heck one or more) Mufti -Family Existing -Plus -Addition
=ront Orientation: North / East / South / West / All Orientations
(Input orientation to degrees and cirde one.)
,4umber of Dwelling Units:
=loor Construction Type: Slab / Raised Floor (circle one or both)
3UILDING SHELL INSULATION
Skylight .......
THERMAL MASS
Type/Covering Area Thickness -
slab/exposed. tile. etc.)--(st) (inches LoCation/Description kitchen. batn.
—t4ft=
v. Awd dWWW71992
Construction
3omponent
Insulation
Assembly
LocatiorvComments
etc.1
Type
R -Value
LI -Value
attic. to garage.typical.
Wall ..............
J .�
'PAP (GM, 22,L
...........
Wal—
D
Roof .............
Roo
Roof.............
Floor .............
Floor ... :.........
Slab Edge .....
_.
FENESTRATION.
Shading Devices
Fenestration
Area
Fenestration
Interior Exterior Overhang Framing Type
blind. etc.) (shadescreen. etc.) (yes/nal (metaltwood/vinyl)
Orientation
(sf)
LI -Value
(roller
Front..... ( )
Front..... ( )
Left .......
Left ....... )
Rear..... (k)
, 75
�5
Rear ..... (. )
Right..... ( )
Right..... ( )
Skylight .......
-
Skylight .......
THERMAL MASS
Type/Covering Area Thickness -
slab/exposed. tile. etc.)--(st) (inches LoCation/Description kitchen. batn.
—t4ft=
v. Awd dWWW71992
Certificate of Compliance: Residential
f _
—77--,
_
(Page 2 of 2) CF -1 R
Date
HVAC SYSTEMS
Nate: input hy4mic or mmonnsd hydroruc oats under Water Heating Systems. except Design Heating toad.
Distribution
Heating Equipment Minimum Type and Duct or
Type (furnace, heat Efficiency Location Piping Thermostat
Puma. etc.) (AFUE/HSPF) tducts/attic etc 1 R -Value Tvoe
Cooling Equipment Minimum Duct
Type (air conditioner. Efficiency Location Duct Thermostat Configuration
heat puma, evao. coohna) (SEER) (attic, etc.) R -Value Tvpe • (sold or package)
WATER HEATING SYSTEMS
Energy' External
Rated' Tank Factor or Tank
Water Heater Distribution Number Input (kW Capacity .Recovery Standby) Insulation
Type d I Type in S stem or Btu/hr) (gallons) Eff iciency. Loss(%) R -Value
1. For @men gas storage (rated input s 75.000 BoAr), eisetNe resisunce and Met pump water heatws, list Energy Factor.
For ia►ge gas storage water heetwu trdtad input a 75.000 Stumr). list Elated Input
For Instantaneous gas wstw heaters. list Rated Input and Recovery Efficiency. Redovery Effiohnry and Standby Loss.
SPECIAL FEATURES/REMARKS (Add extra sheets if necessary)
COMPLIANCE STATEMENT
This cendicate of compliance lists Itis balding features and pertarma= specifications needed to comply wUh Title 24, Parts t and 6, of
the CaGforma Code of Regulations, and Me.admirusuative regulations to implement them. This centficate has been signed by the
individual wrath overall design resco nsaidy. • When ttus oendicate of compiwm is submitted for a single building plan to be built in multiple
orientations. any shading feattue that Is varied is Indicated in the Special FeatureVRemarks section.
Designer or Owner (per eusinesa a Professions Code)
Name:
Tide/Fimn:
Address:
Telephone:
Lic. a:
(signature) ' (dalla)
Enforcement Agency
Name:
Tide:
Agency:
Telephony.
• (sgrtattuerstamp) (�)
IlevtsCd .Syn. �;r ", , , t Atilt
Author -
Nome:
TidelFirm:
Address:
Ulephone:
y
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