9611-056 (BLDG)LICENSED CONTRACTOR DECLARATION
l,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
c\i" W f Professionals Code, and my License is in full force and effect.
M License # Lic. Class Exp. Date .
(� LO
1
ZO r Date Signature of Contractor
T
_
_O � a'
J U OWNER -BUILDER DECLARATION
�
HWW I hereby affirm under penalty of perjury that I am exempt from the Contractor's
U) Licen-se Law for the following reason:
Z_ �- (�) as�owner of the property, or my employees with wages as their sole
<oYGompensation, 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).
LO () I am exp pt under Section , B&P.C. for this reason
O N Dates' ./ Signature of Owner
o�
Q WORKER'S COMPENSATION DECLARATION
2 Z I hereby affirm under penalty of perjury one of the following declarations:
O () 1 have and will maintain a certificate of consent to self -insure for workers'
K W �= compensation, as provided for by Section 3700 of the Labor Code, for the
D � Q performance of the work for which this permit is issued.
n Q U ( ) I have and will maintain workers' compensation insurance, as required by
j C) Q Section 3700 of the Labor Code, for the performance of the work for which this
i rn permit is issued. My workers' compensation insurance carrier & policy no. are:
IT z Cartier Policy No.
(This section need not be completed if the permit valuation is for $100.00 or less).
(% 1 gprtify that in the performance of the work for which this permit is issued,
Issalj 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
Codte, 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 $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person, upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorizq representatives of this City to enter upon
the above-mentioned propert�y�,o.,rr inspection u�rposes.
Signature (Owner/Agenti "' Date
PERMIT # CONTROL #
BUILDING PERMIT. 1
96 11 -056 4346
DATE VALUATION LOT TRACT
JOB SITE
ADDRESS 79-641$ 8'i AK,1,`.W*vvcit ,i[. m it .
APN
OWNER
CONTRACTOR DESIGNER ENGINEER
tis LAND
siNLTU
79,605 S'T`AR Fi.C1iM'EX'[%tAIL
1,tX-QU!'NTA Cts +92253
USE OF PERMIT
131 s. f. LA-fJ1 CE fAlra .G&VefZ_
},;>.iT�.:'1•),'�t%7'1'rJ i:l�+.tlf3:>F�`
PLAN Cf t_% 1,T11
O lK;; VRA K!Ir ICIIN 0l4 1011 ")-,t 1 90w) a
.`.i`iY;)NG !t!'f,)TION TTt'13 RESlt) 101-000-241.01M
PAI
D
F 3 0
1997
CITY OF LAA.
SO [MAI, (.'ONS'1'RUCTION :AND 131 AN f--tfF k
�7/r�
[[ ��
Lil.`'SS 45IZE—VATI� i'Y:4 l
rr�Ii
$00)
"1'<iI AII,PE12NOT 11 ENS OVE, NOW
VIA$
RECEIPT
DATEBY
DATE FINALED '
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
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
POOLS - SPAS
BLOCKWALL APPROVA S
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. 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
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.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
L.
Cr of a Uinta
ty Q
1 - Buildinging 81 Safety Div' n
Bo
P. •• x l 50 4
• aIle Tampico ,p
•78 495C
°1 �6l
inta CA 92253
La Q u
`
Building Permit Application and Tracking Sheet y . .
r
Project Address: STA
FLAWE IfPWl L
Owner's Name: u v. _Lf1 tiJ^
A. P. Number:
Address:
'Legal Description: L 6;-r
City,ST,.Zip: 4A. . CA . 1225�3 �.
r:
Contracto8
Telephone: � 2.S 3
� L
9
Address`: A�� 7 �/�3 y. " ,
Project Description: i .P T/ 0 COt/�/L
City.ST, Zip: c Ari $•
h
ne:
TeleP o
State Lic. # ' �.
r
City Lic.
Arch., Engr., Designer:
Address:
.City, ST, Zip: •, f
Tele hon .Cstrc
- k -
on Type: Occupancy p
Y
•
ProJ'
ect tYPa(circle one): New Add'n Alterr Repairair DemoStaeL
Name of Contact Person:
Sq. Ft.:
# Stories:- '.
#Units:
Telephone # :of Contact Person:
Estimated Value of Project: Y700,
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO FT ,r
2ND FL. SO. FT. •,�
POR.50. FT
GAR. SO. FT. 4t
CAR P SO. FT .,Z
WALL SO FT Z
y0 cT. u
ESTIMATED CONSTRUCTION VALUATION S
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR STS—Te,;—
YSTEMPOR.
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Net to ce :,sed as ,roceny :az ia!uation
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVARCOOL HOOD
SIGN
WASH ER(AUTON DISHI
APPLIANCE ti DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPIEQUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
KITCHEN SINK
ABSORPTION SYSTEM B.T U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE.TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. e. c
BATH TUB
SO. FT. 0 c
WATER HEATER
MAX. HEATER OUTPUT. B.T.U.
SU. FT. RESID rA Ic
SEWAGE DISPOSAL
SO.FT.GAR >.c
HOUSE SEWER
REMMIKIk
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. fISE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING III AIR COMO. SOLAR
SETBACK
GROUND PLUMBING
U14DERGROUNO
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 APPIEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BONO BEAM
WATER SYSTEM
GRADING
CLL yd.
f plus xt
o _
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP,
ROOFING
REMMIKIk
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATK)WSOUNO
FINISH GRAOING
FINAL INSPECTION
CERT. OCG
FENCE FINAL
�nsre�. wR a aryww � �ww� wr � �a
GARDEN WALL FINAL
00
000
0
odood000
LO%GW%.APOK4W'
MENNEN High Performance Systems & Solutions
,-lAmimetl 214� 7
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61-- ZA &f1V7-,,q 3ZA
72!!f Z9,11 LD ,q ' C4,10 -J, Z'
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echnotogies,lnc.
AdivisionofEnPointeT
Three Pointe Drive, Suite 212
Brea,Calilbrnia 92621
Phone: 714.671.2500
Fax: 714-671-2540
hutncuwnLha P4kOTECTOR PLUS ;
FIRE INSURANCE EXCHANGE, LOS ANGELES, CALIFORNIA
Declarations Reflect
INSURED PAYS PREMIUM
Loan
AGENT—TOM N BREITFELLER—PH 19/770-9300 i9o.� 730804
05-20-96 To 05-17-97 at 12 1 AM Standard Time at az.scribed residence premises
If checked here, this policy will continue for successive policy periods as follows: If elect to continue this insurance. we will
renew this policy if you pay the required renewal premium for each successive oolicy period subject to our premiums.
rules and forms then in effect. THIS POLICY INCLUDES BUILDING ORDINANCE COVERAGE
Dpiir,, Number
"JUDY L LAND IF 91266 77 19 '
. ,
RD 356 BRANDING IRON
Agent
+._ WALNUT CA .91789 99-31-363
Same as mailing address unless otherwise stated: / keze4 141117
a 79605 STAR FLOWER TRAIL
. , LA QUINTA CA 92253 _`.: r Trj '�s��7Sa
' TEMPLE—INLAND MORTGAGE CORPORATION
ITS SUCCESSORS AND/OR ASSIGNS
PO BOX 4874 U,/ --3y-- 7//,y/��
HOUSTON TX 77210-4874
We provide insurance only fur those coverages indicated by a ;aecific r a ar oin.r ',-iauo!:.
SECTION I PROPERT% _ SE"T.
A - Dwelling B - Separate j C - Persona, Piss EXTD REPL COST
or Mobile Home - (Other) i Property
Structure_ I
1721000 179200 1291000 86700000,000 HeOOD
e.a. cccurr n oerson
Construction: FRAME I Additional Premises - Section li - Puro __ ctf use is residential. un!eSs stated otnere:!s..
No. of Units is: 001 ROOF:505; S FARRELL AVE #F34 PLM SPRNGS CA 92262 2ND RS
Insured is: OWNER CONCRETE
Protection Class: 04 Outboard Motors o:sr 25 h.p. (Single: c- :,prnbinec• - Section Il
Premium Group: 01
Territory: PC I MOTOR A iii�i i 0R
Premium Total PreDcld Subject t;. E4207 1ED E6018 1ED H6114 1ED
First Year Premium Ithefollowi^c 438BFUNS 5-42 E6179 1ED 59072 1ED
5?5.00 Forms an:; E6047A 1ED H6106 1ED
Endorsements
Deductible - Cov. A. B or C S 500 Excet) iio t if checked her- d ct = of S250 aoolias to loss for ce ;- o�
In case of a loss under Coe. A. B. or C. we cover cr E' that r7— iie tot loe. ~e�_ sfar
'For Landlords Protector. Coverage is Loss of Ren::. Cove. -a,:1. °" ?usmr- 'L'
n TEMPLE—INLAND MTG 04 52 94
'PC BOX 4874
, HOUSTON TX 77210 PCO: BOX -9012'- I
CARLSBAD, CA 92008 05-21-96
— NON—SMOKER, NEW HOMES 50 PLUS � •
This Declarations page is oast of your ocincld. It suoc;snoes a : rroiS : d` ��'�'�=�•:�
terms of the policy. �% �� cP`t'=✓ , _
��.
See reverse .QC.-Tl,;CP. E: ,� .. } -:• -'
., side for Lenders Loss Payabi,.e Eng
44++Tltfs.',y�t6"'F �rrym;^ „;M:f»M►,,;�u tW,ara.�-rc- .v:•^«..
_I
• t
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 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 numbef on all permits for,which they
apply. 'y
If you plan to do your own work, with the exception of various trades that you'plan to subcontract, you should be
f 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 carr'y 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). Tor 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
Q 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
DEFT. OF BUILDING AND SAFETY
78-105 Calle Estado +
La Quinta,. CA 92253
(619) 564-2246
FAX: (619),564=5617
OWNER'S SIGNATURE /DATE
r i—cwGe- Te
PROPERTY ADDRESS
-C)S�o
PERMIT NUMBER(s)
4/18/97
To: Daniel P. Crawford, Jr.
Building Department
City of La Quinta
Ref: Permit No. 9611-056
I hearby certify and attest that the four Simpson 'CB66 column bases for the patio cover at
79605 Star Flower Trail, La Quinta are embedded into solid concrete measured at least 12" cubed.
I used two 601b bags of redi-crete in each footing hole.
4RogZJ. Hart
(760)772-1132
•
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LCAT (b5"
41,4A)P1W16A1Ztl6tA NOPEafy
RAFTER SIZE AND SPACING
7SPECIFY ROOFING NO SHEATHING OR OPEN LAr=i
(SEE ROOFING NOTE ON REVERSE) 7
ROOF PITCH
. . . . .
CONTINUOUS LEDGER
SIZE
'T' ANO v STRAPS
I 'lrxb'xI,x1/f •PRM I
OR 9OLT
(4) 16A NAILS I
-RAFTER SPAN. 2C
;� POST SPACeNC
O.M.
O.M.
'- r "
r
OVERALL o - "
OVERALL LENGTH: LOUTH
6 o t-rg walslr ON. 4rxC POSTS m
REAR,SETBACK
SIDE SETBACx
411,
'
i
FINISH GRADE
2000 P.S.I CONCRETE — L_
FtM3M CRAOE V_ yam. If x12" FOOTNIO T
J
. I
1? BELOW Oft
PROYOE '1' CIFJIRANCE
BETRNEEN POST IMO
CONCRETE
OPEN LATTICE PATIO COVERS IMT BE ATTACHED TO DUSTING FASCIA
U-~ OR ANGLE
VIA ONE 11,C x r, LAG SCREW THROUGH FASCIA INTO EACH RAFTER TML.
NON-OORROSNE PLATE
P•
3/tr x S LAG SCREWS INTO STUDS AT Ir O.C.
�
• CONTINUOUS LEDGER
(4} 1 ed NAKS
OORR BOLT
I f r"
U -STRIP OR ANGLE
_.. _
(i)- lea 11AU
Ql�t OOLT
JOIST HANGER OR SOLD BLOCKING
MAIL RAFTER TO BLACKING
ANCHORINTO (BAND
r M. BETWEEN POST��
CONCRETE
BUILDING DEPARTMENT USE ONLY
TYPICAL PATIO COVER
PERYTT NUMBER
DATE OF AFftM W
PERMIT ISSUE DATE
owoom TWE
FINAL INSPECTION DATE
STREET AD01lESS
SPECIAL CONDITIONS
Cm. ST Zi
TELEPHONE
N.O.A. APPROVAL Slomn RE, pAIE