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9904-209 (AR)LICENSED CONTRACTOR DECLARATION ,hereby affirm under penalty of perjury that I am licensed under provisions of ' 6hapter 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 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 nb r Date _ — Signature of Owner.j u ax f .R C r-•+ 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 11 maintain workers' compensation insurance, as required by Section 370O.of the Labor Code,'for the performance of the work for which this perrhit-'is issued. My workers' compensation insurance carrier & policy no. are: Carrier Policy No. (This section need hot. be completed if the permit valuation is for $100.00 or less). ({)A 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 ? i o .A t Alm Y / . •, 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 authorize representatives of this City to enter upon the above:mentioned property for inspection purposes. Signature (Owner/Agent) } j �M� =•'� : bl� Y,/ ate + • ��� k BUILDING PERMIT PERMIT#"0t)9 DATE VALUATION S8,413.20 LOT TRACT JOB SITE ADDRESS -"Ss SOMME”MLLE APN 76-9-451-078 1 � OWNER CONTRACTOR /DESIGNER/ ENGINEER tLAINTR M, 114CKINLAY 54855 SC)U'I'i= ERN WLLS LA. Qil3NTA. - USE OF PERMIT A 92:153 03IN CONbIXI; MS3':l'; O AMUM INTO IVR S.F. c)r ICS; 7 Cttars)3N1 C0i�',Tt'TRLTC'3 LG' Ai 108.00 3F I.W.11A IA'!'ED COST bF CON`.T;tUCTIONN eEE'.i1iff .PEE S%iMl'1'3AIRR PLAN QfffiCK FEE 104 4_10-439m318 570.20 C()' 151MIl "I'VON F9_9 I fi f 40-41 A -M Volt.t110 hJECIJAN1 JP,A ` Fes: 101-000 dot 000 $21.50 Ilt 111 llv AL F U, : 101-00042,0-000 F+LUN- 3il+610 Ff,U 101 -W -419 -WO $2:1.00 M."R014 AffOTTC1N FFT. _ iiR`41'O A01-11111,2414)01) $ P4 Sllft.."ri..X) AL C.ONST'R[ (TrION ,LINT) PIAN CPE.CK LESS PRE -PAID FEES TOTAL PERMIT Ff.'l 15 OUE NOW RECEIPT DATElc DATE FINALED INSPECTOR 3141120 $240X2 $0.00 $?411.3? 1 f� Sllft.."ri..X) AL C.ONST'R[ (TrION ,LINT) PIAN CPE.CK LESS PRE -PAID FEES TOTAL PERMIT Ff.'l 15 OUE NOW RECEIPT DATElc DATE FINALED INSPECTOR 3141120 $240X2 $0.00 $?411.3? PP 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 8 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 Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) COMMENTS: 11 11 .......................................... kCC7f . . .......................................... XX City."b La Qu nta C'i .. ......... X.- .... .. .... ....... : .. Ex, ....... :::: . .. ..... N.: Building, 81 S, .-PiviMon:, 7.7. '�fe(y P.O..�Box 1-504 ...... ......... ...... ::.:.X.:.X.... i7a Calle Tampico -495 La Quifita, CA 92253. ............... ........ .............. ..... ......... X, ...... Tefrnii A -Sh'et •T Buildintz g. ficaelo'n and Tracking e .�X ... .. ..... .. ... Project Address: S' WYSS Own er's �ame:' A. P..Nui ber' f -7 Address: Legal Description: City,ST, Zip:- 94 i J 2.5-3 ontraFtor: 4Teleph one: &,o -7 -7 3 c>s 4 ............. ...................... .......................... . . . ... ....... . ..... Address: Project Description: City.STI, Zip: Teleph6ne: ............................... ............. ..... .... .. .. ................ ....... ...... State Lic,'# City LiCA: Arch., Engr:;Desigriei:.c- Address: City, 5T:,Zip• D-- Telephone: ........................... ...... ...... ..... ..... ............... ... . ........ ... .............. ... Construction ype: �CtipanCy: State L 'ic. #: .. ................ .... ..... ................. . XXXXXXXX.. .............. . ....... .. .... .. ......... . ........... X'X+ X .............. XI X'X -++ ............ .. . cle on Re Demo P�roje, t type (cir e eWL Add'n Alter a Naive e Irson, ,N of Contil&T Sq. Ft.: Stories'. Units: Telephone 9. of Coniact Person:,. " Fsti'in ated Value of Project: 4 LE—v,&O 11 11 .......................................... kCC7f . . .......................................... Coachella Valley Unified School District P.O. Box 847, Thermal, CA 92274 (760) 399-5137, Ext. 235 i This Box For District Use Only DEVELOPER FEES PAID AREA: AMOUNT: i RCPT M . CK 0: CASH: INITLMZ: DATE: CERTIFICATE OF COMPLIANCE (California Education Code 17620) Project Name: Date: May 4. 1999 Owner's Name: Elaine McKinlay Phone No. T;z! - ;3N e0 Project Address: 54-855 SahthemPffli l l s- La Qui n a, PGA Project Description: Room Additions APN: 769 451 078 Tract #: Type of Development: Residential , XX Commercial Total Square Feet of Building Area: 108 Sq. Ft. Lot #'s: Industrial Certification of Applicant/Owners: Theyerson signing certifies that the above information is correct and makes this statement under penalty of perjury and further represents that he/she is authorized to sign on behalf of the owner/developer. Dated: - �V — 9 G/ Signature: SCHOOL DISTRICT'S REQUIREMENTS FOR THE ABOVE PROJECT HAVE BEEN OR WILL BE SATISFIED IN ACCORDANCE WITH ONE OF THE FOLLOWING: (CIRCLE ONE) Education Code Gov. Code Project 17620 65970 Approval Number of Sq.Ft. 108 Amount per Sq.Ft. $ 0== Amount Collected $ Agreement Existing Not Subject to Fee Prior to 1/1/87 Requirement Note: Pursuant to AB -181, any room additions or enclosures of 500 sq.ft. oreless are exempt from developer fees By: Foch "Tut" Pensis. Assistant Superintendent Administrative Services Administrator in Charge Certificate issued by: Marcela Valdez Signature: NOTICE OF 90 DAY PERIOD FOR PROTEST OF FEES AND STATEMENT OF FEES Section 66020 of the Government Code asserted by Assembly Bill 3081, effective January 1, 1997, requires that.this District provide (1) a written notice to the project appellant, at the time of payment of school fees, mitigation payment or other exactions ("Fees"), of the 90 -day period to protest the imposition of these Fees and (2) the amount of the fees. Therefore, in accordance with section 66020 of the Government code and other applicable law, this Notice shall serve to advise you that the 90 -day protest period in regard to such Fees or the validity thereof, commences with the payment of the fees or performance of any other requirements as described in section 66020 of the Government code. Additionally, the amount of the fees imposed is as herein set forth, whether payable at this time or in whole or in part prior to issuance of a Certificate of Occupancy. As in the latter, the 90 days starts on the date hereof. r IAC 440 C� OF IE�9wS ' 78-495 CALLE TAMPICO — LA.QUINTA, CALIFORNIA 92253 TELEPHONE (760) 777-7012 FAX (760) 777-7011 . !? OWNER/BUILDER INFORMATION Dear Property Owner: " r An application fora 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/ `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 variuusirades 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 contiactois or subcontractors, then you niay 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 unemploymeni'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. ` +r For more specific information about your obligations unde'r.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. t . Information about licensed contractors may obtained by contacting the Contractors' State License Board in your community or at 1020 N., Street, Sacramento, California 0814. r 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 ihe•verificadon is returned.. 1 Very truly yours, „ 'CITY OF LA QUINTA 1 r DEPT. OF BUILDING AND SAFETY . _ 78-495 Calle Tampico - _LIQuinta;'CA 92253 '- (760)777-7012 FAX: (760) 777-7011 + ` i OWNER'S SIGNA /DATE,.; - -4- �� T c. p 2 "c S F. PROPERTY ADDRESS PERMIT NUMBER(s), t ,