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0001-230 (AR)A+ LICENSED CONTRACTOR DECLARATION I 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 Professionals Code, and my License is in full force and effect. • License # Lic. Class Exp. Date ik i /ate Signature of Contractor-- OWNER-BUILDER ontractor- OWNER-BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's L* nse 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)"f r `�.' k)/ram exempt under Section,-, B&P.0 fo-rt - abate Signature of Owner ,-0— WORKER'S COM_ PENSATION 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. (This ce tion 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,suu ject to the ,workers' compensation laws of California, and-ag"ree?that ill should become subject to the, w9rkers' compensation provisions of;Sectiorffr O0 of the Labor Code, I shall,forthw�ith comply with those provisions. Date: /�/t� Applicant Warning: Failure to secure W rkers' 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, tateoiaws relating to the building- construction, uilding construction, and hereby authorize re111�pfesentatives'of this City to enter upon! the above-mentioned property fo iinspectro ,purposeSf- Signature (Owner/Agent)' Date P-H{� PERMIT#,o BUILDING PERMIT 3��-��► ;,,,; �� , ,� DATE VALUATION ` �� � � � LOT TRACT, 3 JOB SITE 51-160 AVf+:NIDA. PrklRwLE!jV APNr ADDRESS 113 - C�3 - Gq7 OWNER CONTRACTOR/DESIGNER/ENGINEER iEu'BrV1 NVN All 4i�1 t 1. 51160 A ENIDA Vr1(. LEJO LA. QUIT -AA. CA 92253 � USE OF PERMIT .k AlAIL.Y X00fa1 A10111 t3UN 60051,, COVLd LW V1 -1,1U f 1t1S1', 3PA Ali Q 2AL 6' & 32LF 5' QA; 1)EN BLOCK WALL. l'1LDITI C1AV 603.00 I PWL AMYOR SPA 4,(Oi.00 L9 vi ' PORCiafi'M 0 330.00 I.SF tis 6 ITT, WA11, 24,00 LF ^3' g 1- I% WALL 32.00 LF f S'1`,"N"fEM C OS'f O.ft" C0NS'fRUCTION 42,26 .80. PLAN CHECK K FEE 101--000-439-318 V31 AO Jt �^•i✓ �r:. 4 nt-�rofs..�ftR-t�I�luft �a�F•'m � , q��;�rvr��r��rr�nr Lill^tIV+I-•v43� `.�'.+'i.50 l�Jfu�'S~.f4�1,�r'CALl�� � . kl;CFM iN .FE 102 -MI -419-000 533.y0 TRfi'PJt'3• TOCYrION FREE. - RE4;Pi') to GRAMICi ri''- wifi,C PANIC AL FEE, -- POOL Kati -i1C 421-000 ELE(.7FMC;AL FEE, _- POOL ! 101 -000 -420 -0 -Cd) FU PC.f.)WONOFJ. E -- POOL 1 -(390• -419 -.Mn, S1JOA CvEI-N'FMI T -R -710N AND K A43C HECK L14,E. S P E -'IUD YE�iS X3.00 TOTAL PE•11211'dI-iC FEI?,t9 DI{'b:,N0W $793.75 RECEIPT DAT ! t f BY j t DA FINAL D w/ 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 77 6"o F.A.U. Framing Compressor Insulation ._ &AV Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath 37 Drywall - Int. Lath Final Final o ?/ BLOCKWALL AP ROVALS Set Backs Footings steel Electric Bond527 Main Drain POOLS - SPAS �7 Bond Beam —p4 Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines Neater 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: Desert Sands Unified School District 47-950 Dune Palms Road Notice: La Quinta, CA 92253 Docump5, Cannot Be Duplicated 760-.771-8515 CERTIFICATE OF COMPLIANCE Date 2/4/00 'APN # 773-063-007 No. 19997 Jurisdiction La Quinta Owner NameMatthew Turner Olsen Permit # N455'L--1.60 , Street Avenida Vallejo ) Log # ' City La Quinta zip 92253 Study Area Tract # Lot # Square Footage 600 Type of Development Residential Addition No. of Units 1 Comments At the present time, the Desert Sands Unified School District does not collect fees on garagds/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: 'EXEMPTION NOT APPLICABLE This certifies ithat school facility fees imposed pursuant to Government Code 53080 in the amount of 1.93 X 600 or $ 1,158.00 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 Matthew Olsen - CASH Telephones 564-2%20,, . Name on the check ' By Dr. Doris Wilson ' F :Superintendent Fee collected /exempted b Ell n Patino p Y Pa ent Received ym ..r $1 �58.00,' -r�:, r Check No. CASH'�"�` 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 )ove 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 Alect 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 OWNER/BUILDER INFORMATION Dear Property Owner: An application for a building pe , rmit has been submitted in your name listing, yourse If 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 number on all -pefrfiiis, for which they apply. • If you plan to do your own work; with the exception of various trades that yob 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 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 inclucling;State and Fede'ral,.iricome [ax withholding, federal social security taxes;- worker's compensation insurance, disability insurance costs and unemployment compensation contributions. There may be financial risks for yu if you do' not carry 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 Adminstraiion). 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'thcir 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/ guilder" 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, a're performing 'their own .work personally. Information abdut licensed contractors -may be obtained by contacting the Contractors' State License Board in your community or at 1020 N. Street, Sacramento, California 95814. •J. ' Pleaie complete and return the enclosed owner -builder verification form so that we can confirm that you are aware of.. it will not be issued until the verification is returned., these matters. The building perm Very.truly yours, CITY OF LA QUINTA DEPT. OF BUILDING AND SAFETY 78-495 Calle Tampico La Quinta, CA 92253 (760) 777-7012 FAX: (760) 77 -0 E_R'_S SIGNATURE/.DATE _o PROPERTY ADDRESS 000/ - a/0 J PERMIT NUMBER(s)