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9812-101 (RPL)LICENSED CONTRACTOR DECLARATION I,hefeby 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 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). ( Y) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business & Professionals Code). )/1 am exem t u rtSection , B&P.C. for this }reason VDate %ii ►C�'T 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. (This section need not be completed if the permit valuation is for $100.00 or less). ()9 1 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 shyi ll forthwith comply with those provisions. ons. {,Date: /y_. --y©-y�Applicant t t �i-,�.t� 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. V'Signature (Owner/Agent) . i -r+ ♦ 7y �1 � BUILDING PERMIT PERMIT# 9Xy 1-101 DATE VALUATION LOT TRACT S�E,�EiO.tzt1 , ;o.11)JOB —11 SITE ADDRESS .j�a}..S2,r151VERBENA DRI'V'Lj" APN — OWNER CONTRACTOR/DESIGNER/ENGINEER AIt, V A Pt.0 J & AriC GLA J H E ''NAN:)1?"I.. ON%NI ER/BulLOrR 4I5'.5 VERBENA DR LA QUINt'A CA 92253 t i - f:Ft1.M USE OF PERMIT Ptx: L AND/OR SE;A ('CnOlr'SPA ONLY, ALr RMS ARiciWS SHALL BE N AT Pa-PLAS ER NSN1sc:"1'1eJN, POOL ANWOki. SPA 8.100.0) LS Et ST C.'U T OF CONI S' RM. FIGN 8,100,00 PE'R IT FEIN. SUM MARY PLAN 0-11E{.K IFF11 101-000-439-318 (IONSTRf 7(^ ION FIFE 1014.W-41 R-4} O $1 tax M MM- IANWAL FM -- MOL 101-OOW-421-000 $21.00 E'LECUICAL FEE -- POOL 101-0{i()-424-000 � &41S.k4s PLU1114t31Nt3 %'FX — KXX 101-000-4313-000 327.00 1 R t >; 9 I ; Sl,i)i-T)7"AL CO N.C1_"t1 ICTION AND RAN M1?C $274 711 P. fiy, • ; LESS PRE -PAID FEES f $000 DEC 3 0 1998 TOTAL PERMIT li`XF-441 1JUNONV $274.241 RECEIPT' DATE —7— Y DATE FINALED INSPECTOR 4 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 APPROVALS Steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric L-3 i< Underground Plbg. Test p0 / 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 C 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) "`"�c-v..-^.'i...-..-r.......1�1r�../4f-.P"T-�'`�-i.-r'7�1►+L%-�...�r.r'1..'^...ti..r-.-,.,:r.'.,r-Yl.�,v�+�..�..y,-�"'�"^N`'�.'�f"'y-��F.�.^^.s..�'Y^•^,SY...yy..,(--^..wr'�"�+�'.+ryra..,.,,.�y:..�"..,.-;,#:..; r+�:.^'"'"*.^.-r. . I . 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/ 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 various trades 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 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 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 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. 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 DEPT. OF BUILDING AND SAFETY 78-495 Calle Tampico La Quinta, CA 92253 (760) 777-7012 FAX (760) 777-7011 OWNERS SIGNATURE/DATE PROPERTY ADDRESS 98a --lel PERMIT NUMBER(s) CITY OF LA QUINTA SUB -CONTRACTOR LIST OB DDR FSS Jj�� kt4&Ao'0 2M. PERMIT NUMBER OWNERAZ BUILDER A e A his form shall J&_Pq_92d on the job with the Building Inspection Card at all tomes in a conspicuous place. Only persons appearing on this list or their employees are authorized to work n this job. Any changes to this list must be approved by the Building Division prior to commencement of work. Failure to comply w ' ill result in a stoppage of work and/or the voidance I Sir% C.1 11 i� nm- an ni-r-aptnhin racnnnQP_ I building permit. For each applicable trade, all intormation requesteG De10W MUSt Ue GOMIPIuteu !s License:: tate CdrtiictoF* Classification License Number Exp. Date (e.g. A, B, C-8) (xxxxxx) (xx/xx/xx) Uy OPE! '-d"L. %.041 we . ............ Workers ra* ompensati 4Insurance Carrier Name Policy Number Exp. Date (e.g. State Fund, CalComp) (Format Varies) (xxixx/xx) ity8usiness: Li ce a License Number Exp. Date (xxxx) (xx/xx/xx) Trade /Classification Contractor 7 Company Name EARTHWORK (C-12) CONCRETE (C-8) _Tc YKr--Lk)lv5 ).2 rAlie, FO LYAJ _Z FRAMING( -5) STRUCT. STEEL IC -51) 5- vie '7_'TJ e),yi PTI *.V B AJ LE., MASONRY (C -29) PLUMBING (C-36) 1A LATH, PLASTER (C-35) DRYWALL (C-9) HVAC IC -201 ELECTRICAL IP -101 ROOFING (C-39) SHEET METAL IC -43) FLOORING 4C-1 5) GLAZING IC -17) INSULATION (C72) SEWAGE DISO. (C-42) PAINTING (C-33) CERAMIC TILE (C-54) CABINETS IC -6) FENCING IC -13) LANDSCAPING (C-27)0 fe., 1 POOL (C-53)7 4F * 3 liz/ I b a 1� Jr e- All UVA SPA EXISTING DECK .. I S CENEFIAL SPEC 1F'ICAl'l0Nf!S SIZE 14 X 32 r �ru_ moma, AREA 'o 384 PERIMETER - ano j:cnQj, tiol --r, �jpjjtv I DEPTH w . ................... L AND ALL APPLiCAKE CODES w RESIDENCE ir 10 0 SLIDER. MOTOR 1111 FILTER STA RITE .300 GASLINE Uff FT. POOL LIGHT 400 W CLOCK ELECTRICAL BY. PT GALS GPM HP SQ FT GPM M14 HRS_ DECK TYPIE STEP FT. SPA SPEC_S_._ SIZE RAISED_ LITE 100 WATTS TRI LEVEL SEATS 22" 24" 27" DAMWALL 1.X Lei'.IDESIGNER , DAMWALL TOP ;JCHARD/131/. SPILLWAY SIZE WIDE DATE, 10-20-98 .Name: HER NANDEZ RESIDENCE Address: 4l-525 VERB'A NA CISH LA QUINTA TRACT LO'T# �zw od S0 .0 Poa w I PALM DESERT TEMECULA '13-01 1 COUNTRY 28910 RANCHO CLUB DR. sTE F-4 CALIFORNIA RD. 1/8 =T';'CALE [PALM DESERTTE CA. S 206 0'02260 TEMECULA CA. NOTE: 92591) LANDSCAPE AND FURNITURE J .(760) 346:4032 ARE SHOWN FOR ILLUSTRATION I ONLY.Al"4D ARE NurINCLUDED11 LIC ## A-9174127 .1 11 0 —re BUI i L D! 01 F'SCUBJEU ACCEP PEI w . ................... L AND ALL APPLiCAKE CODES w RESIDENCE ir 10 0 SLIDER. MOTOR 1111 FILTER STA RITE .300 GASLINE Uff FT. POOL LIGHT 400 W CLOCK ELECTRICAL BY. PT GALS GPM HP SQ FT GPM M14 HRS_ DECK TYPIE STEP FT. SPA SPEC_S_._ SIZE RAISED_ LITE 100 WATTS TRI LEVEL SEATS 22" 24" 27" DAMWALL 1.X Lei'.IDESIGNER , DAMWALL TOP ;JCHARD/131/. SPILLWAY SIZE WIDE DATE, 10-20-98 .Name: HER NANDEZ RESIDENCE Address: 4l-525 VERB'A NA CISH LA QUINTA TRACT LO'T# �zw od S0 .0 Poa w I PALM DESERT TEMECULA '13-01 1 COUNTRY 28910 RANCHO CLUB DR. sTE F-4 CALIFORNIA RD. 1/8 =T';'CALE [PALM DESERTTE CA. S 206 0'02260 TEMECULA CA. NOTE: 92591) LANDSCAPE AND FURNITURE J .(760) 346:4032 ARE SHOWN FOR ILLUSTRATION I ONLY.Al"4D ARE NurINCLUDED11 LIC ## A-9174127 .1 11 0