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0106-147 (RER)`r N aj Osco d,V_ W oZI-- c�o0c H� ~a to Z co LO N O� U Q CL— r Q 0 lL O J Co Q VU O MH It Z coo O J LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Cha.pter 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 Cony ctor OWNER -BUILDER DECLARATION1 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 Orofessionals�Gode). ( ) I, as owner of ..the -property am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business & Professionals Code). (w)�l am exempt under Section , B&P.C. for this reason v' tD"ate. Signature of Owner_ at..:' a' ,:rJ'°r WORKER'S COMPENSATION DECLARATION ✓ // e I hereby affirm under pe4lty 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). ( ,),OI 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 1 should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. ate: 1 Applicant Warning: Failure to secure Workers' Compensation Average 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 IawsF4relating to the building construction, and hereby authorize representatives of this City to enter upon F the above-mentioned propertyfot inspection purposes: � v •Signature (Owner/Agent)+(ata �•���/•1�tr•��1=�j� BUILDING PERMIT PERMIT# DATE VALUATION LOT 010&147 TRACT JOB'SITE ' tv ADDRESS APN 4S,1S4Q)DXV&1T AM S1 - OWNER CONTRACTOR / DESIGNER / EN INEER I ioL a- ku-MLY LO :I. 45 -540 DEZEMN AIR ST ,L4 C?ON'd:A CA 92253 USE OF PERMIT + _-. fom^ >° S eeal 6e 'i '2PNIOWL. MAWIMR >SATH . ADD SlrA tW AND LAY MISTINGMASTIM R.Et"O;NtlTRUCT Iff[HO `I't.61+i TO SHOWER STA141,101CLOSUr-M 414MMIATIt -MO SM1;i 009, R. -A It°iDEL TO MA;°PERI WALK TH CJfre,9SM. VALUATION 31090.00 iZ i PERMIT Film stalway 1').M CHECK ME 101.10©-439.318 5400 C014S": RUC TION FE,X ;V_ ' 101-000-418-0M $"Td,a �(? - #,Ja� �WX—MIUCALk ryrya-Ii�Affs�Y-�A [O�pthpt'ii p$13.77�5 Litt N 14 2001 '�7Q�ftl�����lk'""1c^:`!f3`f.tY - INANCF �. V 7� a. ` Gf:00 TOTAL FErW-rFE16 DOE NOW. ta• $167,05 J RECEIPT N , ' ,DATES f BY fit r DATE FINALED INSPECTOR ,�/ INSPECTION RECORD ' OPERATION a 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 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 _ Waste Lines �` Water Piping Gas Test Electric Final Heater Final 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: LIVING ROOM LOWELL 45540 Desert Air Street 360-4915 CITY OF LA QUINTA BUILDING & SAFETY DEPT. APPROVED FOR CONSTRUCTIO DATE r," A_Kt-INJt't mum rtt ur im WILL BE CHARGED IF THE APPROVED PLANS AND JOB CARD ARE NOT ON THE SITE FOR A SCHEDULED INSPECTION. NO EXCEPTIONS! a r resistant const. of showeure materials to a height of n. aboove the drain inlet. 2666 8050 4010L200i U 1068 1068 O w aw _ ® cr Shear Wall Ends 12 Ft. LIVING AREA 463 sq ft ......', �0� er_ Bath '` •.... ........ BATH MASTER io OoO Hdr 4x6 r Bath Also 12" k 0 iqz Tub 2668 ' 5'3 Master Cl set fl 12'6 4'6 22'1 1088 2686 Y246081066 5'21 98 30'5 LIVING ROOM LOWELL 45540 Desert Air Street 360-4915 CITY OF LA QUINTA BUILDING & SAFETY DEPT. APPROVED FOR CONSTRUCTIO DATE r," A_Kt-INJt't mum rtt ur im WILL BE CHARGED IF THE APPROVED PLANS AND JOB CARD ARE NOT ON THE SITE FOR A SCHEDULED INSPECTION. NO EXCEPTIONS! a r resistant const. of showeure materials to a height of n. aboove the drain inlet. 2666 8050 4010L200i U 1068 1068 O w aw _ ® cr Shear Wall Ends 12 Ft. LIVING AREA 463 sq ft ......', �0� er_ Bath '` •.... ........ BATH MASTER io OoO Hdr 4x6 r Bath Also 12" k 0 iqz Tub 2668 ' 5'3 Master Cl set fl 12'6 4'6 22'1 A. 5'2 1068 5-2 1'11 30'5 518 3'3 13'6 918 911 35 4' Tl 0 2-8 1-11 p 2'3 1'6 1,9 58 4010 I 2040 1068 2668 1068 LOWELL 45540 Dieser 360-4915 Before I Ing Room C5 v 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 (7/60) 777-7012 fes"FAK (760) 2 7; PROPERTY ADDRESS ,4106 .y -,z -ill' - Amodz, PERMIT NUMBER(s) FMA I - Bin # City of b .Quints Building 8r Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # 'Project Address: pefwf,41� , -Owner's Name: A. P. Number: Address: Y5_00 Legal Description: City, ST, Zip: 4 0 �2 7- 5-3 'Contractor: Owlle,,, l'y Tele hon .................. ... ......... iiii, .................. . . ............... 'Address: S.tA to to- "Project Description: "City, ST, Zip: U J'A 7� L/- M/ '7ZZr,_3 _-C4 -f 9P- IA� 19 4 "Telephonef 710) 360 Y91� ....... ... ..................... X"': ........ : ................................. ................................. ................................. ................................. ................... .................... X .......... ive V iy� _5 �State Lic. # City Lic. #: /"- 57 Arch., Engr., Designer: T-/, to t/1-110-ScIt- W) Address: City, ST, Zip: /1� 11P r -(GL 0V e, Telephone: ........... ................... ............... ........ ........................... ............................ .........XXX .. -.x. :: ................... .................... ............................ ............................ ................... .................... ................... .................................. ................................. . .................... ...... Construction Type: ri�y_ State Lic. #: Project type (circle one): New Add'n Alter Repair Demo Name of Contact Person: Sq. Ft.: # Stories: # Units: Telephone # of Contact Person: Estimated Value of Proje WX -a APPLICANT: DO NOT WRITE BELOW THIS LINE N Submittal Req'd Ree'd TRACKING PERMIT FEES Plan Sets Plan Check submitted ofF 01 Item Amount Structural Cates. Reviewed, ready for corrections A Plan Check Deposit Truss Cal 6. Called Contact Person &1�1611 Plan Check Balance Title 24 Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Q A Vdo I Mechanical Grading plan 2"" Review, ready for corrections/issue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- Review, ready for correI Lons/issue -Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees TotalPermitFees