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0204-119 (BLCK)LICENSED CONTRACTOR DECLARATION �' • I hereby affirm under penalty of perjury that'I am licensed under provisions of Chapter 9 (commencing with Section 7000llM DiviLaon 3 of the Business and Professionals Code, and my License is in full for ecr and effect. ' License # . Lic. Class It. Exp. Date Date Signature of Contractor OWNER -BUILDER DECLARATION I hereby affirm under penalty ofperjury that I am exempt from the Contractor's License Law for the following reason: ()"r�._ 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). ( ) 1, -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&RC. for this.reaso�n /Date Signature of Owners WORKER'SCOMPENSATION- DECLARATION t, ' 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 l. if the permit valuation is for $100.00 or less). (X),. I certify that in the performance of the work for which this permit is issued: hshall not employ any person, in any manner so as to become subject to th(i' workers' compensation laws of California, and agree that if I should become sub1ect to the workers' compensation provisions of Section 3700 of the tabor Code; I shall forthwith comply with,those provisions. Date: 411o. Y LL Applicant Warn ing.Failure to secure Workers' Compensation coverr'•age.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' b whose request and for whose benefit work is performed under or pursuant to .r• 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. kagree 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^, T 1 `1 ,"'Signature (Owner%Agent) L _. PSS{ n° �'�' Date B.UILDING PERMIT '" PERMIT # ,r - ,1�, DATE t VALUATION ` LOT TRACT JOB SITE ADDRESS ,' Q��«�1 �f'�°.I�Y�s;��b3�."�.' APN OWNER CONTRACTOR/DESIGNER/EN 6INEER DAVM l'•i'Ua3:MO t�'�+��a�c.i.amm 28-4105 F"WIF E.IrT.WAA GA92,02 GBLO { USE OF PERMIT 18 ,,l* 4` WOO) ki—!WI K HQ.k APd' RC7Vr L ON FILM; 'i�'?> �iTfJ �i? PENCE 1�.�� LF .. " `S fkkra elf+ C10Nk"1.�d':(1��,1r.1(0. ? _ •; �6,)f ��••v����Tyi?��avvgql�����°ggyy��qqtt//�s�yy��'lh������'zf:�' y,tt�� t�•y�. yy S pp��y�rqq f Cyt �iy'L15'f.Ldi'�114.-'.iJWE•E S=3'r.�* - .. ,LVtF4# . a ., APR' 1Vt ,�-,ly - .•.� {'p y'7� �`� ,a•�J'�{,�[9(�:yp'( �'y�,p ��gy '.y y�.q-• /• (�'�('g��{i'}p' 1.l1.i.CY C.11. J.P l,+0-14S7.,1..Vwl C..GOi'�7 �:LVJ,.��d'.�-M •.I•i:]3'•3. K [f `ry - Ir �I'�.1 FEW .W�"'Y.�d.6dLt $0.00 't`'�:A?.Cl:' Ct': :QIP N i'3.Q4 R xr � RECEIPT DATE BY DATE FINALED y ' INSPECTOR �- INSPECTION RECORD OPERATION I 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 Patty 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 I Gas Piping PLUMBING APPROVALS Gas sTesElectric 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 i 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: DAVID A. GUSTAFSON 28405 Faircrest Way Escondido, CA .92026 (760) 751-1258 %41? U (760) 715-1258 (cell) e y (760) 751-1006 (fax) Q? davegustafson@earthlink.net March 2, 2002 To: Villas of La Quinta From: Dave Gustafson . Subject: 49-145 Washington Improvements I recently purchased the property ,at 49-145 Washington. I would like to make some improvements in the next year. It may take`me some time to make all the improvements, but it seems easier and more courteous to request them all now:-. I am not sure of the process, but will adhere to any rules and restrictions that are necessary. &� nd the patio by. 10' with a concrete slab, but no wall. This will include the addition �of a hose bib and electri outlet on the south side. I would like to replace the oleander as well. Replace the front and back sliding doorswith French doors. dd a Dish Network satellite dish Add a back patio wall which will be an extension of the end wall and will not extend beyond the existing atrium. The new wall and gate will not block access to any utilities or to the underground covers. It will involve moving .the air conditioning unit out about 3 feet. Install a skylight in the master bathroom. . 6. I also want to make improvements inside. I am not sure these require permission, but I include them in case it is necessary: New kitchen cabinets Water to the refrigerator for an ice maker Remove the wallpaper and paint the interior �+ Add new flooring -tile and carpet , eplace the master bathroom shower with a tub; shower, and steam shower combination, O\ :. Add garage organizers As I said, I will not be doing all of. these immediately.. However, I would like to do as many as possible before I move in. This will occur as soon as.I sell my other home. If I need to provide other information, please ask. I' am eager to cooperate. Sincerely 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 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 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 Iproviding 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 OWNER'S SIGNATURE ATE. X 41-14S PROPERTY ADDRESS 0zol4-h PERMIT NUMBER(s) DEPARTMENT OF BUILDING &SAFETY COUNTY. OF RIVERSIDE 'FIELD OFFICE CONSTRUCTION ESTIMATE M " ELECTRICAL FEES PLUMBING FEES - 1st FI:t '. 2nd FI. r Por. Gar. ". Car P.. WOII Sq. 'Ft. @ HEAT & VENT FEE NO. r No: Sq. Ft' @ PLUMB. FEE Sq. ft. @ 266 Sq. Ft. @.�'POLES. $3q. Ft @+ SIGNS'. ORAINAGE PIPING .Sq. Ft. @ --TRATSC AND/ DRINKING FO:TA"IN UN ' '- 'MOTOR H.P.' - URINA-L MOTOR -M.P: 'WATER PIPING _ ESTIMATED VALUATIONj $. - G " nnOTOR H.P. FLOOR DRAIN - MECHANICAL FEES 1.. MOTOR ' 'N. P:. WATER SOFTENER. _ VENT SYSTEM (21 AN -❑ EVAP. COOL GYTi 000 - ; MOTOR - `-H.,F. WASHER (AUTO IDI SM) J� V A '_ ' �L E ANC ,. PPL I ) FIXTURES _ � GARBAGE DISPOSAL 11 > FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED - 4. OUTLETS LAUNDRY -TRAY Z AIR HANDLING UNIT - 1 0 SUB -PANEL ' KITCHEN SINK -J GAS.PIPE ❑ NATURAL' ❑ L.P.G. ❑ OIL - WATER CLOSET Q U COMPRESSOR �HP • t' •�,,,` ...:."`;- RANGE.AND/OR.OVEN LAVATORY W APPLIANCE VENT •" .C. _WATER HEATER :SHOWER,- , SY ABSORPTION SYSTEM D B. T. U. - SPACE HEATER'.. _ BATH TUB U INCINERATOR DOMESTIC ❑ INDUS -:,❑.COMM. CONSTRUCTION 'POLEj�'V - - 'WATER HEATER I,. HEATING SYSTEM * CD -FORCED ❑ GRAVITY'VICE LEGA L S I I N '• ' � � . ENTRANCE •- �} SEWAGE DISPOSAL R - BOILER O B.T.U.. .. RESID. IT S0: FT. HOUSE SEWER .. - RESIDE NTAL FEES - SQ. FT.�@, 1 GARAGE iQ 50. FT. GAS PIPING I' PERMIT FEE PERMIT FEE f r� ` PERMIT FEE. !PERMIT "'I6 M REN: OBL'. TOTAL FEES HEAT & VENT FEE PLN. CK. FEE Jr. CONS T. 'FEE ELEC. FEE - PLUMB. FEE 266 mss^ 6. 1.. 'J F ''MM A- J F M - A M J- J A S S O' N •- D - O_ N. D SET BACK' LOT SIZE • UrSE` N JOB ADDRESS - - OWNER +.r f .F - S . R ✓ V •J C8 C% ZONE LrSEfOF BUILDI G • A '+ ~ "q PLAN C H E;C K FEE . _ •�,,,` ...:."`;- CHE K O B CO U IS T- .C. UNITS VALUATIONS OF MECHANICAL FEE LEGA L S I I N '• ' � � . f RMIT BE 1 62 � 6R� CONSTRUCTIONFEE - SPEC. INSP.., .. . - SVPP. TO PERMIT - .. -1 .' ELECTRICAL FEE' 1. +Nw/ PLAN. CHECKER - BOND $ I BONG I CASH .PLAN FILE 11 1 FINAL DATE /• INSPECTOR ' PLUMBING FEE �Y <. r+• a t / /O -o W"L,���� TOTAL. FEES gid. THIS PERMIT SHALL BECOME:VOIO IF WORK ISNOT COMMENCED' WITHIN 60 DAYS' CESSATION OF WORK.FOR 120 DAYS SHALL. ALSO CAUSE PERMIT TO BECOME VOID. j; I HEREBY AGREE. THAT ALL WORK- IN CONNECTION WIT-H.THIS d: CASH CHECK M. o.' N.C. ,RECEIVED BY - SEWAGE SYSTEM - -_ '. t{ PERMIT WILL BE DONE IN ACCORDANCE WITH',THE LAWS OF RIVER- a RIVER - 'LL SIDE COUNTY AND.THE STATE OF CALIFORNIA. I ALSO AGREE TO ., u r' {.,y� CARRY COMPENSATION INSURANCE UPON MY EMPLOYEES. COMPLI- OMPLI-ANCEWITH LAWS OF THE STATE OF-CAL•IFOR' IA COVERING CON ANCE WITH IN FOR MJi'rlo-N TRACTORS IS ALSO GUARANTEED.��'/`.�j F2 ' OWNER -• -;' CONTRACTOR Uri IACD RESS'- - ADDRE • •. LICENSE NO. - 284-208 11/87 ' ,