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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
,r
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).
(x I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).,.
O Ism exempt under Section B&P.C:�foris reason rr
„Date 1 Z h "r f `t (t Signature of Owner s �c:
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).
()s I certify that in the performance of the work for which this permit is issued,
I s'h'all not employ any person iri 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 thoe provisions.
date: 1 '7 lApplicant''�f r 1
' L
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 bove- mentioned property for, inspection purposes.
r � / q
nature (Owner/Agent) I 'Y r ' r / Date 1 a' �%`' /'7
BUILDING PERMIT PERMITr 111-22 r
DATE 12/29/1 "VALUATION $3.464.€0 LOT TRACT
JOB SITE 77-227 CALLE :E NSriAADA
APN 773-243-04
ADDRESS
OWNER
CONTRACTOR / DESIGNER / ENGINEER
FREDOLF(
0 IT,11.1 13U1410Lit
}'O BOX Iola
1.1(�UFN rA. CA 922.53
s
�°
;) - �► C-BLO
USE OF PERMIT
G N&KAI., BUILDING
1 fife ,L...R „ 5` 0i%ikDFN WALL, Ci•i Y a T A.NufutU (WiA' 0316JJUR, WEST
1108 OF SQU'1 H PtxQP LIN))';)
• .1
51".►. WALL 160.00 i.i,
PERMIT ij1'ir.R SUMMAI
CONST1'<UCT10N Hit-, 10! -000-418,000 $6100
,WVKWAL C0NF7'R(JC 1'J0N .ANT.) PLAN C H'1ACK
V-3 00LESS
..�
ME,nt�D.I�,1i.ES
90.00
'MT:11., k'EItM11 IF'E'EN 'DUJ;l 'NOWr
.iii► $.110
RECEIPT
DATE
lay/
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION 17
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 5
Approval to Cover
Equipment Location
Underground Electric
Final l_ _
Underground Plbg. Test
Gas Piping
PLUMBING AP ROVALS
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:
,
Bin #
City of La Quinta.
Building 81 Safety Division
P.O. Box 1504A
Perri t #::.:<` <>
78-495 Calle Tampico
La Quinta, CA 92253
Building Permit Application and Tracking Sheet
Project Address: -22 7
CAIt-f- a.#j5JtLJ ADA
Owner's Name: 0LFF + kA U oLrt�
A. P. Number:
Address: i, o O y C
Legal Description: ko' 2 kr
6cocK i3 SAArA (AQ Lt-ru
City,ST,Zip: A(Pu Mr, .d p, 2? 3
141 V t.H A. U1 6
%R FMIt 51
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Tele ho n t(
UD
Contractor:
Q OLF��
Address: 7 0
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Project Description:
Ciry.ST,Zip:
CA R27.
u A' K ?EooT .,WAti. AQUU 'C�
Telephone: P
A o
C T
R u
t wy t2
L t:l. E S
State Lic. # :
City Lic. #:
Tq C VC yl OW 14, QIr 1/07A IAJ tq66 (at -e.
Arch.. En. -r.. Designer:
ko A Lt t 4 RIC �O ftg o1J6
Address:
Zu TOOT' A t L " tG o u-ril
City, ST: Zip:
t H) . r
Telephone:
Construction Type: Occupancy: �..
c
LO� W Ya,_
State Lic. #:
...................
...................................
Project type e one):: New Alter Repair atr Dem0
Name of Contact Person: �Izcl>�A,
W a GAF
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project: O0
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ft; Appi
CONSTRUCTION ESTIMATE NO• ELECTRICAL FEES N0. I OLUM81NG FEES
tST FL.
2ND FL.
POR.
GAR.
CAR P
WALL
EST'MA'EO CONSTRUCTION
SO FT !r 2
UNITS
A.G. UNIT
SO. FT..�
YARD SPKLR SYSTEM
SO FT ,4 MOBILEHOME SVC.
BAR SINK
SO_ FT. •a POWER OUTLET
ROOF DRAINS
j0. FT •t
DRAINAGE PIPING
SO FT It
DRINKING FOUNTAIN
;O FT. Ji
URINAL
VALUATION S
WATER PIPING
NOTE. Not to oa .sea as ,receny :ax ea!aathon
OTHER APPIEGWP.
FLOOR DRAIN
MECHANICAL FEES
TEMP.POLI
WATER SOFTENER
VENT SYSTEM FAN EVARCOOL 'HOOD
SIGN
WASHER(AUTCOOISH1
APPLIANCE DRYER
FINAL INV.
GARBAGE DISPOSAL
FURNACE UNIT 'WALL FLOOR SUSPENDED
WATER SYSTEM .
LAUNDRY TRAY
AIR HANDLING UNIT CFM
sS
KITCHEN SINK
ABSORPTION SYSTEM B,T U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE.TEMIPERNI
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT 4. c
BATH TUB
SO. FT ►c
WATER HEATER
MAX. HEATER OUTPUT. B.T.U.
SO. FT. RESIO A lea c
SEWAGE DISPOSAL
SO.FT.GAR 0 4c
HOUSE SEWER
'PL
PERMIT FEE
PERMIT FEE
OBL
TOTAL FEES
MICRO FEE
MECM.FEE IPL.CK.FEE
CONST. FEE
=FEESMIUMSFEE
STRUCTURE PLUMBING ELECTRICAL HEATMIGAAIR OOND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.G. UNIT
COLL AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL]
OTHER APPIEGWP.
REINF. STEEL
GAS (FINAL)
TEMP.POLI
GROUT
WATER MEATEIR
SERVKZ
FINAL INV.
BOND BEAM
WATER SYSTEM .
ORAONq
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= php xf
sS
LUMBER GR.
FINAL INSP.'
FRAMING
FINAL INSP.
ROOFING
REMARKS
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INGULANW80UNO
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
OPtJCG FINAL
- - IINSPECTORi 5IQIMTUII4§fI4ITML6
GARDEN WALL FINAL
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- 21 -
CITY OF LA QUINTA
BUILDING AND SAFETY DEPARTMENT
GARDEN WALL STANDARD
6' C.M.U.
rm- 135Opsi, Fy- 4OOOOpsi
/4 0 24' Vert. O CL
/4 O 32' Horiz
I 'I
v
6 1/4-
W. ALTERNATE
3' CLEAR T BENDS c
/4 HORIZ. AS SHOWN M
I '_t 6 6' C.Y.U.
1 - rm- 1350psi, fy- 4O0DOpsi
/4 O 24- Vert O CL
/4 O 32- Horiz
Scale: 3/8- - V-0-
6' C.u.U. '
1'm- 135Opsi, Fy- 4OOOOpsi 3' CLEAR T
/4 0.24' Vert O CL /4 HORIZ. AS SHOWN 1
#4 0 32' Horiz
OPTIONAL '
10-11/16' 30'LAP GARDEN WALL
Scale: 3/8' 1'-0'
ALTERNATE
3' CLEAR NOS c
/4 HORIZ. AS SHOWN T I
6- C.M.U.
e'Tr 1350psi, ty- 4000opsi
/4 O 24' Vert O CL
/4 O 32' Horiz
GARDEN WALL
Scale: 3/6' - 1'-0'
r 6' C.M.U.
f•m- 135Opsi, Fy- 4O0OOpsi
#4 O 24' Vert O CL
l #4 O 32 Horiz 3' CLEAR T
• /a HORIZ. AS SMOwN
` I •I
in
kS
AL
ao=;,/16GARDEN WALL
Scale: 3/8• - V -p'
TE rf,
3' CLEAR �-
/4 HORT AS SHOWN T
t4
Scale: 3/8' - V-0'
0
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JOSEPH KICAK ycs
v Ho. 21775
Exp.L 9.30.97 7O
SCALE: 1" =40' _ va
EN Nf
0 20 40 80 120 \
Rev 2/2/94
CITY OF LA QUINTA
RIGHT OF WAY VACATION PLAT
EXHIBIT IIF-F°�
por-A
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'IY,23
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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 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 Stare
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) 7-7012
77-701
V Apq
OWNER'S SIG TURE / DATE
77—'427 Cru 6 C041jp�IADA
PROPERTY ADDRESS
qR t 2 - 220
PERMIT NUMBER(s)