0303-310 (AR)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
HChapter 9 (commencing with Section 7000) of Division 3 of the Business and
N W Professionals Code, and my License is in full force and effect.
=) ch License # Lic. Class Exp. Date
t\ d B7
W
oZ r Date Signature of Contractor
�Olr�-
J U C:) OWNER -BUILDER DECLARATION
W LU I hereby affirm under penalty of perjury that I am exempt from the Contractor's
U) License Law for the following reason:
Z_ (/) 1, 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)./."• r
I am/exempt under Section B&��R'�C. for this reason
O N /Dat i Signature of Owners
rn
CL Q WORKER'S COMPENSATION DECLARATION
C:) CC I hereby affirm under penalty of perjury one of the following declarations:
Lo FZ O () 1 have and will maintain a certificate of consent to self -insure for workers'
X w compensation, as provided for by Section 3700 of the Labor Code, for the
O J Q performance of the work for which this permit is issued.
M Q C) ( ) I have and will maintain workers' compensation insurance, as required by
tj 0 Q Section 3700 of the Labor Code, for the performance of the work for which this
? 0 Z permit is issued. My workers' compensation insurance carrier & policy no. are:
Carver Policy No.
ob 5
i
Q
J(This section 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 subject to the
workers' compensation laws of California, and agree that if I should become
3 subject to the workers' compensation- provisions of Section 3700 of the Labor
Code I shal forthwith comply with °t'Iose provisions.,,,,.,—
4,
-,Date+/��' Applicant _ -" ""r —�"'"
0
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 proerty for inspection purposes.
X�}
' Signature (Owner/Agent', - Date 1 / Q /0J
PERMIT #
BUILDING PERMIT
1 jJ 0303-3,10
DATE i, �j f /0 '7 VALUATION WPM xi'. LOT 5 TRACT
JOB SITE
ADDRESS 78-2.25 CA7(.%'�':1!'C3i2�°iIIRA
APN M
OWNER
CONTRACTOR / DESIGNER / EN (NEER
WCMIA1, & T'ATIAHAFMMCU
t1WNTl - ,3UMD)M-
78.225 CAt iZ MI,M)NA
LAQ1 DTrA CA 92253
USE bF PERMIT
RE IDIN:IIAL ADDJTIO-4
4 H 3Y'' ii7 1 i'iC: .R: 1J1 ilJM KJ C.K.! ! IV Y.P 1L.C•:,i►YJ�E•II: L°
ADDITION 499,00 3F
ES11i AIED CO'NirOF COIti1�'�.I,��1JCTION
2710%"170
P4i;RND.1 F11T IKAM, RY
PLAN CHECK FM 101.000-439.318 $176.48
CaNSTXUC'ITON FZZ 103-000-418-000 V711501
MECHANICAL M 101.000a421M000 V3.00
'9I; TI:ICA.x,Ik?9 101-0064-.20-000 $.50.(to
rLIUM�AlTi{rt"s�FenFIZ . 101.0.00.419.000 $55,50
1pyp rs�e.SYv
S'IR'.t�NQ IkAW S ICJIN IP• . a RZ51Lf 1011-000-241-000 $22.11 ,
D Q �
APR 14 2003
CITY OF LA QUINTA
FINANCE DEPT.
OiT_ ,-'ICQ'y`F� � <:AIWCLU I:4ON AND PUN 0 ECK
$S71 19
(. 9 : l ��A 'r
$0.00
TOTAL :E'ERIO TT ITE:S W.9 J90W!'
$571.19
RECEIPT
DATE I ��
B'" 1
DAT NALEDVTINSPE
/„
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
Ox to Wrap
. p g,
F.A.U.
Framing
el
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 -- —U
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
Gas Test
Electric Final
Waste Lines
O
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Piaster
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:
VA
J
Bin �lC
Permit # O�"
n3
City of La Quinta
Building at Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinn, G4 922S3 - (760) 777-7012
Building Permit Application and Tracking Sheet
Proiect Address: Z Z G LL D Nif
A. P. Number: " SCI — / �� — Un `j
Legal Description: 4 J l Jr Bis; Q Gf/y o �y
Contractor:
Address: �j � - z 2 — C fs'c ATL r ' —�iv,4
trner's Name: /t(, G l 1-i-111VA ��✓ �
.4ddress: _ Z Z—
Cir'. ST. Zip: <,+ 'l ZZ
�Krelephone:
PipProject Description:
A %7` q
Cite. ST. Zip: C . �/�ii'
Telephone:
'Z✓c'
j /UG's r
State Lic.; :
Cin• Lic. =:
Arch.. Ener.. Designer:
Address:
Cin•. ST. Zip:
Telephone:
Construction Type: Occupancy
State Lic. _:
Project type tcircic one): Ne%% Add'n Alter Repair Demo
Name of Contact Person: ��� G
c n`j i
Sq. Ft.: G/4
= Stories:
n Units:
Telephone a of Contact Person:
Estimated Value of Proust:
APPLICANT: DO NOT WRITE BELOW THIS LINE
a
I Submittal I
Plan Sets
Req'd .
Rec'd
TR..%CKI',G
Plan Check submitted 7 D/
PERMIT FEES
Item Amount
Structural Coles.
Reviewed. read%• for corrections
Plan Check Deposit
ZTruss
Coles.
Called Contact Person
3
Plan Check Balance
Title 24 Coles.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
��r�
Mechanical
Grading plan
2" Review. read• for corrections%issue
Electrical3
- eAa
XCA
Subcontaetor List
Called Contact Person
Plumhine
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IV HOUSE:-
'" Review, ready for correctio i iissue
Developer Impact Fee
Planning Approval
Called Contact Person
-P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
Lecc,c to CUP
CERTIFICATE OF COMPLIANCE
Desert Sands Unified School District
47950 Dune Palms Road
Date 3/28/03 La Quinta, CA 92253
No. 24259 (760) 771-8515
Owner
Michael & Tatiana Hinkle
APN #
Address
78-225 Calle Fortuna.
Jurisdiction
City
La Quinta Zip 92253
Permit #
Tract #
Study Area
Type
Residential Addition
No. of Units
Lot #
Unit 1 5
Unit 2
Unit 3
Unit 4
Unit 5
Comments
No. Street S.F.
78225 Calle Forunta 499
Unit 6
Unit 7
Unit 8
Unit 9
Unit 10
Lot # No.
Q BERMUDA DUNES r
C4 RANCHO MIRAGE t:;I
INDIAN WELLS
di PALM DESERT ,y
LA QUINTA
INDIO
O YJ
770-155-005
La Quinta
0303-310
1
Street
S.F.
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patios/walkways, residential additions under
500 square feet, detached accessory structures (spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation) or replacement mobile
homes. It has been determined that the above-named owner is exempt from paying school fees at this time due to the following reason:
I
EXEMPT
This certifies that school facility fees imposed pursuant to
Education Code Section 17620 and Government Code 65995 Et Seq.
in the amount of ' $0.00 X 499 S.F. or $0.00 have been paid for 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 Exempt - tatiana Hinkle Check No.
Name on the check Telephone
Funding Exempt
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Sharon MCGilvrey 1$0.00
Payment Recd Over/Under
Signature c
NOTICE: Pursuant to Government Code Section 66020(d)(1), this will serve to notify you that the 90 -day approval period in which you may protest the fees or
other payment identified above will begin to run from the date on which the building or installation permit for this project is issued, or from the date on which
those amounts are paid to the District(s) or to another public entity authorized to collect them on the District('s) behalf, whichever is earlier.
NOTICE: This Document NOT VALID if Duplicated
Embossed Original - Building Department/Applicant . Copy - Applicant/Receipt Copy - Accounting
TO:
FROM:
DATE:
RE:
MEMORANDUM
Tom Hartung, Building & Safety Director
Steve Speer, Assistant City Engineer
April 11, 2003
78225 Calle Fortuna
Floodplain Hazard Regulations Not Applicable
Pursuant to LQMC 8.1.1.030(C), entitled "Compliance", the Flood Hazard Regulations
codified in Chapter 8:11 do not apply to existing structures in the floodplain, when the
proposed addition to an existing structure does not exceed the criteria that defines
"Substantial Improvement". Substantial Improvement is the 31St definition in Section
8.11.020.
The 499 s.f. proposed addition to the existing structure at the subject address does not
constitute a "substantial improvement". Therefore, the Flood Hazard Regulations are not
applicable even though the structure is located in Zone AO.
No Floodplain Development Permit is required. This memorandum has been issued as
evidence citing the reason for not requiring a Floodplain Development Permit.
If you have questions regarding this determination, please call me at (760) 777-7043.
TAPWDEPTtFloodplain ManagementTloodplain Development Permits%Floodplain exemption letter, 78225 Calle Fortuna.doc
CITY OF LA QUINTA SUB CONTRACTOR LIST
JOB ADDRESS -�fg "k 1,11, PERMIT NUMBER OWNER M. e 77 BUILDER a-AX4,
This (grin shalt be posted nn the jeb Waith theBuifcjina Insnaction Card at all :irnes in a cors6picuous place. Only persons appearing on this list or their employees are authorized to work
on this job. Any changes to this list must be approved by the Building Division prior to commencement of work. Failure to comply will result in a stoppage of work and/or the voidance
of building permit. For each applicable trade, all information requested below must be completed by applicant. "On File" is not an acceptable response.
Trade f Classification
Contractor
State Contractor's LicenseCo'm
-.
Workers Cpensation fns6rance
City Business License
Company Name
Classification
{e.g. A, B, C-8)
License Number
Ixxxxxx)
Exp. Date
(xxlxx/xx)
Carrier Name
(e.g. State Fund, CalComp)
Policy Number.
(Format Varies/
Exp. Date
(xx/xxlxx)
License Number
Ixxxx)
Exp. Date
(xx/xx/xx)
EARTHWORK (C-12)
CONCRETE (C-8)'
CG G %G nJCIA
&,61- 63
e3512V
FARMING {C 61. ' :aL
uwu C!L
STRIJ¢T.'STEEL (C-61).'
*} -
y(i lKaJdN !
L -Li
s?o / r /u,
?. -7 `1• rr
7.r : .1•.�:x C 'Gd?- -
wti(- 6241 o
-0 3
O 6'q. 1f
PLUMBING {C-36}
VkUi; ';�.Is.4' lNt
L- 36
0,.? 0
�3v :a3
CIA i-rovorJ o1.4T;,�,vn
:,,R�arcc, ca u
o 6tR -Or'2� 2"f �Tt
la- -a'
oa7 4,� l
3-24-a
LATH. PLASTER (635)
j+V-)b1dA 6Ar Z 4- (1/c
% _
7 C G• %`l
v- ,; - ;c
, ;,. r. !
57%F7G Con• cfJ$617N•u
ajctAr�Gr•:.: urlr
- 0 J�/-Oi'tl
G
O 1 i
2-31-cZ.
DRYWALL (C-91
HVAC (C-201.21
u
4�3 �,.,3
-_ "• ke /7
�.F k L.v, r 7 __
_.....
0295-3
ELEC,TRICAL'IC-10)
W EGgG7rLl (�
�- / O
-7�p?�
I 3/
S��Q%� F✓.��
iq
to Q
30c> 7
ROOFING(C-391
/6
L' ? �/
C 2 ! 22
/,
/0VYcHJ
t l 'r:G
G1-i�
SHEET METAL {C-43)
—$-
Cr Ana airy it nc�
GLAZING (CA 7)
INSULATION (C-2)
t-
Gtr �le-
--421. .
--421..
PAINTING IC 931 "-
G'w N E2
CERAMIC TILE'(C-54)
r✓n/B/2
CABINETS -(C-81:
W N ErR
FENCING TC -13)
—�} -
LANbSCgPING'-'-zJ-
POOL IC -69)
- U
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 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
760) 777-7011
� OJ
ER'S SIGNATURE/DATE
PROPERTY ADDRESS
PERMIT NUMBER(s)