0110-119 (SFD)r LL'"
QA'd �i
' W
C Z
c�D 0.
U�
UJa
Z
C?)
u')
N
ON
_U °)
,qt0_ Z
LoFQ
— O
LU LL
0 J J
mVU
O
d rn H
`T Z_
cb Z)
r, ()
LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapt 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 / ! r 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).
( ) I, 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&P.C. for this reason
Date r""'%' /..s e 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:
Cartier Policy No.
(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
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions.
Date: Applicant
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety `
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon Whose'behalf this application is made & each person it
whose request and for whose benefit work is performed under or pursuant to
arty permit issued as a result of this applicaton agrees to, & shall, indemnify,
I '& hold harmless the City of La Quinta, its officers, agents and employees'99
2. Any permit issued as a result of this application becomes null and voidi'
work is not commenced within 180 days from date of issuance of suo
permit, or cessation of work for 180 days will subject permit to cancellati
I certify that I have read this application and state that the above informatio is
correct. I agree to comply with all City, and State laws relating to the build ng
construction, and hereby authorize representatives of this City to enter u, on
the above-mentioned property for inspection purposes. S
Sigriattire (Owner/Agent) y �' •��•✓x ' "`"' Date .�
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 0110-119 TRACT
JOB SITE
APN
ADDRESS 61.0 MIX G'T.d YMM
77".�:01
OWNER
CONTRACTOR / DESIGNER / EN (NEER
Y i C int, FM!'�f�MIRE
RMCIFT11
'd}t 3.01 iT:O1DR7A111
:CSA. QI'M+T;f; A CA,. 92253
Me, ,
USE OOF�fpPERMIT
7 � (� (��psT��T � j
Wall.Y �..i LE i.�9A�.i� ILY D V 7.uJ+UNG
SPP w PERMIT t "AS :NOT INC'1..T3'TM S Ilk. * 'WAr,..T.4 POOL OR 1)R1N,@:afi3 A.Y
TRACT x:014 3'! RUC'1'.YON �,JSl.T1t3 wF
PC)I"iCwlh.rlo
W,3tA.G1~',�P;t, RPORT 1,014.09 3F
A.B.AVA�Yiaal+l}J)°+ter L.'a3A,, o A. a•4.��R'�A'�0.M.i CM�al'Ah
207."i'..�3XV
ygy'y�,y /��[�+ py- �gyyg �{°p, n*pay.�ita7l
t' pf51+I.S'TRiTC.i'10N FRE 101.000-418-4110
PLAN CHOCK FZE 102-000-439.319 W.16
1,"f`� DEMENT 101-000-439,•318 -$.M."
MEE.',HAINICAQ..`,V`YE 101-000421-000 $3"o
ELECTRICAL FEF 101-000-420-000 $212,57
PLUM1I1RO F SH 1, 01=000.41.9-000 $184.10
STROW MU't ION 'FFR - RMsW 101.000.741.000 MIN
MAIL) FlAr 101-000-423-000
OEM, IM PACT Irk -9 St,�il� a{➢
ART !'3E Pk.7L IJC' PLACES 11.921r 270-000,445-000
f:
Sq:.1B _11aTAT, f:O1~ySIM.[ff17- 10. N AND 1?;1.. Ali'' r"ITT` `:
$4,2119.55
..
1-.9 z,".'f� t &tl?.-'AID AMS
-$250. GO
�J !
TMAL PERAUTIZES DIVE NOW
e � )
$410119.615
AFr. 18
FIV:�.'�
RECEIPT
DATE, �.;
BY I
DATE INAL
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
' BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
?
6
Ducts
Slab Grade
( l� �_
_ /�/
Return Air
Steel_
Combustion Air
Roof Deck
_
Z -f 3�2—. � L
Exhaust Fans
O.K. to Wrap';
_ _
GlC
F.A.U.
Framing
O
_LG
J%G�i�
Compressor
Insulation
�, - dZ
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
O Z
Drywall - Int. Lath001 (
Final
Final
( �v
POOLS -SPAS
BLOCKWALL A PROVALS
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 est
Elect c Final
Wagte Lines
t/
j�%
Heater Final
Water Piping
_ _d
1
�'G
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
/ /
/ 7 a
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
�� `�-,�'?i
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit .
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
T
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
Building
50-4,30Art
rfraaa
T -VY
_
P.O. BOX 1504 APPLICATION ONLY
78-495 CALLE TAMPICO
INTA, CALIFORNIA 92253
e -i n- I I
v
1111 , !`tet. l t, V y I 1 tV BUILDING: TYPE CONST. O C. GRP.
Mailing
Address 4GS01 RNU DCJ, CA f,4.0A.P. Number 71 v
~0`3 S r �_ _
..� Legal Description
City IZip ITel.
State Lic.I City
& Classif. Lic. #
Arch., Engr., / J 11 E
Designer �� 14JE , i
Address 0} - n 3 6P+G� 0 Tel
Citl `, 0 i� F!;L;�o
StateJ pLic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that lam licensed under provisions of Chapter 9 (commencing with Section
7000) o1 Division 3 of the Business and Professions Code, and my license is in full force and
effect.
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5%siness and Professions Code: Any city or county which requires a
permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to file a signed statement that he Is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code, or that.he is exempt therefrom, and the basis
for the alleged oxemption. Any violation of Section 7031.5 by 'any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
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, Buisness and
Professions Code;The Contractor's License Law does not apply to an owner of property who
builds or improves thereon and who does such work himself or through his own employees,
provided that such improvements are not intended or offered for sale. If, however, the building
or improvement is sold within one year of completion, the owner -builder will have the burden
of proving that he did not build or improve for the purpose of sale.)
1'1 I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner of property who builds or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
17 I am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
n Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
or less.)
I certify that in the performance of thf 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
L aws of California.
Date Owner
NOTICE TO APPLICANT: It, alter making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
Ihereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I certify that I have read this application and state that the above information is correct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives -of this city to enter the above-
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
Project
W
Sq. Ft.
Size
New Add ❑
6.4
No. I No. Dw. 1
Stories Units
'19,- 3135
P,I 0k
)fd '42 -
PERMIT Z
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
Alter ❑ Repair ❑ Demolition ❑
AMOUNT
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
Notice:
Document Cannot Be Duplicated
Desert Sands Unified School District
47-950 Dune Palms Road
La Quinta, CA 92253
760-771-8515
CERTIFICATE OF COMPLIANCE
Date 12/18/01
No. 22771
owner NameMike & Celeste McIntyre
No, 50-630 Street Calle Guaymas
City La Quinta
Tract #
Lot #
APN# 770-093-001
Jurisdiction La Quinta
Permit #
Log #
Zip 92253 Study Area
Square Footage 3351
Type of Development Single Family Residence No. of Units 1
Comments
*Owner can also be reached at 760-360-3585.
At the present time, the Desert Sands Unified School District does not collect fees on garages/carpoits, covered
patios/walkways, residential additions under 500 square feet, detached accessory structures or replacement mobilehomes. It
has been determined the above-named owner is exempt from paying school fees at this time due to the following reason:
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of
2.05 X 3,351 or $ 6,869.55 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 CC / Valley Independent Bank - Mike McIntyre Telephone
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collec4/exepted by
Signatur
Annette Barlow
Payment Received $6,869.55
Check No. 259764
JOTICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified
ibove will begin to run from the date on which the building or installation permit for this project is sssued or on which they are paid to the District(s) or to another public entity authorized to
collect them on the District('s)(s') behalf, whichever is earlier.
Collector: Attach a copy of county or city plan check application form to district copy for all waivers.
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting
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 Fecl ial 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 maybe financial risks -for you if -you -do not carry out these obligation"s, and`iheseii'sks 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.,infosmation 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 "bur
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) 777-7,011
OWNER'S SIGNATURE/DATE
Sy K-� O
PROPERTY ADDRESS
Q_ 0 — I
PERMIT NUMBER(s
78-495 CALLE TAMPICO
LA QUINTA, CA 92253
(760) 777-7075
APPLICATION
FLOOD PLAIN DEVELOPMENT PERMIT
BUILDING SITE LOCATION
FLOOD ZONE 'AO"- DEPTH 1
COMMUNITY- PANEL NUMBER
j0- (o�jp Cflu.,e GUfrYMUS
060709 0005 B
Map Revised: 8/19/1991
APPLICANT INFORMATION SECTION
APPLICANT NAME
/01,4/LV>AO /�'1>C�%lifL / I CENTYR�
APPLICANT
¢G" 36I �U(/��'L Ljin/�
ADDRESS
(MAILING ADDRESS, NOT THE BUILDING SITE)
'
DAYTIME TELEPHONE NO.
INSTRUCTIONS
1. A Flood Plain Development Permit is required by LQMC Section 8.11.040(A). The Applicant should complete the
Applicant Information portion of this application and submit it to the Engineering Department along with the
required documentation noted hereon at the same time the Precise Grading Plan is submitted to the Building and
Safety Department for plan checking. '
2. Documentation required for STEP 1 OF 2 APPROVAL prior to receiving clearance for Building Permit issuance
• Copy of the proposed Precise Grading Plan for review and approval containing all information required by
the checklist shown on the back of this application.
3. Documentation required for STEP 2 OF 2 APPROVAL prior to receiving Flood Plain Development Permit approval.
Note, this approval occurs after forms for the lowest habitable floor are set and before the Building & Safety
Department authorizes foundation construction.
• Submit a completed FEMA "Elevation Certificate" form to the Engineering Department.
• Submit 95% relative density soils compaction certification to the Engineering Department.
STEP 1 OF 2 APPROVAL
STEP 2 OF 2 APPROVAL
The Precise Grading Plan submitted for this application has been
All requirements have been satisfied. This Flood Plain
reviewed and found to contain all data required to satisfy the
Development Permit is approved.
requirements of LQMC 8.11 The proposed dwelling is eligible to
receive a building permit upon satisfying all other Building &
Safety Department requirements.
Idly)
(IT.IIIZilllGN#AT41E /
6ATE
AUTHORIZED SIGNATURE DATE
La Quinta Engineering epartment
La Quinta Engineering Department
FILE: Upon Step 2 approval, original goes in "Flood Plain Development Permit" file; copy goes to Applicant
F090 REV -2 7100