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0111-104 (RER)LICENSED CONTRACTOR DECLARATION lekI hereby•afflrm under penalty of perjury that I am licensed under provisions of F-, �: Chapter 9 (commencing with Section 7000) of Division 3 of the Business and nj 'Profbssionals.Code, and my License is in full force and effect. M License.# Lic. Class Exp. Date Q W o Z ti Date Signature of Contractor O:rl- r-- f= 0 r` OWNER -BUILDER DECLARATION _U W W I hereby affirm under penalty of perjury that I am exempt from the Contractor's ~ fl License Law for the following reason: to 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). ( ) 1, as owner of the property, am exclusively contracting with licensed contractors to construct. the project (Sec. 7044, Business & Professionals Code). Cl)O I am exempt under Section B&P.C.-for this reason LO O N --Date 4/ • d.., 7 Signature of, Owner L) Q WORKER'S COMPENSATION DECLARATION p � I hereby :affirm under penalty, of perjury one of the following declarations, , H p O I have and will maintain a certificate of consent to self insure for workers' X W Yz compensation, as provided for by Section 3700 of the Labor Code, for the i Q performance of the work:for which this permit is issued. Q 0 O 1 have and will maintain workers' compensation insurance, as required by O U Q Section 3700 of the. Labor Code, for the performance of the work for which this a m F- permit :is issued. My workers' compensation insurance carrier & policy no. are: Nr Z Carrier Policy No. ob a g (This section need not be completed if the permit valuation is for $100.00 or less). ({� I certifythat'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 ode, I shall°forthwith comply with those/pyoylsions. `-Date: Applicant `f /. ,,r Warning: Failure to secure Workers' Con9pensation 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 attoney'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 upori whose behalf this application is made & each person at Whose request and'fo whose benefit work is performed under or pursuant to any permit issued as a result of this appiicaton 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 permittocancellation. 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 property for inspection purposes. p- )Ignature (Owner/Agent) Date EUILDING'PERMIT PERMIT# DATE 1 VALUATION LOT 0111-104 TRACT UNUMIXII JOB SITE f / APN ADDRESS '18-270 H MNIM 1,A QUINI'A, I)R - OWNER CONTRACTOR / DESIGNER / EN (NEER 1 20t 5T117 AVB 0000 P33'1'13'!(31J3tC.3GF.i 1'A 13222 t mi* USE OF PERMIT KITC HLN & i661:r3.Ni'f ER BATH. I& MSr.)IDEL RES, RMODF.i:; 109,000.09 [.S E91MNIRD C'OYC Ole ry E3MMUMOIT 100AYMW PUH C!'ll"t X Me 101-0004391.311 R $415.68 CONSTRUCTION ION V1lev, 101 _0004 181-000 $639.50 Meir.CHANICAL, "M 101 •d.N)0—M -000 ° 41 $14.30 Lp1,HC7ittC r�T?f:l 101 -00 20-00(k $22,50 A1.-U�DE�t�i� ISi1�OC.>OL�f19�001'k 8�+,0fi: nFr, 19 2001 ,�.� 4 �igCAt ':P/- .;g [i7',%aTC ' �"•f3A1'O1 2U'M011 ANO P'L./4�T=M-1[o'CW 1X0, S PRR41AX) MW RECEIPT DATE + / j BY .... DATE:FINALED INSPE INSPECTIG�� REC��RC� OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BULDINIO APPROVALS MECHANICAL APPROVALS Set Ba s Electric Bond Underground Ducts Forms & Footings Ducts Slab Grade 2 Return Air Steel Root Deck Combustion Air Exhaust Fans O. K. to Wrap Equipment Location F.A.U. Framing 2 — o S Compressor Insulation L — -=A _ r: Z Vents Fireplace P.L. Final Grills F (replace T.O.40Fans Party Wall Insulation Gas Piping &Controls Condensate Lines Party Wall Firewall Gas Test Electric Final Exterior Lath Drywall - Int. Lath _� 9'_-� Z��Yzr Heater Final Water Piping Final Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underqround Conduit Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power I Final Final /. 2'.7 2 I "0OLS - SPAS Final - _ �1-Z� BLOCKWALL APPROVALS Steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final Gas Piping 7LU6AfflNG APPROVALS Gas Test Electric Final Waste Lines Heater Final Water Piping Plumbing Final Plumbing Top Out �2 _ 2A Shower Pans Equipment Enclosure O.K. for Finish Plaster Sewer Lateral _ Sewer Connection _ Pool Cover Encapsulation Gas Piping _ _ Gas Test Final Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underqround Conduit Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power I Final I� APPLICANT: DO NOT WRITE BELOW THIS LINE # # Permit # City of La Quints Building ler Safety Dlvis M P.O. Box 1504, 78.495 Calk Tampico 1a Quinta, C4 92253 - (760),777-7012 Building Permit Application and Tracking Sheet Ree'd Project Address: 78' O Owner`s Name: A. P. Number: Address: -- j Legal Description: City, ST. Zip: /.,z Contractor. L� 2,�4 Oce �rJEI!E+ Telephone: Pian Cheek submitted I(,�i • Address: Project Description: SCO PE o,' Wo&K Structural Colo. City. ST. Zip: NITG'� v i2 Re h?od Gl � JC t TG h en - ,Gbss 'Reviewed. ready for corrections Telephone: • �� '� ~ :{..::.::..::::: a nye /e'w� State Lic: # : Citv Lic. : t hen/ f✓ �i, rs A of , Arch.. Engr.. Designer �f � ,{ ew &C'-s6'e-j Address: b Gx r,„r 4-S /, •; a r.11 r a wt /dam I City, ST,,Zip: d �� k.7L�e.+ ..$tRkt w same f'ruvfte v, : i Telephone: State Ltd..:.::......................... .:...:.:.;.:.,: e •* Gi.•r �e�J onsttaction Type: o sOccu Occupancy: Project t) pe (circle.one):, New Add'n Alter Repair Demo Grading plan Name of'Contat Person: R,S AV Sq., Ft.: 37,o p # Stories: f � # Units:.' Estimated Value of Project /�Q 000 f APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Ree'd TRACKING PERMIT FEES Plan Sets Pian Cheek submitted I(,�i • 1��6/p Item Amount i Structural Colo. 'Reviewed. ready for corrections Plan Check Deposit I Truss Coles. Called ContactTerson (1 Plan Check Balance Title 24 Cales. Pians picked up IlI?� Construction • Flood plain plan Plans resubmitted tZ echanical • ' Grading plan V Review, ready for corr ,fonsfissvc (�i lectrical • Subeontactor List Called Contact Person lumbing Grant Deed Plans picked up S.AU. H.O.A. Approval Plans resubmitted Grading iN HOUSE: '"' Review. ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person A.1.P.P. Pub. Wks. Appr Date of permit issue School Fees 1 1 Total Permit Fees M-//� r o C` La Quinta I P. 0. .Bos 15 760/564-2177 Association La Quinta CA 92253 FAX 760/564-4882 November. 5, 2001. Planning Department CITY OF LA QUINTA P. 0.. Box 1504 La Q.i:nta CA 92253 RE: Remodel at 78-270 Hacienda FRANK KOZEL Ladies & Gentlemen:. The Board of Directors of Villa La Quinta Homeowners Association has reviewed the plans for remodel of the above referenced residence. The plans indicate. there will be no alterations to the roof line or additions to the house itself. The changes are to the irnterior and cosmetically to the exterior. Since there is no violation to our CC&Rs, the plans are approved. If you have any questions, please contact our office. Yours truly,, Anne Tuttle, Association Manager T -T , -1--- I_ ! �� (,-t 1 �! -du d .; -s I i I I I I I 41- _ � I _ This e G✓ I I� a-;5 av � I I ova—fia I I , I I i y he, - eW. f'ha, 4 lS i i eu le vd-� o I I I I Inip-. Ke, I� �� A mao/ _ I I I I I I i I ji I ` I---- -I----- '-+---�-- -'I - --- - -i -' -- -- - I I i �► _ �� I i �. l � 1� I I( �� � �(� I fr: 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 byiproperty owners unless,theyare personally performing their own work. If your work. is being, performed by someone ocher than yourself, you may protect yourself from possible liability if that person-ipplies for the proper permit in his.or her name. 5*t; 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 6200.00 or more for the entire project, and such ,persons are not licensed as contractors or subcontractors, thea you may bean 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. 1&i e�tha) j, a Anancial risks for you if you do not carry out these obligations, and these risks are especially seriouswith 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 df 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 rna[ters The-6uildirig-pertriit-wffl nof�beis tiedu(itil the`werification 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) 777-70.11 1z1,3 & OWNER'S SIGNATURE/DATE LA ra- e-.4 92ZS-9 PROPERTY ADDRESS I �/// /04/ PERMIT NUMBER(s) t CItY OF LA e r-x,s -Ny_ �;��� a ! ?UINTA f/XJo''re.a ✓gid 'F/x�b. ; 3.6XIb.,, + - 3.�X BUILDING & SAF' TY�DEPT -- __-------- _._ :_----------- - NF1 ! - `a FOA CONSTIR UCTION Iv� �� I}— f - — DATE e ; 1 .1A low 000% Qr�15X A. - - - - _.._ . — ---------�`---------�VE-INzirtullurfE X38 WILL BE CHARGED IF THE APPROVED 1 �eEaMICAlY PLANS AND JOB CARD ARENOT ON ED c o peas THE SITE FOR A S INSPECTION. AIL .n cv/cos„�NSI- isAV W - -771 pxi5`1irv} vof/ i - !.AL Cons ]rRc Trow_ tiw/_/_corP y wt fh f'� QQA�✓i,vG FRANK vv': Koz L_: INGG /Q n / aid .,Ejc�tric -f mod12 1 I II_ r _cna.,cc5;,.- i- FX-,��►�riw� I r I 763 '-Z ?o! ,iia P -•+d a. 9a Jr,` '' :ti •r•. Y -a. ' `.R=`•„ . •=. 'x. •':.., S i !`Y'^ .Tt;; °'4:' ` h` . ti.�ks"ri'". r.;`;� tl :;�' '.,r'"y f.�.._. 18'. /---- 45' 1 /-- 24" ;k� 36" 24" 36" 24" 36" — 46' 98.. 27" --7,4- 24" AllAimensions size designations2n given are subject to verification on job site and -'adjustment to fit job . �' rec�noioc s fi-Y This is an original.design and must not be released of copied unloss applicable fee has been pai&or job order placed. KOZEL2, ....kit• Fp 3 Drawing#: 1 FRANK KOZEL 28270 HACIENDA II Designed: 12/11/00 Printed: 11/29/01 .QANk No Scale. conditions.LA QUINTA,.CA. 92253 `./� C�•,s t JvG/arr Shy// G�rn�� cu1Th THc /yy� G�ft7drnr. ,va�isF�f �Hd Illy ��1 a.;.�a��a-a.d /e�;J,,,C,f Co.IP.6 CITY OF LA QUANTA SUB -CONTRACTOR LIST JOK ADDRESS7$=zZo dde, (.e JO Ar ks,,� PERMIT NUMBEOWNER 617_ -AK 64 BUILDER OW YI -eV — lCr�+it kC This form shall be posted' on the job with the Building Inspection Card at all time in a conspicuous 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 reauested below must be completed by applicant.' "On File" is not an accpntahip rpcnnnsA_ Trade / Classification Contractor State .Contractor's License Workers Com ensation Insurance City Business License Company Name Classification (e.g. A. B. C-8) License Number (xxxxxx) Exp. Date (xx/xx/xx) Carrier, Name (e.g. State Fund, CalComp) Policy Number (Format Varies) Exp. Date (xx/xx/xx) License Number (xxxx) Exp. Date (xxlxx/xxl EARTHWORK (C-12) CONCRETE (C-8) 0 W 14 _e FRAMING IC -51 STRUCT. STEEL (C-51) MASONRY 1C-29.1 PLUMBING (C-36) 0.W .Q -r LATH, PLASTER (0-35) CIO M -R --V' DRYWALL (C-91 (.V .e. HVAC (C-20) d Vj klRr - ELECTRICAL (0-10) O (,v �A �e..j/ ROOFING (C=39) ''// tN- V� IL kQ:, 3 6 Fjff 0 6 Z --3 U -o S20 te (,)M F . —tlfa t'// t� 2 $fV f" 7`'!7 1 "�" ° Z 03 SHEET METAL (6-43) - - FLOORING (C-15) 10 (^/ yj -k yl - GLAZING (0-17) INSULATION (C-2) SEWAGE DISP. (C-42) Q U) n'"e-y' PAINTING IC -33) 0 W I/1 •Q CERAMIC TILE IC -54) p (hi h,Q ye CABINETS IC -6) D W y) -e r FENCING (C-131 LANDSCAPING (C-27) POOL IC -631 12/19/2001 13:33 4124`347197 TKI PAGE 01/01 KEY WELL SERVICES, FAX Phone: Fax.phone: 'TAD- -9'77— 701/ Dater Number of pages including cover sheet: �^ From: KFV WELL,SERVICES FIFTH AVENVE PLACE 25" FLOOR PITTSBURGH, PA 15222 Phone: .412-434-5616 Fax phone: 412434.7197 REMARKS: '0 urgent ❑ For your review ❑ Reply ASAP [] Please comment Dir eDt rA4-a 70 COwIDENTUUN NOTICE . This facsimile transmission (and/or the documents accompany pit); may contain confidential information belonging to the sender. The information is intended for the use of the individual or entity named above. If you are not the intended recipient,. you are hereby notified that any disclosure, copying, distribution or the taking of any action in reliance on the contents of this information is strictly prohibited. if you have received this transmission in error, please notify sender by telephone call to Arrange for return of theAocuments. If all of the pages indicated were not received or if there were any problems in transmission, please call (412) 434-5616.