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0108-106 (AR)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 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.fheir sole X '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 ekem/pp�t under Section , B&P.C,jpr this reason I Date .- 1r.,, 9,,1 Signature of OWnef;�, 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). (,,•) 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 othe workers' compensation pr�yo ,isions of Section 3700 of the Labor Code, I s fall forthwith comply with-th'ote provisio Date: Ot r�- p ADDlicant' ....w....:,.. satiy,...�.,..o,.,. Warning: Failure to secure Workers Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his application. 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Ouinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is • correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for inspection purposes. A.n•.JT �� yw•W �~ A Signature (Owner/Agent) "`✓� Date} BUILDING PERMIT PERMIT# DATE VALUATION LOT �� Q-�{�" TRACT ' -- S22" JOB SITE APN ADDRESS :JA^YnGi'Y� A'7ft 8.C`.A.�I�.i�l•8 s��gSA.S'a..4ilX4d'F � i�VE'if"ti1.L� OWNER CONTRACTOR/DESIGNER/EN (NEER MARIO M ROT"OA i iAYl IZIa 51125 AoaMM'A1MR.1+KA CA 92253 MI L O USE OF PERMIT 90LAND01NCt3WALA 420 S.t Y'.AM%!X R001W J.bDVITION PER APPROV90 PL,AN$ TRACT Wgiln'RUMION 420.0 UP EWMAXAD CM, OF Cd,:�l�ohv"xM11C311 ?.v°.'$ 21718 6.00 �•9`1�' HI �'y'eay.����K��.�')�,p��N IP4 1{ 01-,Vyt.�y/0.41y. $.2M,00 ps3�a0A00 PLAN GC'�NTA.a% '51;�.3i A/(j; r 'l t.11-iikdSJ-439-3 9 $I�Ot.E'iC+ +Y MECHANrd°.�.I. Y/FE 101.00€ -421-000 33ZSC ELAUC:rM,, L FEE lou -000-420-000 W.70 mt,momomm nr&"ReenD i0f. i7QtMi-ow SZ 214 t:41tWDkt40 rE•Z 101-C.3i)'�i4.23-,t30(� AUG f 70 2001 , •! • �.fi.`i�—..�.._ UffJY. B -TO iyC9i►5.,5.Pd'd L3 �4J M.+1�1.�.JT 3k, p�q �r�q,� yy��ya�sy�ryL�.T-AIQ SUB -TOTAL Ji r �. 4 A_-..- j fv3I AL FEW "i' ITES DVF .NOW wM $591 Zai i RECEIPT DATE l BY DA FIN LED INSPECTOR r1/. U/ -t2 -- I INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs _ _�. Forms & Footings I i iat S Underground Ducts Ducts Slab Grade Return Air Steel Combustion Air Roof Deck n ( C O.K. to Wrap {a'�-�O-I �y t Exhaust Fans F.A.U. Framing Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans 8 Controls Party Wall Insulation Condensate Lines Party Wall Firewall _ Exterior Lath Drywall - Int. Lath Final Final z BLOCKWAL AP ROVALS POOLS - SPAS Steel Set Backs Electric Bond Footings Main Drain Bond, aeam Approval to Cover Equipment Location Underground Electric ' Underground Plbg. Test Final Gas Piping PLUMBING APPROVALS 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.1. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) COMMENTS: - Notice: Document Cannot Be Duplicated Date 8/10/01 No. 22367 Owner NameMario Estrada Desert Sands Unified School District 47-950 Dune Palms Road La Quinta, CA 92253. 760-771-8515 CERTIFICATE OF COMPLIANCE APN # 773-063-016 Jurisdiction La Quinta No, 51-125 Street Avenida Herrera City La Quinta zip 92253 Tract # Lot # Type of Development Residential Addition Comments ion is a family -room addition - 420 sq. ft. Permit # Log # Study Area Square Footage 420 No. of Units 1 I 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 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: EXEMPT This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of 0.00 X 420 or $ 0.00 the property listed above and thet biulding permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued . Fees Paid By Exempt - Mario Estrada Telephone Name on the check By Dr. Doris4Wilson Superintendent Fee collected /exem ted by Annette Barlow Signature Exempt Check No. $0.00 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 tbove 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 :ollect 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 N 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 FAX (70) 777-7011 OWNER'S SIGNATUR197DATE TY ADDRESS PERMIT NUMBER(s)