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0107-120 (RPL)N N N W Ouch t�L0, P_ t- o Z P- CO 0' C HCID IW— a rl- to Z M LO N ON U_o Z o.� CC ��0. LL O JJ m< cn H Z obZ) Q� J LICENSED CONTRACTOR DECLARATION I hereby affirm -under penalty of perjury'that•I am,licensed under provisions of . Chapter 9 (commZncing{,with Section7000) of Division 3 of the Business and Professioffals 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 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 &�/erooffeessionaalls Code). •( ) I am exempt under Section B&P.t�)Or t i 'reas/on Dater Signature of Owner ! .+Pr/ t�1�d'✓ WORKER'S COMPENSATION DECLARATION I hereby,offirm 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'3706 of the Labor Code, for the performance of the work foPwhich this permit is issued. My workers' compensation insurance carrier & poticy. .`no. are'. Carrier Policy No. (This section need not be. completed if the permit valuation is for $100.00*r`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'tti'e workers' compensation laws of California° and agree that if I should become subject'to the workerscompensation pir'osio vins offSeati84,37004 the ''abor Cod 'A' hall ,forthwith�comply with t&ese pro isions,. Date: C: °! 'Applican`t+ Warning: Failure to secure Workers' Compensation coverage'.is unlawful and- shall nd-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 tfie Labor Code, interest and attornW!�'•fees. , IMPORTANT Application is hereby made to the Director of Building and Safety .for a permit subjectto the conditions and testrictions'set forth -onhis 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 pursilant to . any permit issued as,a result of this applicaton agrees to, &•shall, indemnify & hold harmless the .City of La Quinta, its'offiders, 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 readthis -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 iRspeetion put oyes. /.1#1 Signature (Owner/Agent) ='. B`UILDING PERMIT • PERMIT# DATE' VALUATION LOTTRACT JOB SIT �, '' 7"; , - , APN ADDRESS I OWNER s CONTRACTOR / DESIGNER / ENGINEER Z> . 7b bdf"9 ? ca LM AWD AM) MAdf BA -600M 53•475 AVDAIDAWRRERA CA 92253 USE OF PERMIT Pr' Qt,ttiM� ALARM Y.RA> AJ1W.3' &'4j,'L BRiN PL4CP AT PR&P1,A.`:jT ,R, PFC1`l:O i. AC3�9 t,1�1Et' @lel °' P9CP�?�s6}1t 1dor 133:;1.UDED. : '. ` Pi^I� 1,.AD`f;OJ0A 5PA :,i atJ,U0f3.1ts� iWo EHIMATIM COST OF, CsOA&MCMON r9R,'tD<��y/`4��pp°`sr�t�S y�.;• ��lppYil1r'�.tl��'.' fft�pp� p y�y - .i��=e�4rc�lt�.�a.��y�q,�! •r�� 7r„Mry�aAa��`r�q��T+l�ey:'apptYy�Ytr7eee��..�eet;la 99. [YB I:e�%8.f'UfM1 4tim.*")Sl d`S,rS�"' 1.'�,Jfy3.1' J hvvH"'�ba 1''VVU .%24,00 &?Cxm . 101 v 10N.ANDFLA4CI-MOC, $285%05 LD JUL - 3 2;Gic ' rIXESD11112.Now U -W A FiNIA NCE. DEPT I RECEIPT DATEBY D7 FIyA`CP� INSPECTO FI 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 0. K. to Wrap 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 I POOLS - SPAS BLOCKWALL APPROVALS Set Backs Steel 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 Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection EncapsulationZ Gas Piping Gas Test Appliances Final COMMENTS: 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) 1-5.5'— a, v. CITY OF LA QUINTA. Babcock Residence P001SA06§ SAFETY DEPT. FQfib CONSTRUCTION , 'ATE BY —5.5'-- 1 S' House A 32 ' RE-INSPF�tON FEE OF $30 W1 LL BE CHARGED IF THE APPROVED PLANS AND JOB CARD ARE OT ON Th E6'SITE FMI A SCHE MED IN VECTION. -�-- NO EXCEPTIONS! rm Lcv Perimeter 51' Cement Perimeter from House to fence 23' from pool to back fance I Grass/Landscaping 53-475 Avenida Herrera, La Quinta, CA 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 Tice from the City or County. They are also required by law' to put their license number on all permits for v�'•.-: apply. If you plan to do your own work, with the exception of various trades that you plan to subcontract, yo�l _- o,ac' h,: 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 marceJais 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 maybe obtained by contacting the Contractors' State License Board in your community or at 1020 N. Street, Sacrament , California 95814. Please complete and return the enclosed o ner-builder verification form so that we can confirm that you are aware of these matters. The building permit will n t be issued until the verification is returned. Very_truly-yours,-_._.-- --- — - - -> - - CITY OF LA QUINTA DEPT. OF BUILDING AND SAFETY 78-495 Calle Tampico LaY77 92253 (72FA-7011 / OWNER'S SIGNA RE/DATE PROPERTY ADDRESS I PERMIT NUMBER(s)