9704-113 (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 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,• B I & rofessionals
Code):
(„�am��niqnature
ction B&P4.Q
Dated% of Owne
WORKER'S COMPENSA'iM DECL,410MINI
I hereby affirm under penalty of perjury one of th 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 ection need.not be completed if the permit valuation is for $100.00 or less):
(7certify 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 beeo subject to the
workers' compensation laws of California, ree th Y' should become
sutiject to a workers' compensation pr Io of Se 00 of the Labor
C derf all fo ith comply pr s.
C
Applican - f
IV
War ng: ilure to secure r Co an coverage is unlawful and
shall subject an employer to criminal pen ies civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to:the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuantjo
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, Vd'State laws relating to the building
construction, and hereby authori rep sent rives of this City to enter upon
/Signature
above-mentioned property Ins ' tion s:
Signature (Owne-IAg t) D
PERMIT # CONTROL#
BUILDING PERMIT
r��� od.$ 50-38-
DATE tg�� 1 VALUATION BiG1 LOT TRACT gr
ADDRESS r�}9.084)1�;i1S1+1,NHa�W;@t.1)kR;IVE, JOB SITE
APN
OWNER
CONTRACTOR / DESIGNER / ENGINEER
TfI0N1.A.S N. IDuni✓
(J1WINIt ft.rl'IJ11,i: ElZ
4:9-080 EtSENHOWER, DRI VE
LA (,RRN'Ni CA. 92253
m
n't,f!
USE OF PERMIT
Af�1�h1
iit:*4,A;4Y I-i,Al' 6UL.S t 1101,13E i058S ' Cilff.i�V1C"i'
250.,`V1 AND WALL 6 e i 51A
1%.1►l.i.tA'IiON 9$,A' :2.0 L:i
$��c�cn,���f���a��> c_����f�>;� nliif� c���.:t� �'�{r.�s<:�.���
��� �-t•�•,,t�l
i�li�'1'Irl,fr;'I'ir �N !'H7�' 1t21—fNxl�.f fft�(Hti) 51t�xj itr�
NI AN i"tlVVK- I.014111-d1.19-1lf3
1t)t.OW-121 000 SIG 5o '
EIA:( 1'i4CAL lillr it7i-fiipi .i a—ink) tw?lekx
t�t.QiP.fl;lht+lil!f: 101 -(Ax) -1119 40) €(77401
fy'1'i itlt'i• 1+?`t`If')hf {;!%Pr , tli `ah 1011000_w .1IAloo Vj .10t
it'N1I:Y9Nt I"cl-, 101 10) 123 00-6 R20.1"10
24.-�%-00, 44: �- 3
14 4
` l Y!' d{1, t.".1'jhi`�I'I{i.JC�1'„ff:)IV _APit`) I'I1A'N (11414111,
AID
$1,5sl 11
APR 241997 a'aaI'r\9, ell-Q010T gi'VFII 4 I.)ij_IE N0%V
'1io , k0111
C :1
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
UILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footing,5x
Ducts
Slab Grad
Return Air
Combustion. Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing 077
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 4z
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
PL MBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
W g
Plumbing Final
Plumbl g Top O
Equipment Enclosure
Pans
O.K. for Finish Plaster
Lateral
Pool Cover
Sewer nn ion
Encapsulation
iping
Gas Test
A to
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
!ding
Address
Ti tit 4u
X. 1504
7&1 5 CALOLE ESTADO
kA QUINTA. CALIFORNIA 92253
& Classit: I Lic. #
Designer
Address Tel.
CityI Zip I State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed. under provisions of Chapter 9 (commencing with Section
7000) of -Division 3 of`the Business and. Professions Code, and my license lain full force and
effect:
SIGNATURE DATE
OWNER -BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5, Business and Professions Code: Any. city or county which requires a
permit to construct, akar,. Improve, demolish, or repair any structure, prior to Ifs Issuance also
requires the applicant Tor such permit to rile a signed statement that he Is licensed pursuant to
the,prodsions of'the Contractor's License Law, Chapter 9(commencing with Section 7000) of
&vision 3 of the Business and Professions Code, or that. he Is exempt therefrom, .and thebasis
for the alleged exemption. Any violation of Section 7031.5 ,by any applkant for a permit
.subjects the':apoicant to a civil penalty of not,more than five hundred, dolkrrs:($500).
0 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, 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.provinprthat he dM not build or improve for the purpose of safe.)
I1 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 applyto 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.)
0 1 am exempt -under Sec. 8'. & P.C. for thlipreason.
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that 1 have a certificate of consent to self -insure, or a certificate of
Worker's°Compensation Insurance; or certified copy thereof. (Sec. 3800, Labor Code-)
Policy No Company
D Copy isfiled 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'thp 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.
Date Owner
NOTICE TO APPLICANT., If, after making (his .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 perk shall bedeemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there,is a construction tending 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 taws 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
BUILDING DIVISION
APPLICATION ONLY POOD
TYPE CONST. OCC. GRP.
Number
Description
1 Description � �N�L�
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add 0 Alter ❑ Repair ❑ Demolition, D
tstimatea valuation p p
/OO. pd n
PERMIT
Plan Chk.. Dep.
Plan Chk.
Const.
Mech.
Plumbi
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
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: r
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING F
75T FL SO. FT. g $
UNITS
SLAB GRADE
2ND FL ' S0, FT. (s7
BONDING
YARD SPKLR SYSTEM
POR SQ FT 0
MOSILEHOME SVC,
BAR SINK
GAR. SO. FT. 0
POWER OUTLET
ROOF DRAINS :•
FOUND. REINF.
GAS (ROUGH)
DRAINAGE PIPING
CAR P. SQ, FT. ACL
OTHER APPJEQUIP.
REINF. STEEL
WALL SQ. FT. Q$
TEMP. POLE
DRINKINGFOUNTAIN
SQ, FT. ®
GROUT
URINAL
ESTIMATED CONSTRUCTION VALUATION S
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
WATER SYSTEM
FLOOR DRAIN
MECHANICAL FEES
=S
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
KITCHEN SINK
ABSORPTION SYSTEM. B.T.U.
TEMP USE PERMIT SVG
WATER CLOSET
COMPRESSOR HP
POLE. TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO, FT. Cid c
BATH TUB
SPARK ARRESTOR
SO. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U,
SO. FT. RESID Cp IIA c
SEWAGE DISPOSAL
LATHING
SQ.FT.GAR p ?Ac
HOUSE SEWER
MESH
'GAS PIPING
PERMIT FEE
INSULATIONISOUND
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=S
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES71N171AL8
GARDEN WALL FINAL
Desert Sands Unified School District
Notice: 82-879 Highway 111
Document Cannot Be Duplicated Indio, CA 92201
619-775-3500,
CERTIFICATE OF COMPLIANCE
Date. 4/21/97
No. 15441 Jurisdiction
Owner Name Thomas N Dodd
No.49080 Street Eisenhower
City La Quinta zip 92253.
APN # 631-341-008
La Quinta
Permit #
Log #
Study Area ��
Tract # Lot # Square Footage 1058
Type of Development Single Fancily Residence
Comments
No. of Units 1
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:
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of
1.84 X 1,058 or $ 1,946.72 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/Wells Fargo Bank
Name on the check
By Dr. Carol McGrew
Administrator in Charge
Fee collected /exempted by Pauline Pearson
Signature ,� P-0 ,,,, Aapyy�_
Telephone
Payment. Received $1,946.72.
Check No. 503002081
NOTICE: Pursuant of Assembly BIII 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 9D -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,sssued or on which they are paid to the DlWct(s) or to another public entity authorized to
collect them on the Disblct('s)(s) behalf, whichever is:eartier.
Collector: Attach a copy of county or cityplan check application form to district copy for all waivers.
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting
From : TIMEPIECE DES.. INC. T.DODD
�a�a�ONI �tN LAND TRLI CQ.
PXcORD%Ma 1!ftunsTUD 8To. .
Thomas M: Dodd, 'Trustee
trsurat ancoraub MA2L Too
I
Tltwaas !1: bold, Trustee
Y'.O. S'Nt 1500
La Quanta. CA 92$53
PHONE No. : 619 776 1471
U, i v
trN11�i1�lGi�ii�Gflp
X10 0
Apr.0.3 1997 10:11FM P01
4056G9.
A98VEDFURML6080
AT8:00=WCK
F ;, DEG 6
Doc Trm"Nor Tax
FMW,K. JOHNSON. �;,e,etiasatlaroaw
Ritr. Co. Rfppkw a � Heroes►
sYACB "ovs Title LIME FOR RXCORbER•B.USB
0 R A X T D82D rrr�-
The undersigned Grantor(s) dsclare(s)s Documentary transfer tax is $:137.50
As8ESBOR•s PARCEL No.e 631-341.023(X) computed on full value of props�'?ty'oonveyed, or
TITLE ORDER NO.s 777/} (h% computed on the full value lads loins or f
SSCROu NO.s 10090 -JC 49" 00- ✓ encumbrances remaining at the time of sale
FOR A vALUABLB consimATION, receipt of which is hereby acknowledgeds
itrair P.' Gulesserien and Margaret Quleseerian, or their euccessor(s), Trustees under
Revocable Trust Agreement dated March 2, 1979, as amended
hereby AWT(8) to Thomas N. Dodd, Trustes of The ThomasIg. Dodd Trust dared July
24, 1990'
I
I
The following real property in the -City of be Quint&, Riverside county, state of
califvznias We 001-/
described apt Lot 110 aadVI/2 of lot 109 of La Quina Golf setates No. 1, as shown by
Map on -file in Book 37 Pages 96 through 99 of Haps, Records of Riverside county,
California.
Dates november 20, 1995 • n
P �.
ortir P. Gulesserian, Tiustes
STATE" OF .CAL1rO*NX
COUM or !targe Guleadbrian, Trustee
On 1\_ before me, �_...�s6oa.•..a_a
personally known to sae (or proved to wo on the basis
of satisfactory evidence) to be the person(s), whose
nameta) Ware subscribed to the within instrument
and acknowledged to me that he/she/they executed the
same in hie/her/their authorised oapacity(ies), and
that by hia/hos/their aignature(s) on the instru,tent
the persons) or the entity upon behalf.of which the
person(s) acted, executed the instrument.
Qulmedan
witness my band and official seal. AfirR�at�%=?
8"rO«ua awnry
saguaro _ V.4m IE 00, ". t°°°
Hatay (typed or printedf -(This area for official notarial seal)
APR -03-1997 10:12
619 776 1471
89%
P.01
r La Quinta Golf Estates
Co r„ nzinity Asodadon
P.O. Bax 162
La Quinta, Ca 92253
619/564-2177
February 3, 1997
Planning Department
CITY OF LA QUINTA
P. 0. Box 1504
La Quinta CA 92253
Sbj: NEW CONSTRUCTION
RE: Lot 4110 and
1/2 of Lot #1.09
LA QUINTA GOLF ESTATES
Gentlemen:
The Architectural Committee of La Quinta Golf Estates Community Association
has reviewed plans submitted by property owner Thomas Dodd for new
construction of Guest Residence.
The Committee has determined that these plans meet all the requirements for
construction setforth in the governing documents of our :Association.
If you have any questions, please contact me through the Association office.
Yours truly,
TOM KENNEDY
Chairman
Architectural Committee
TK/at
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Alt
NTY OF RIVERSIDE HEALTH SERVICES AGENCY A88E8$OR'B PARCEL NUMBER
DEPARTMENT OF ENVIRONMENTAL HEALTH
PERMIT APPLICATION FOR A SUBSURFACE SEWAGE DISPOSAL, SYSTEM
APPLICANT: Submit this form with four copies of a SCALED plot plan (1-20 SCALE) drawn to County specifications as indkWed on the attached check List.
A non=refundable filing fee Is required when the application Is submitted. Check must be made payable to the County of Riverside. Approval of this applica-
tion shall remain valid for a period, not to exceed one year from date of Devinent
l I tY tai �A
LOG if
Agent, Contractor, Contact Person
Address City State ZIP
Telephone
,IFC -4441-
trial •
Owner
Address C State 230
Telephone
.
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O
Job Property Address,
CRY
Zip
U.
til
Lot Size afar A
tbRCQctIA f44cr�
Use of Permit, PIP, SUP, PUP, etc.
1riG ESQ /�lu�C
legal Deaaiptlan
S L�7 lob tai I! iAG'u.,;vn, �ucFlsYlla '
�l� fLc 1 VIS'f4lr
Dwelling, MH Site Prep., etc.
Signatu loan M F#" W180 Ufa 113 � 91
Date
r
CHOCK—BOX IF REQ IRE
❑ Holding Tank Agreements Completed
❑ Detailed Contour Plot Plans Required (1 ta5 foot intervan
❑ Certification of Existing S.D. System Required
❑ Grading Handout Provided
Z❑
WQCB Clearance Required
Ll Staff Specialist Lot Inspection Required
0
(Attach For DOH -SAN -007, Santa Ana Region Only
❑ Lot Inspection
ULlSolis
Percolation Report Required
LU
N
❑ Special Feasibility Boring Report Required
❑ Date Lot Inspection Completed: Initials
Remarks:
e
13 .Maintenance Booklet Provided
Iniliais Date
❑ Final Inspection by Department of Environmental Health is required.
C/42 / Sats Percolation Boring Report by LkilPro)ect # Date
M 679
Soils Map PapeSoH Type ` Approved By Date
No of Systems
Type of System(s)
No. Dwelling Unna/'/
(1) Septic Tank.
Soil Rate Otej&Sand
O Holding Tank 0 Replacement
Bedrooms, RbrerM4*#W-
Gr9adVInkQjVnt Trap
O'New O Addition
O Existing
.2 9/) ^^y ,,7,14r, . A Cr44 ,
0 ac -1.
I,p " I sem~ e
Sq. Ft.
Total Linear
Sidewell Allowance
Learn Bed sq. M of
ttom Area.
t. rccli/ ea, tt running R
Install e(s) ft long it. wide with
gp Area
Inlet. Tested Dep NA
min below dralnllnes or
U
Proposed Bottom Te _ Depth
Z
Leach lines/bed epactal design for slope:
(3) Pt Diameter
No. Pits
Pit Below Inlet (BI)
Seepage Pit
Maximum
Depth
UTotal
Applicable
r
- [j
Depth
LU
N/A—Overburden
V
TQ 13'
*3r
Well Review Approved: Date: Well Drilling Permit N
81oNATURE
Grading Plan Approved: Date:
803NATURE
Sewer verification Approved: .
yG ®Date
REMARKS: {IL f
/D
L /�GGtJ
-Ae
r
This application kPRO SWT -ION B
FOR OFFI& USE ONLY
abcwe; regarding the design of a subsurface disposal system as Indicated on the
acompanied plot plan, using the requirernents,set forth In SECTION C, above. A bulki-
is
/ {d
1.2 36P a?
Ing permit necessary for the inslallation of the abovedesigned system. No construe
Revenue code Fee $
tion Is permitted in the reauired .ro owed 100% exwmalon ai#ea
017 minimum from any wet' b
(1) Septic: Tank must be 1lls. � 1 fl , • �`
�Chsdk: li 0
(2) J each ilnes.must be 1W minimum from anywells; Inducting expenebn°area
Date [ 1 Initial
(3) Sewer lines must be So' minimum from any wells.
% r r ` I / M7
Z
O
(4) Seepage pits must Do 150' minimum from any weds, Inducting expanslon area.
;
LU
t.
Signature of HealthO81dal
4
Date
OA
6 N3
DON -SAN 122 (Rev'03)
1 Ursmouuon: nro r c—vmcv rue; 7CLwn—npp11can1; rrnn—plug. uapb urcn � L—rranWmecoros.
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/I
April 9, 1997
TO WHOM IT MAY CONCERN
Re: Construction of Guest House
49080 Eisenhower, La Quinta, CA
Edward G: Wise
This is to advise you. that. I am the owner -builder of a guest house on the above -
referenced property. Edward G. Wise is a general contractor and superintendent
of the construction project. I hereby authorize him to take whatever steps are
necessary to expedite the project as my agent. He may order materials from
material men and hire labor on my behalf. He may also deal with the City of La
Quinta and any and all utility companies as my agent. He may present my checks
with my signature affixed thereto to creditors or .for payment as the case may be.
This authorization shall expire on May 31,, 1997.
Ff omas V. D . , d
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 yoii.do not:cairy Ou[ these obligations, and'thise ticks 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 aish, the U.S: Small,Business Ad"minstration). 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 ownerswho are not licensed contractors are allowed to perform their,
work personally or through their own employees, without a licensed contractor ousubcontractor, 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 95.814..
Please complete and return the enclosedowner.,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
78-105 Calle. Estado
La Quinta,. CA 92253
(619).564-2246
FAX (619) 564x617
•� — _�_ r- .-;, &�i v iiiri
OWNER'S SIGNATURE/DATE
PROPERTY ADDRESS
PERMIT NUMBER(s)
CITY OF LA QUINTA
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