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9708-049 (SFD)cn_. N W �. O Q f; LU OZ% CID0- 0 ti Lua Z LICENSED CONTRACTOR DECLARATION eby affirm under penalty of perjury that l am licensed under provisions of Wiapt err 9 (commencing with Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. I License # Lic. Class Exp. Date s_ 0 Date Signature of Contractor OWNER -BUILDER DECLARATION 1 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). 0) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business & Professionals Code). O I a . exempt. under Section B&P.C.,forthis rea°n Date 1 } ' 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: Carrier Policy No. (This section need not be completed if the permit valuation is for $100.00 or less). X) 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 �ode,,b ub'ect to the. workers' compensation provisions of Section 3700 of the Labor shall Jorfhwith comply withjf pse ro ' ioVDate: � - /`3 • Applicant. 6 Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost.of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his application. 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the building onstruction, and hereby authorize representatives of this City to enter upon 5905 ,1he above-mentioned property for inspection purposes. Signature (Owner/Agent)f�� el. Date2 /S = y - PERMIT#` CONTRO BUILDING PERMIT 9708-4414-9'D DATE 4i',r'1$/97 VALUATION 1632-18.410 1 ,SO COT j f ,; TRACT I; lk:l.'4 _.. JOB ADDRESS :.... `.j +3 ..• a. ;_, r. _ APN lA! 4-.D 3.6 •iPi! i • 12o Eis rimmomim li&it OWNER CONTRACTOR / DESIGNER / ENGINEER : USE OF PERMIT 3fG - Kubi fl i Lsak... NOT flgCi OF&-: tij.04F :K hP tv.Gs (.) ' ec% G G .. (Ir.JLV a�Utfa� 1 i Pt Pk0iAPA 110 1 Zt t +:til :?its i ialCt.r',i?#7t'r41 tb'a.1C�'!' iCt t.itfl .3V a; 1rnnn .�"Vy 1%W`r V4, Yf. 1b 4,141'�4rffsrf(,fA0r,&i! 1_.:. !• Y4?lGt N. l.r!} \ •{,IJ!1 n A Y.►\. ! iv, sena #ht V ,t L (:Nlpq.aTv,.t)( 'tit IN I'llip., l+�:f ,{inti-4i.`s0)() ey,i� �, i,t(V sir / aft-y>'E:.[�E:C; !%tt0)0_43'1-31X 4fsi",tt39 -. /`tif 1S111ti'ttrlY�Eft Al, FF -E 1.01 -WO --1s I-ti(A f 1 f CTIO At, Ft*', 3) '7.74 ® rn Pi, T'tR lTali,{('i 'fit? ? (5 i ..lb00 -1114>�f V In :`t i'K(.t 1(; h'SC� tt: iJ f.'1>f i2E;S11? 3U t Glk?-:9 t19f?ih`) G;'t,�3=1 ti X12/11.tIt-.it� �Lilti Itfi!-11{)�1-•7i.s•l.)f)II 5;'�ti1,Iitl � XNF'Rs1r;t'l�i3r'"1iiRh pi ks 1'2 ffClO u,i,1 =1r;� ;; 79. 13 W Pl?I�i 11,%3, P1:;S.N t(tl-l:lfw).�ld], "t.t &7K {t0 c1) r'�WC 1.I14 fq_4_ LfC PLA?'E:�'.-- 12 :S11: _70!-000 255-N1110 r 'M1[ lV 1')�I',t-'(?►�f:'."1'I?1'(7171t.*3 ANI 1 PI AN C3It•TI TO•II'A.C. p'Clwl}tiAHT FF -Es WIIC NOW N7,34,9.25 RECEIPT DATE BY' DATE FINALED INSPECTOR NSPIEC CMM �IRECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BWLD1NG APPROVALS MECHAN9 CAL APPROVALS Set Backs 1. A Gas Piping Underground Ducts, Forms 8 Footings fAW47111 Electric Final Ducts Slab Grade V f Water Piping IPlumbing Return Air Steel 42 Equipment' Enclosure Combustion Air Roof Deck Sewer Lateral Exhaust Fans O.K. to Wray 1(//„ G F.A.U. Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath Ae BLOCKWALL APPROV Set Backs Final Steel Electric Bond Main Drain Approval to Cover Equipment Location Underaround Electric POOLS - SPAS Final I I Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines, Heater Final Water Piping IPlumbing Final Plumbing Top Out Equipment' Enclosure Shower Pans O.K for Finish Piaster Sewer Lateral Pool Cover Sewer Connection Encapsulation Gas Piping Gas Test L If Final Utility Notice (Gas) ELECTRICAL APPROVALS Temn. Power Pole Fixtures Main Service Sub Panels Exterior Receptac G.F.I. Smoke Detectors COMMENTS:. CITY OF LA QUINTA SUB -LIST CONTRACTOR Dov 4 l od S /4, T! ADDRESS OWNER D oA=5 an�f JO.B ADDRESS�/9 -2Co /SeJVh`vwF This form shall be posted! on the job with the Building Inspection Card at all times in a conspicuousID ace. It is the responsibility of the General Contractor or the Owner/Builder to. ,monitor °the sub -contractors that are on this 'list are the same persons performing the work. Any changes to this list must be approved the City of La Quinta Department of Building & Safety gjLa to work being performed by a changed sub - ,contractor. Failure to comply will result in a stoppage of work and/or the voidance of building .permit. i 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 parry 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 workis 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.morespecific. information about your obligations. under State Law, contact the Department of Benefit Payments and the Division of Industri.'al 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 Quina, CA 92253 (760) 777-7012 FAX (760) 777-7011 6WNER'f SIGNATURE/DATE 7/ 2 C U ei5 F/Nft PROPERTY.ADDRESS ` X)8 -o+ 1 PERMIT NUMBER(s) Tiht 4 4 Q" April 6, 1998 78-495 CALLE TAMPICO - LA QUINTA, CALIFORNIA 92253 - (760) 777-7000 FAX (766) 777-7101 TDD (760) 777-1227 RIVERSIDE COUNTY ASSESSOR'S OFFICE 4.6-209 Oasis Street, Room 406 Indio, CA 92201 To Whom It May Concern: Please be advised of an address change for the following structure. The structure formerly addressed as 49-260 Eisenhower Drive, APN #631-341-012, Lot 113, La. Quinta Golf Estates #1, the construction for which building permit #9708-049 was issued, will now be addressed as 49-120 Eisenhower Drive. Please note this change and feel free to contact me if I may be of further assistance. Thank you. Sincerely, BUI ING & SAFETY PARTMENT Greg Butler Counter Technician MAILING ADDRESS - P.O. BOX 1504 - LA QUINTA, CALIFORNIA 92253 1 I �., o 4a" ,ff--e6& fD2 P.O. BOX 1504 APPLICATION ONLY Building,� % 78=495 CALLE TAMPICO Address l' -2 C zP l,, S f v f"E "" x LA QUINTA, CALIFORNIA 9225.3 Mailing � Address ' Address City Zip Stai Lic. LICENSED CONTRACTOR'S DECLARATION 1 hereby affirmAhat I am licenseed'under'provislona of Chapter 9 (commencing with Section 7000) of Division 3'of the suelness and Professions Code, and my license is in full force and effect: SIGNATl1RE DATE OWNERBUILDER DECLARATION 1 hereby at" that 1 am exempt from the Contractors License Law for the following reason:,(Sec. ,7031.5,ttualness and P.rofesslona Coder Any city or county whkh requires e pemxf to construct, Mer, Improve, demolish, or repair any structure, prior to.'ifa kiairarre0, also requhes 'the, epplkaf t for .ouch permit to Me a monad Statement that he b licensed pursuant to the prodaiona of f Contractor's License Law, Chapter 9 (common c6rp with Section 7000) of OWlaloe 3 of 9ua/nSOS and Professions .COOS, or Met. he Is exempt therefrom, and the bads for the , edexemption. AnIf vlolaikai, of Secflon 7091; 5' by any appNcanI for a permit S" to the applkent.to a'civll penaHyot more then: five hundred dollars ($500). r� 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 said. (Sec, 7044, euiSeess-end Professions Code: The Contractor's l,fcerrse Lsw doss not apply to an owner o/ prapefty who b&#ds' or imp -roves thereon and who does such work hknself or through hie own employees, proiAded that Such imp7o_ vemerde are not intended or offered for We. H, however; the, building or improverrisnt Is soft within one yew of completion, the owner-buDder wlN have. the burden of,proving that he did not build or improve; the puipose ofsale.) 1; as owner of the property,•am exclusively contracting with licensed contractors to con• steucl the project (Sec. 7044, Business and Professions Code: ,fie Contractors Llosnse Lew 'does not apply to an owner of piopedy who bWlda orMiproves thereon, and' who contracts hu such pro/ecfs wHh•a confractor(s) Ikensed.pursuarltto:tha Contiaotor's Lkwise Law:) 1-1 1 am exempt under Sec. B. d P.C. for this reason Date " � Owner WORKERS'.COMPENSATION' DECLARATION I hereby, affirm that I havd�a certificate of consent to sell -Insure. orr a certificate of Worker's Compensation Insurance, ora certified copythereof. (Sec. 3800, Labor Code:) Policy No. Company. n Copy is:tiled with the city.. ❑ Certified copy Is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be edmpiefed H the pdrmit Is for one hundred dollars ($100) Valuation or.oss.) I certify that in the, performance of thtnwork-for which this permit Is Issued, I shall not employ any ppesrson in any mannerFaO as to become.sub act to the Worl ere' Compensation Law�.pf CellforMa. NOTfCE TO APPLICANT:. H,. mer making -This CertHkate of Exemption you should .become subject to the Nbrkers' Compensation pmWi4o is of the LaborCode, you must forthwith complywith such.provislons-or this Permft shalfbe deemed revoked. CONSTRUCTION LENDING AGENCY I hereby 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 abuilding permit when propedyfilledout, signed and validated, and ls.aubject to expirstion if work thereunder is suspended lot 180 days: 1 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 constiuction, and hereby authorize representatives of this city to enter the above• mentioned property -for inspection purposes. 'c Signature of.al3plican ��% .�! Date` Mailing Address City, State, Zip_ ✓ 11 A ii nim s TYPE"CONST. OCC..GRP. umber Description La"f 113 C?6JT ,t Description sFi7 Sq. Ft. No. Site Storh Dw. New.❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ r Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. , 00 Plan Chk: Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL REMARKS 1; WHITE ,= FINANCE YELLOW a APPLICANT PINK= BUILdINO'DMSION ZONE: V MinimuwSetback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from..Center Line Side Setback from Proper FINAL DATE INSPECTOR Issued by: Date_ lLa For gi OO Validated by: 01404//''��.� ��ff" Validation: 1; WHITE ,= FINANCE YELLOW a APPLICANT PINK= BUILdINO'DMSION LQ 4itGOI PS ww P.O. Bahr Ia. Lo Q=t4 Ca 92253 619/564-2177 August 7, 1997 Planning Department CITY OF LA QUINTA P. O. Box 1504 La Quinta CA 92253 RE: PROPOSED CONSTRUCTION Lot 113/La Quinta Golf Estates Ladies and Gentlemen: Please be advised that the Architectural Committee of La Quinta Golf Estates has reviewed the plans for proposed construction of residence of Mr. & Mrs. Douglas Stone on Lot 113/Eisenhower Frontage Road. The Committee finds these plans confirm to all criteria as specified in the CC&Rs governing this Association. If' you have any questions, please contact our office at the number listed above. You s tr ly, TOM KENNEDY Chairman Architectural Committee TK/at