0212-181 (GRES)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
i.. .
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 offeredfor
sale (Sec. 7044, Business & Professionals Code).
I, as owner of the property,�am exclusively contracting with licensed
contractors to construct the project (Sed'7044, Business &%Professionals
Code). 13
O I amoexemptJunder Sections B&P.C. i t this rrelason
Date �%/rte°} ' ., Signature of Owner'Ki/, "�! 4 1 11h#1,d.1_✓'
r 1131 f
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
() I have and will maintain a7certificate 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�topthe workers' compensationprovisions of, Section 3700 of the Labor
.Cocle,di.91jall fort:•'?hwith comply w�,1 1ith,those pr v dons
-
Date:. h //a . Applicant / %17 r eJ/,�e i
Warning: Failure'io 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
•:t
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.
-scertify that I have read this application and state thaYl a above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authofize representatives of this City to enter upon
the above-mentioned property for ins ection puoses j
Signature (Owner/Agent) / �s�' �:( /� f Ratel,
PERMIT#
' BUILDING%.PFRMIT;;
.
r L �`
DATE VALk'TION` LOT TRACT
JOB SITE ` .
APN.
ADDRESS :.2A ColA�fti�
OWNER
CONTRACTOR / DESIGNER / EN (NEER
44_2,95 VM CORONAl: O
T.rA Cw7V''.INaTA: CA 92W
03TA
USE OF PERMIT
C:iARAGY OR CARHC1.1'T
3 '
t,1t�7.'�.CHtp13 Cf`�,lu�t;SY X33 �.N.i�t�l'f;:i"f'dC3,i1.'I'ICS•1�' frff.�' �g,4'3?35�� �E?� 2�3�7
U1=1ITNAM DMPOS't'R.ATI -000, §301,41 POWWOW ��.i�.:C V WITHOUT
1%J1LL�SPf61 ��:1tMt't': �� .�. .✓ � ••,...
MAY 14 1003 .
CI
OF LA OUItiTA a
•
INANCE DEPT.
EYY pp++��-���• ++�88.�p�v�p .�,��Lww*GL .*�yy p� n�i y r 7 py
. rlAnd:'.J:dAl'RSr➢r 1:101V6 OF .. O UJ..,Y13.�4�i�..i=O
fir/ t
FEMWIFF2 SUMMARY
PLAN CHEM ITER3,03-QQQ40'"41,8 3t�,SD
t; ONSTKLIC'CION FEE x 01-(100.41 awooi3 00.00
E -LOC ',MrAf FEF~ 101 -OW -420-000 $23,23
S?'I�O�+if� �,�ta'£tO1t1 1�;�' R.T:SiS� 1 Q9 �•%�0-�k �. -QilQ A.65
s
ORA13I1• O W- 101.000.4.44.OV) g% 1flA
Tt'fY'1KSTlQrts`k'.f0h 17d?k: 101.000.423-000 a9ti.€tEi
L,.j1L'd:1`.4 k.`' YAT, Wl.ffrfR-V i:'LL`✓J.T ifSC8gldqq.��l'�Ll'}gqfti��'•'1../ �C��dyyA'•.,,
, (W��Slt/7r .4 1
L g
TOTAL P MIJ Yrys DUE 14 ow
411).
4 #
RECEIPT
DATE
BY 1
w r
DATE FINALED
INSPECTOR
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
O.K. to Wrap
_
_
F.A.U.
Framing
_
,p
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
r
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
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
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
S .r Lateral
Pool Cover
Sewer ,onnection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring 1-703
Low Voltage Wiring s
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
its 'Bin #
: Of
1r, - r City La Quints
Building 8r Safety Division
1%Permii # P.O. Box 1504, 78-495 Calle Tampi o -
La Quints CA 92253 -'(760) 777-7012 t t
Buildin PermitA li
g , pp cation and -Tracking Sheet.
Y' Project Address: S t� Q /� Wrier's Name:'.' WL /UFSS
A. P. Number: �� t • - Address: I T V/ Co,�
Legal Description:
Cita. ST. Zip:' A, A_ Clo1a S 3 ,
Contractor:
U QL elephone:
Address: A t�4�'� / S— CU Project Description: AJ Cr
Ck Zip _
he
Telephone:
P
ho
ne:
:::::......
a
State Lic. # Cit,: �
Lic. #:
Arch.. Engr.. Designer` t a
Addres > - o u N p
S: , r 1
' City. ST, Zip: 9�
I
r - I
TelP
e hone:
Con •
st
ructi
on v
T
.P
e.
- Occ
u
p
anc�•:
•
�.
Std[e
Lic. #•
xx
P •
ro
e
ct t,
e
ci
rcl
.I ( e one : ' New . P ) . .�dd'n Alter Repair • Demo:
Name of Contact Person:J
r/"1 S . Sq. Ft.': K Stories: # Units:
Telephone # of Contact Person:Coo_ W Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
# Submittal 'Req'd Recd - _ TRACKING PERMIT FEES y i
Z Plan Sets Plan Check submitted fo
.Item Amount
s Structural Calcs.,; Reviewed, ready for corrections � ��_ . Plan Cbeck Deposit
Truss Calcs. Called Contact Person I� Plan CF.eck Balance e
Title 24 Calcs. ° '.( Plans picked up Construction o
t
Flood plain plan Plans resu _ ed w Mechanical
Grading plan end Re%�iew, readv correct' s i e �Z4 Z% Eleciric-3l O •
Subcontactor List Called Contact Person -
Z1 Plumbing.
Grant Deed Plans picked up
• � S.11.1. o �
H.O.A. Approval ` Plans resubmitted
• Grading!
9
IN HOUSE:- adv'for correct' s/issue '
•_! /(o Developer Impact Fee
Planning Approval_ Called Contact Person
/li A.I.P.P.
+� Pub -Wks. Appr . Date of permit issue 71 t INV
School Fees
;_dA R
CIA
t Total Perunit Fees
3Acki6
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 psrty 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 subco-ttract, 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 employerand 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 Rev --,nue 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 performi_ig 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.922
(760) 777-70 /%
FA�: ( 7 -701. , �/ O //J,,IA
OV9gR'S SIGNATURE/ ATE
,.
PROPERTY ADDRESS
PERMIT NUMBER(s)
rt
/�/¢L��� 'p:) CITY OF LA QUINTA SUB -CONTRA, TOR LI T
JOB ADDRESS�T—o��Jr`�G(, (.v7W�Lufi'!/ PERMIT.NUMBER OWNERBUILDER
h
This form shall be posted on the job with the Building Inspection Card at all times in a cou
nsoicous Ip ace, Only p rsons appearing on this list or their employees are authorized to work
N 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
a of building permit. For each applicable trade, all information requested below must be completed b n
a licant "On File" is t 1,1l
y pp not
Trade /Classification
Contractor
aaccep a e response.
State Con>taetofs License, WorkErs Compensatitin Insurance
City Business license
-,Company Name
Classification
(e.g. A. B, C-8)
License Number Exp. Date
(xxxxxx) (xx/xxlxxl
Carrier Name Policy Number
(e.g. State Fund, CalComp) (Format Varles)
Exp. Date
lxxlxx/xx)
'License Number Exp, Date
(xxxx) Ixxlxxlxx)
EARTHWORK (C-12)
,
CONCRETE IC -8)
C'
p
O
�p
//
Of ' —6v, I/2. 7
0S-5
FRAMING (C-5)
`
STRUCT.:STEEL (C-51)
MASONRY (C-291
PLUMBING IC -361
5)
LATH, PLASTER (C-36HY WALL (C-91
HVAC IC -20)
'ELECTRICAL (C-10).
ROOFING. I C-39)
i r
O
SHEET METAL (C-43)
FLOORING (C-1'5)
r
GLAZING IC -171
INSULATION (C-2) :
SEWAGE'Di&.
PAINTING
oERAIMIC, TtLE:IC-54) ,
FENDING (C=?13}`
iLAiYI�SCAM' G (C-271:
POAL IC -531
FROM :KATHY.WERNESS FAX NO. :7603455530 May. 09 20043 10:13AM P3
' C
0
. J 1
'KATHY WERNESS
44-295 Via Coronado - LaQuinta, CA.92253
760-345--5530 -. 760-413-2846
Mr. Serifin Rubi
82357 Mountain View Avenue
Indio,.California 922:01
This letter will serve as confirmation that I wish to
employ you as my contractor to constuct a free-standing
garage at -the above referenced property. Since,,you,
were the Superindent- at the site I purchased my home
last year, I feel confident that you know what you are
doing, and feel the quality of construction will be-
<consistant with'the rest of my home.
The free standing garage will be approximately 15'x20'
as per the plans submitted to the City of LaQuinta for
their approval, and follow guidelin-as as required.',
As we verbally agreed, your rate will be $25.00 per ,
hour with.a maximum labor charge of.$6,000, and I will,
,pay for all building materials, that we will.order thru Y
Home Depot -or other sources as necessary. (i.e: roofing
materials,,' stucco materials, etc.
Construction will 'start upon approval by the City of
LaQuinta and you estimate approximately.two months to
construct:the garage.
The plans have been submitted to the City for approval,
:signed off by.the architect and now awaiting a
Workman's. Compensation Policy to employ you on ray
.behalf. Your signature below will allow me to submit
and proceed with any other necessary approvals the City
might have prior to construction. '
Thank you, Kathy.Werness, Homeowner
_approval by Serifin Rubi,
P. O . Box 1504
t,. 78-495 CALLE TAMPICO
G (76.0) 77777000
04 J LA QUINTA, CALIFORNIA 92253 'FAX (760) 777-7101
FINAL NOTICE OF VIOLATION
7/2/2003 •
�. Kathy q,OVerness ;:,� •
44295 -Via -Coronado
La-Quinta; TCA_92253
RE: VIOLATIONS OF THE LA QUINTA MUNICIPAL CODE AT 44295 Via
Coronado (APN 604-211-017), LA QUINTA, CA.
On 11/14/2002, you were notified by this office that you were in violation of the City's
Municipal Code. Our records indicate that you were made aware of the nature of yoar,
violation, the action necessary to correct the violation, and that you were given ample
time to remedy the violation.
Another inspection was made of the subject property on 7/2/2003: That inspection
revealed that the necessary corrective action had not been taken. This letter will serve
as notice that if the violation is not corrected before July 16, 2003 an administrative
citation will be'issued or a notice to appear in court to seek compliance.
if -you have any questions concerning this matter, you should contact the undersigned
immediately at (760) 777-7021, Monday thew Friday, between the hours of. 8:00 a.m.
an 00 m:.
Sin rely,
J c •e isuraca, Code Compliance Officer
•- KATHY WERNESS
44295 V.IA:CORO.NAD
LaQUINTA, CA. 92253
Home Phone 760-345-5530
April 04, 2003
Jackie Misuraca RE: Case # 7673
City of LaQuinta
78-495 Calle Tampico
LaQuinta, CA 92253
Dear Jackie
You should have received a fax from Judy Handy, Handy & Parker Insurance Agency in Riverside verifying that
sheds processing the Workman's Comp policy for me on the construction of the garage at my home.
I wanted to bring the completed plans back to your office because today, April 4th, is my only day off and I want-
to get this handled. Judy said she would keep you updated on the stated of the Policy and Binder.
One of the other issues in the "Red Line" remarks was you wanted a letter from the Homeowner's Association.
The home owners at the Santiago tract have never implemented an association or had any meet--ngs since I have
owned the property, in September, 2001. The builder had a provision for one if the home owners Would act upon
it to start one, so far, not.
As I mentioned yesterday on the phone, the designer of plans for the garage is working on the plan for the deck .
but is back up with a couple of other jobs, and 1 will provide that as soon as possible.
As a note for the file, what was the third car garage is only being used as a "doghouse" and stc rage. Because of
my hectic work schedule, and the floor plan of the house being so open, I could not leave the dogs inside, so I had
the garage door removed, I installed the french doors so the dogs could be out there and watchpings going on,
have daylight, an*disturothe disturb theeighbors, yet ca go in and out of doors and protected with .he weather.
Sincerely, .
Kathy A. Wernes
04=03-12003 07:13PM
HANDY &. PARKER INSURANCE AGENCY
11735 WEST NORWOOD AVENUE • RIVERSIDE. CA 92505
PO. BOX 8487 • RIVERSIDE, CA 92515
(909] 689-9441 • FAX (909). 689-1705-
ARIL 2; !2003
C�TY OF �A QUINTA
PO BOX 1 04'
LA QUINT I, CgLIFORIVIA 9'2253
RE: 'KAT4Y 'A: WERNESS
44215 VIA CORONADO
LA UNITA, CA,92:2�3
PAP, CASE #'7673/J. MISURACA
iTTENTI N "OFFICER j7i;'MISURACA: FAX T0: 760-777-7101
2 PAGES
THIS ,LETTER WILL•jSERVE..•TO. VERIFY THAT HANDY ,AND' PARKER INSURANCE
GENCY IS It THE PROC�SS OF BINDING A WORKMAN'S COMPENSATION INSURANCE
BLICY FOR OWNER/BUILI3£R, KATHYRN A WERNESS, 442.95 VIA CORONADO, LA
UINTA, (ICALIFORNIA. :THE POLICY IS INTENDED TO PROVIDE WORKERS
'OMPENSA'TION INSURANCE FOR (1) CARPENTER WHILE HE IS BUTLDING;.A
gTRUCTURIE ON THE PROPERTY OF KATHYRN A WERNESS. MWE INSURANCE
ORRIER !OF THIS POLICY WILL BE STATE COMPENSATION INSURANCE FUND
AND THE IND DATE WILL BE SOMETIME. NEXT WEEK, AS SOON AS THE INSURANCE
"IS IN. PLACE; STATE FUND WILL PROVIDE THE CITY OF LA QUINTA WITH A
�ERTIFICA,TE OF INSURANCE.
i
I IF YOU `NEED FURTUER VERIFICATION, PLEASE FEEL FREE TO CONTACT
4E AT MY'OFFICE:
INCEREL
UDY NDY
CC: KATAYRN: A WERNES�'
04-03-03 18:`16
RECEIVED FROM:
P.01
FROM Insurance OFFICEtes Ins TO 1760?777101 P.01
•
Lqv\ _
.. � r.. %'-".� _ ^tom 4 •; �.:i.'F �w t�'�-.Phr. ; y
- _ P.O. Box 1504
78-495 CALLS TAMPI.co (760) 777-7000
LA QUINTA, CALIFORNIA 92253 FAX (760) 777-710.1
i
NOTI
'
CE
01F
PUBLIC..
NUISA C
N E
March 19, 2003
Kathy A.dWernessRE:' 44295 Via Coronado
44295 Via. Coronado Parcel # 604-211-017
, a, -Quints, California 92253 Case # 7673
Officer: J. Misuraca
Dear Owner(s):
THIS NOTICE is hereby submitted to you as owner(s) of the above. referenced property.
A recent inspection ofkyour property revealed'con'ditions in violation of the La Quints''`
Municipal -Code. You_ are required to correct these violations within TWENTY-ONE (21)
DAYS from the date of this notice. Your property will be re -inspected to verify
compliance after the twenty-one (21) day time frame has lapsed.
NOTICE OF VIOLATION
Case # 7673 - March, 19, 2003 l
Page 2 of 4
SEEATTACHED INSPECTION REPORT FOR VIOLATIONS)' AND
CORRECTIVE ACTION REQUIRED.
Failure to correct the listed violation(s) within the time frame indicated may result in the
City initiating abatement proceedings and/or criminal prosecution to correct the
violation(s).
If the City is forced to proceed with the abatement proceedings, the ownBr(s) of record .
may incurthe direct.costs of the abatement. Also, any additional costs. assessed due to
possiblejudicial process. , In addition to the above referenced costs, all contractor
abatement costs plus an-additional 25% will be charged to the property owner(s).as a
lien upon the property and shall become the personal obligation .of the`o-Nner(s) of
record. '
You are entitled to appeal the determination that a public nuisance exists to the'
planning commission. Within ten (10) days from the date of personal service, posting or
mailing,the notice of public nuisance, the appeal shall be in writing and fled with the city
clerk.
v By acting immediately to correct the violation(s) referenced, you will avo-d these and
any future costs.
' If you have any questions, please contact J. Misuraca at-(760) 777-7021. Please
provide the complaint number (#7673) and the property address.
Your assistance in supporting the Code Compliance Department to' maintain the safety
and appearance of our city is greatly appreciated. You may contact me at the above
referenced phone number if you require assistance.
inc rely,
ckie Misuraca'
Code Compliance Officer
NOTICE OF CODE VIOLATIONS
N.•
CASE NUMBER: 7673
. PUBLIC NUISANCES
Code Violation:
L.Q.M.C. 11.72.030 (M) Public Nuisance
s
-,Location:
Free Standing Garage with storage, Third Car Garage-
'
Conversion, and a Second Story .Rear Balcony with
Staircase.
Violation Text:
Violation of any of the zoning or sign orc6nances of the
:.
city or any of the uniform codes adopted by,•the city,
including the Uniform, Building Code, Uniform Code for
the Abatement of Dangerous Buildings, plumbing code,
electrical code, mechanical code, swimming pool code-,-'-.
fire code, health code and Uniform Housing Code.
Correction:
The property owner must obtain all required permits,
inspections and approvals to construct o- demolish the
structure(s) from the Building & Safety Department. For',
information on obtaining permits call (760) 777-7012: L
Reinspection Date: April 10, 2003
i
NOTICE •OF CODE VIOLATIONS
• 4
CASE'NUMBER: 7673
t _
PUBLIC NUISANCES
Code Violation:
L.Q.M.C. 8.01.060 Permits Required
Location:
Free Standing Garage with storage, Third Car. Garage'
Conversion, and a Second Story Rear Balcony with
Staircase.
Violation Text:
It shall be unlawful for any person, firm or corporation to
erect, construct; enlarge, alter, repair, move, improve,
.'
remove, convert or demolish any building or, structure,
including a swimming pool, spa or hot tub, or make any
•
installation, alteration, repair, replacement, or remodel
any building service equipment' including swimmin g
pool, spa and hot tub equipment, regulated by this Title,
t _ .
except as specified in Section 301.2.1, or cause the
same .to be done without first obtaining a separate,.
'appropriate permit for each building, structure or
service equipment from the Building Official.,
T Correction:
The property owner must obtain all required permits, ,
inspections and approvals to construct o demolish the
,
structure(s) from the Building & Safety Department. For, J
information on obtaining permits call (760) 777-7012.
Reinspection Date: April 10, 2003 �"