9707-035 (RPL)-LICENSED CONTRACTOR DECLARATION.. I hereby affirm under penalty of perjury ,that I am licensed under provisions of Chapter 9 (commencing with Section 1000) of Division 3 of the business and -Professionals Code, and my License is in full force and effect. License # Lic. Class Exp. Date V4127 A. VDate — Signature of Contractor OWN ER -B UILDER'DECLARATION I hereby affirm under penalty. of,perjury.that I am exempt from the Contractor's License Law for the following reason: ( ) 1, as owner of the property, or my employees with wages a's 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 pro!Ject'(Sec. 7044, Business & Professionals Code). Lam exempt under Section B&P.C. for this reason Date Signature of Owner WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of.0erjury one ofthe following declarations: O 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 wbrk fdf which this permit is issued.- My work&s'-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 the workers' compensation provisions of Section , on 3700 of the Labor C�dTshall forthwith comply with those provisions. Code, ,VDate: Applicant 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, damage's 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 t. any permit issued as a result of this appli6aton 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.canciela'tio'�__ n. tl 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 buildin—g. iconstruction, and hereby authorize' representatives of this City to enter upon the'above-mentioned property for inspection purposes. "Ig nature. (Owner/Agent) Date— BUILDINGPERMIT PERMIT# CONTROL# DATE VALUATION LOT. %707-035 TRACT 5483 5.13,401.00 261.. JOB SITE APN ADDRESS . . 47-145 VIII MONTIGO 643420-1034 OWNER CONTRACTOR DESIGNER ENGINEER CANADAY& COt1VANY STEVE DC)DSON CONSTRU(MON 1.5-70B&OOKHOLU:W1 DWO, SIUWM268 73-011 COWMY CWKIDROVE, S117, F4 SANTA ANA C.& 9270.5 PA N4 DESERT CA. 02260 346-4032 CBL# 104-4 USE OF PERMIT POOL POOL AND SPA ONLY POOL ANDfOlt t0A' 13,401.00 LS V,8T11%VVf IM COS OF CXYNS'T RU'CI'IQN fty 101-00OA39�318 $9.9.45 PLM aWcKiiv ze N CONSTRUCTI014M- 101.000-418-000 $153.00 MFXfb1\NJ CAL F.EE -'POOL. .101-.00(11-421,000 124.00 101-00-42040 $0.00 PLM-IBING Fa,-.', -POOL 1011-000-419t000 $27.0 . 0 SCIDI-TWAL CONSIRUM ION AND PLAN CHECK $3.48.43 -PAID RES LESS PUF $0.00 Je. TOM PFRNHT FEES DUE. NOXV S348.41.5 RECEIPT DATE DATE FINALED INSPECTOR W 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 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 POOLS - SPAS BLOCKWALL APPROVALS 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 Sewer Lateral Pool Cover Sewer Connection Encapsulation Gas Piping Gas Test i 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) .............E:::>::::>>::>:::::>::::':>:<>...................... ... ............. .. .X.X- ..... .. :xxx ....... ............................. i* .............. eias . . ......... . ..... .. ........ ................ ...... ............... ... Bin -7 of -La City ti Qu�n�Q a t is: .. . ............. .. - . ....... * ..... .................... ... . ... ... . . . . . . . ....... Building 8,uSakty Division ::T . ............. ............... .......... . . ............... Ot 'P.0. Box 1504.�, ................ . .... :::::: .................... ............ * .................. ............... * ........... .. . ..... ....... ......... i :::)0�aW, 0 .......... A. ..... ... ........ .............. ..................... : ........... 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Number: ... ... *".*.'. :-. .............. ................... fAddrisg: .................... .. xx.: ................. ...... . xx ... ............. ........ ....... .....>>>»>`:'<<>»666;6: -.7 ........ ....... x: .... . .... . :: .... ........... ....... ... ... ......... . ...... ........................ ................... ... 6.6 ............ ... . ......... .... t, Legal Description:, ........... ....... ...:``.EEE.;?.. .............. .. ................ . . ................. ............. pCity,ST, Zip: ...... ............. %.—I...... -xxxx ......................... 6 .............. ............. .......... ................................. X.X.X-:-:6X-X-:-:-:-: ................... .............. 6 .................. ................. Contractor: ....... ..... ......... OTelephon-e: 3/' 0 3 �2 ....... ................... -X-6 ................ .......... .w ............. Address:, ................ ...... pproject Des �cription-I.r. 3 ZzAi0i06 .......... ................ ............. �.- Ciry.ST. Zip: t v- .. . . . . . . . ... ............................... ................................ .... .... . .. .... ............ . . . . . . . . . . . . . . . ......... 6 . . . . . . . . . . . . . ....... .. Ix. ........... X6. 666 ................... :x Tele hone' ........... .. .................. State Lir. # City Lic. Arch., Engr—De§igner: U Address: City, ST, Zip: Telephone: ............. ....... ........... %.-............... ...... on C struction Type: Occupancy: Statitic: 4: ..................... ............................ .................... X ............... PT type (circle one): New, Add, OJ Alter* Repair De rno vName of Contact Person: �A lz� win �0- $4. Ft.: Stories: Units: aTelephone # of Contact Pqrson::8/0-Z 3 Estimated Value of Project: .... . .................... .... 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I CONSTRUCTION ESTIMATE NO.ELECTRICAL UNDERGROUND 1ST F!-, 2ND Fl. GAR. CAR P WALL ESTIMATED CONSTRUCTION SO =T ;r T UNITS ROUGH PLUMB, I SO. FT..Z/POR. awE HEATING (ROUGH) SO. FT �V.MOBILEHOME SVC; FORMS SO. FT. •d POWER OUTLET jO. FT 4 04AINAGE PIPING SO FT t DRINKING FOUNTAIN SO GT. 4 URINAL VALUATION S WATER PIPING NOTE: Not to :a -,seC as proceny tax ,a:oauon TEMP. POLE FLOOR DRAIN MECHANICAL FEES GROUT WATER SOFTENER VENT SYSTEM FAN EVARCOOL '+000 SIGN WASHER(AUTOXO1SH1 APPLIANCE DRYER WATER SYSTEM GARBAGE DISPOSAL FURNACE UNIT 'WALL FLOOR SUSPENDED LAUNDRY TRAY AIR HANDLING UNIT CFM FINAL INSP. KITCHEN SINK ABSORPTION SYSTEM B.T U. TEMP USE PERMIT SVC WATER CLOSET COMPRESSOR HP ) POLE. TEWPERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SO. FT..a c 1BATH TUB .1 1 _ .., I . SO. FT. @ C WATER HEATER MAX. HEATER OUTPUT, B.T.U. _ SO. FT. REBID 0 Ita'e SEWAGE DISPOSAL SO•FT.GAR a 34C HOUSE SEWER GAS PIPING. PERMIT FEE PERMIT FEE PERMIT FEE OBL TOTAL FEES MICRO FEE MECH.FEE PI.CK.FEE CONST'. FEE ELECT. FEE SMI FEE PLUMB. FEE STRUCTURE PLUMBING ELECTRICAL' HEATIIW S AIR COMO. SOLAR SETBACK GROUND PLUMBING UNDERGROUND A.C. UNIT COLL, AREA SLAB GRADE ROUGH PLUMB, I BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINALS OTHER APPJEOU1P. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER NEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRAOINO Td LUMBER OR. / FINAL INSP. FRAMING FINAL INV. ROOFING RtMAR1I! VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSU ATKNi18OUN0 FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE' FINAL ��s�.wRawYwr..�wwww��wara GARDEN WALL FINAL 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 "Ownei /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 onjall permits for which they .apply. If you plan to do your own work, with the exception of various trades that you plan to sIubcontract, 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 theentire 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 earry out these obligations, and these risks are especially serious with respect to worker'scompensation 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. 1 Please'compleie and return the enclosed owner -builder verification form so that we canscinfirm that you are aware of these matters.. The° building permit will not be issued until the verification is returned.