9712-063 (ELEC)I LICENSED CONTRACTOR DECLARATION
I hereby_ affirm under penalty of perjury that I am licensed under provisions of
"C64pter 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. /U44, buSir)e55 & Nrofesgiorials Code).
( ) I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
( ) I am exempt under Section B&P.C. for this reason 1
j r.
Date /' j - / 1 • `7 %Signature of Owner ,:� Ile, _.
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:
Cartier Policy No.
(This section need not be completed if the permit valuation is for $100.00 or less).
(J 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 ifrI should become
Subject to the workers' compensation provisions oSection•37.00.of-the'L`abor
Code, I shall forthwith comply with those provisions. /
bate: /,Z, IJ !%Applicant /�,fh:�<.,:,,
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
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspectio�/�Date/�J-,
purposes.
r�/Signature (Owner/Agent) i
V k
NNTTROL#
BUILDING PERMIT PERMIT# CO8474
DATE VALUATION LOT y712H063 TRACT . V 4 7 4
12!12417 $850.00
JOB SITE
APN -
ADDRESS
-6.20.AVENJDA RUUTO
. 773-28MO6
OWNER
CONTRACTOR/DESIGNER/ENGINEER
AARON K & RON.DA EICETEL
OWNER / BUILDER
',52t 20 A."VEN113A RUBIO
IA QUINTA CA 92253
C°�3L
USE Ul- PFHMI I
iW?LACE MCISTWO tai ECi,'RiCAL, SERVICE WIrN NEW, 2(u) AnN
SERViC}i (UNDERGRt3UM) SERVME .ENTR.ANCE)
VALIJKrI N I MOO LS
li«S"T'd:MXfED COST OF CONS i RUMON
S�1).1t4i
PERMIT FEE SUM!k"RY
ELECTRICAL FES 101-000-42"00 $33.50
�
PAIL)
DEC 12 1997
CITY 'OF
k
LP!QUNTA
SILIB-T(7't AL C,'Oh ffRUCT1ON AND PLAN CHECK
LESS PRE -:PAW FEES
$0.00
1TOTXL PER1%111T FEES DUE NMI
$33.50
•.
1a -
RECEIPT
DATE
BY%r
DATE FINALED
INSPECTOR
INSPECTION RECORD'
OPERATION
DATE
INSPECTOR
-OPERATION
DATE
INSPECTOR
BUILDING 'APPROVALS f
MECHANICAL APPROVALS
Set Backs
Underground Ducts F
Forms & Footings
Ducts [i
Slab Grade
Return Air }'
Steel
Combustion Air
Roof Deck
Exhaust Fans I P
O.K. to Wrap
F.A.U. tV
Framing
Compressor IR
Insulation
Vents (ax
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines . xt
Party Wall Firewall
Exterior Lathp
Drywall - Int. Lath
g
., R
Final t 3:1•
Final
s
POOLS - SPAS
BLOCKWALL APPROVALS
steel •
Set Backs ;
Electric Bond
Footings
Main Drain {
Bond Beam
Approval to Cover 1 $
-
Equipment Location -
-
Underground Electric
Underground Plbg. Test#
Final
Gas Piping ( t
PLUMBING APPROVALS ,
Gas Test
'Electric Final } 'u
Waste Lines
Heater Final
Water Piping
Plumbing Final (r
Plumbing Top Out _
Equipment Enclosure } ?a
Shower Pans
O.K. for Finish Plaster f.
Sewer Lateral
Pool Cover ? LY
Sewer Connection
Encapsulation t
Gas Piping
t L
Gas Test
Appliances
y;
Final F .'
COMMENTS:
;
,
s
"
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�IG�VI I�� r,
c� OF 9wS 78-495 CALLE TAMPICO — LA`QUINTA, CALIFORNIA 92253
TELEPHONE (760) 777-7012 FAX (760) 777-7011
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
improve'ment-s,-specified.
For your protection you should be aware that as "Owner/ 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 perscnally 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 belicensed 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'wo k (including materials
,arid -,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 emplo9er 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 lbevenue Service (and,'if
you wish, the U.S. Small Business Adminstration). For more specific information about your obligations under Stare
Law, contact the Department of Benefit Payments and the Division of Industrial Accidents.
If -the structure is intended for sale, pro owners who are not licensed contractors are al.bwed to perform their
work -personally or through their own employees, without a licensed contractor or subcontracamc, 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 requiredto be signed by property owners unless they, are performing their own work
personally.
Information;abourlicensed 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 z "
78-495 Calle Tampico
La Quinti, CA 92253
(7G0) 777- 12
FAX (7 777-7011 "
ER'S SIGNATURE/DATE
PROPERTY ADDRESS
u
PERMIT NUMBER(s) F