The URL can be used to link to this page

BRES2024-0480DESIGN & DEVELOPMENT DEPARTMENT 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Permit Type: Permit Number: Property Address: APN: Legal Description Property Zoning: Valuation: Building Residential BRES2024-0480 51555 MADISON ST 777030006 Lot 3 MB 88/42 TR 6682 RVL, 3 $10,000.00 Declaration / Acknowledgement BUILDING PERMIT athita CALIFORNIA PHONE (760) 777-7125 WWW.LAQUINTACA.GOV APPLIED DATE: 12/05/2024 ISSUED DATE: 05/02/2025 Owner: Alam Khan 51555 Madison, La Quinta, CA 92253 Applicant: Manuel Montalvo Jr 46183 Cottonwood Lane, Indio, CA 92201 Contractor: Alam Khan 51555 Madison, La Quinta, CA 92253 PRIOR TO THE ISSUANCE OF THIS PERMIT FOR CONSTRUCTION, ALTERATION, IMPROVEMENT, DEMOLITION, OR REPAIR THE OWNER, APPLICANT AND/OR CONTRACTOR UNDER PENALTY OF PERJURY HAVE AFFIRMED WHEN APPLICABLE, THROUGH THE SUBMITTAL OF FORMS OR BY OTHER ELECTRONIC MEANS, THE FOLLOWING: LICENSED CONTRACTOR OR OWNER -BUILDER DECLARATION (1 or 2) 1) They are licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and the referenced License is in full force and effect, or; 2) That they are exempt from the Contractors' State License Law for the reason(s) indicated by either (2)(a) and/or (2)(b), or (2)(c) where he or she is exempt from licensure by a valid exemption. [Section 7031.5, Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors' State License Law (Chapter (commencing with Section 7000) of Division 3 of the Business and Professions Code] Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).) a) As owner of the property, or my employees with wages as their sole compensation, will do all of or portions of the work, and the structure is not intended or offered for sale (Section 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who, through employees' or personal effort, builds or improves the property, provided that the 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 proving that it was not built or improved for the purpose of sale.). b) As owner of the property, will be exclusively contracting with licensed c) Are exempt from licensure under the Contractors' State License Law. As an Owner -Builder, they acknowledge that, except for their personal residence in which they must have resided in for at least one year prior to completion of the improvements covered by this permit, they cannot legally sell a structure built as an owner -builder if it has not been constructed in its entirety by licensed contractors. It is understood that a copy of the applicable law, Section 7044 of the Business and Professions Code, is available upon request when this application was submitted at the following Web site: http://www.leginfo.ca.gov/calaw.html. DECLARATION REGARDING CONSTRUCTION LENDING AGENCY (If applicable) A construction lender will be used for completion of the improvements covered by this permit and the name and information of which is on file for public inspection during the regular business hours of the public entity. Failure of the applicant to indicate the construction lender on the application does not relieve that person of the requirement to give the construction lender preliminary notice from that duty. WORKERS' COMPENSATION DECLARATION (1, 2 or 3) WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($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. 1) Has and will maintain a certificate of consent to self -insure for workers' compensation, issued by the Director of Industrial Relations as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 2) Has 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. 3) Certifies that, in the performance of the work for which this permit is issued, shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that, if should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, shall forthwith comply with those provisions. NOTICE TO APPLICANT (1, 2 and 3) 1) Each person upon whose behalf this application was made, each person at whose request and for whose benefit work is being performed under or pursuant to any permit issued as a result of this application, the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents, and employees for any act or omission related to the work being performed under or following issuance of this permit. 2) Any permit issued as a result of this application becomes null and void if work is not commenced within 360 days from date of issuance of such permit, or if cessation of work for 180 days will subject permit to cancellation. On or after January 1, 2019, every permit issued shall become invalid unless the work on the site authorized by such permit is commenced within 12 months after its issuance, or if the work authorized on the site by such permit is suspended or abandoned for a period of 12 months after the time the work is commenced. 3) Certified that they read the application and state that the information provided is correct. Agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above -mentioned property for inspection purposes. IMPORTANT: An Application for Permit was made to the Building Official, subject to the conditions and restrictions set forth at the time of application, which is now hereby an Issued Permit. If any part of the information being supplied on this permit is inaccurate or untrue, please contact the City of La Quinta at (760) 777-7125 immediately for correction. Printed: 5/2/25 8:27 am Page 1 of 4 BUILDING PERMIT Permit Type: Permit Number: Property Address: Building Residential BRES2024-0480 51555 MADISON ST Use of Permit KHAN / BUILD NEW INTERIOR WOOD STRUCTURAL WALL. NO OTHER ALTERATIONS TO THE STRUCTURE ARE INCLUDED UNDER THIS PERMIT. 2022 CALIFORNIA BUILDING CODES. Construction Details Residential Work Type Remodel Patio Square Footage 0 Code Edition 2022 Number of Units 1 Dwelling Units per 2 Acre (CVMSHCP) Addition Area Square 0 Footage Number of Balcony 0 Addition(s) Stucco Application 0 Square Footage Number of 0 Fireplace(s) New Electrical Square 0 Footage Number of Non -Residential Appliances Electrical Service? Back Flow Prevention Device? Zoning Subdivision Name Legal Description 0 No No RVL TR 6682 Lot 3 MB 88/42 TR 6682 Conditioned Square Footage Fire Sprinkler Square Footage Number of Floors Building/Unit Occupancy Classification(s) Original Valuation 1880 Garage Square 0 Footage 0 Construction Type V-B 1 R-3: 1 & 2 Family Dwellings 10000.00 Number of Patio 0 Cover(s) Number of Awning 0 Canopy(s) Number of 0 Door/Window Retrofit/Repair Number of Partition(s) 0 Number of 0 Receptacle/Switch/Lig ht(s) Number of Power 0 Apparatus Temporary Power No Service? Sewer Connection? No General Plan LDR Lot Number 3 Number of Bedrooms 3 Grading Required? No Remodel Area Square 200 Footage Number of Carport(s) 0 Reroof Area Square 0 Footage Number of 0 Door/Window New/Alteration Number of Flag or 0 Light Pole(s)? Number of Residential Appliances 0 Number of Signs 0 Water System Install No or Alteration? Septic System? No City Limits Lot Size Within La Quinta Limits 54116.6 Valuation Details Sq Ft Value Printed: 5/2/25 8:27 am Page 2of4 BUILDING PERMIT Permit Type: Permit Number: Property Address: Building Residential BRES2024-0480 51555 MADISON ST Financial Information Invoice No. Fee INV-00014422 Hourly Charge - Interwest Plan Check Engineer 2023 Building Standards Administration Technology Enhancement Fee Remodel PC (<=100) Digital Archiving and Records Management Fee Remodel Each Additional 500SF Remodel (<=100) Remodel Each Additional 500SF PC SMI - Residential Total for Invoice INV-00014422 Fee Amount Amount Paid $135.00 $135.00 $1.00 $1.00 $21.45 $21.45 $177.51 $177.51 $24.00 $24.00 $28.63 $28.63 $64.89 $64.89 $22.90 $22.90 $1.30 $1.30 $476.68 $476.68 Grand Total for Permit $476.68 $476.68 Workflow / Inspections Workflow Step / Action Name Application Completeness Check v.1 Action Type Start Date End Date 12/09/2024 9:32 12/09/2024 9:32 Submittal Document Verification v.1 Plan Check v.1 Generic Action 12/09/2024 9:32 12/09/2024 0:00 01/06/2025 16:56 Building Review v.1 Permit Issuance v.1 Receive Submittal 12/09/2024 0:00 01/06/2025 16:56 01/06/2025 16:56 05/02/2025 8:27 Contractor / Owner -Builder Information v.1 Generic Action 01/06/2025 16:57 Verify & Invoice Fees v.1 Generic Action 05/01/2025 8:09 Ready to Issue v.1 Generic Action 05/01/2025 8:09 Verify Fee Payment & Issue Permit v.1 Generic Action 05/02/2025 8:26 Print, Attach, and Email Building Permit v.1 Inspections - Do Not Pour Concrete Until Approved v.1 Create Report 05/02/2025 8:26 05/02/2025 8:27 Setbacks v.1 Inspection Underground Plumbing v.1 Inspection Water Line v.1 Inspection Footing v.1 Inspection Slab v.1 Inspection Inspections - Cover No Work Until Approved v.1 Roof Nail v.1 Inspection Okay to Wrap v.1 Inspection Framing v.1 Inspection Rough Electrical v.1 Inspection Rough Mechanical v.1 Inspection Rough Plumbing v.1 Inspection Rough Fire Clearance Bldg v.1 Inspection Shower Pan v.1 Inspection Insulation v.1 Inspection Drywall Nail v.1 Inspection -terior Lath v.1 Inspection Printed: 5/2/25 8:27 am Page 3 of 4 BUILDING PERMIT Permit Type: Building Residential Permit Number: BRES2024-0480 Property Address: 51555 MADISON ST Gas Test v.1 Inspection Sewer Connection v.1 Inspections - Masonry v.1 Inspections - Electrical for Meter Release v.1 Inspection Temporary Power v.1 Inspection Temp Use of Permanent Power v.1 Inspections - Final v.1 Inspection Final Building v.1 Certificate of Occupancy v.1 Inspection Certificate of Occupancy v.1 Create Report Inspections Construction or work for which a permit is required shall be subject to inspection by the building official and such construction or work shall remain visible and able to be accessed for inspection purposes until approved. Approval as a result of an inspection shall not be construed to be an approval of a violation of the provisions of the applicable code and other ordinances of the jurisdiction. Inspections presuming to give authority to violate or cancel the provisions of the applicable code and other ordinances of the jurisdiction shall not be valid. It shall be the duty of the owner or the owners authorized agent to cause the work to remain visible and able to be accessed for inspection purposes. Neither the building official nor the jurisdiction shall be liable for expense entailed in the removal or replacement of any material required to allow inspection. It shall be the duty of the holder of the building permit or their duly authorized agent to notify the building official when work is ready for inspection. It shall be the duty of the permit holder to provide access to and means for inspections of such work that are required by this code. Certificate of Occupancy A building or structure shall not be used or occupied in whole or in part, and a change of occupancy of a building or structure or portion thereof shall not be made, until the building official has issued a certificate of occupancy therefor as provided herein. Issuance of a certificate of occupancy shall not be construed as an approval of a violation of the provisions of the applicable code and other ordinances of the jurisdiction. Certificates presuming to give authority to violate or cancel the provisions of this code or other ordinances of the jurisdiction shall not be valid. Service Utilities A person shall not make connections from a utility, a source of energy, fuel, or power, or a water system or sewer system to any building or system that is regulated by the applicable code and other ordinances of the jurisdiction for which a permit is required, until approved by the building official. Printed: 5/2/25 8:27 am Page 4of4 TO J&C Inspection Services, Inc Inspection & Material Testing www.jcinspectionservices.com (951) 271 - 1974 office@jcinspectionservices.com DAILY FIELD REPORT 3753 Tomlinson Ave Riverside CA 92503 Date: 05-07-25 M T W ✓ Th IF SAT " SUN Job #: # 1387 Permit #: BRES2024-0480 Project: Khan Residence Address: 51555 Madison St, La Quinta, CA 92253 Project Site Time: Start: 11:00 am Lunch: N/a Completed: 1:00 pm Project Specification (s): General Drawings, Structural Drawings S-2 Plan Sheet: Structural Drawings Sheet S2 Jurisdiction: City of La Quinta General Contractor: MDA Engineer: First US R.E. Inc Type of Work Observed: Epoxy anchors bolts REPORT: Arrived on site as requested by Home Owner & discuss scope of work. - Observed drilling of of 3/4" diameter holes for 5/8" all threaded rods to (E) foundation with a minimum embedment of 7" on foundation. Location of work took place at (E) Residence Kitchen / Living Room. Prior to application of epoxy holes were air blown using air compressor & brushed. Holes found clean & free of debris. Simpson SET-3G Exp 06-28-2026. Applicable Manufacturers installation guidelines . The Location for anchor bolts took place at girder concrete beam. Work complete & acceptance. Certificate of Compliance I hereby certify that I have inspected, to the best of my knowledge, all work reported above. Unless otherwise noted, I have found this work to comply with the approved plans, specifications, and applicable sections of the governing building codes. Inspector (Print Name): John V Cruz License: ICC # 8068360 Inspector Signature: IN �� j [ •C. i'Cv Job Supervisor: Manuel Montalvo Page 1 of 1 • rW INTERWEST A SAFEbullt COMPANY Bill to: City of La Quinta Attn Danny Castro Design and Development Director 78-495 Calle Tampico La Quinta, CA 92253 Remit to: Interwest Consulting Group P.O. Box 301069 Los Angeles, CA 90030-1069 Invoice #1150633 December 13, 2024 Direct questions to Erica Cuevas ecuevas@interwestgrp.com Professional services for the period December 12, 2024 through December 12, 2024 Structural - BRES2024-0480 - LAQ24-0146 - 51555 Madison Employee Martha D Title Invoice Total (Please pay this amount) Hours $135.00 Rate Total [az Plan Check Engineer 1.00 $135.00 $135.00 Labor 1.00 $135.00 Martha Diaz BRES2024-0480 Structural - BRES2024-0480 - 51555 Madison - LAQ24-0146 Day Description 12/12/2024 LAQ24-0146/BRES2024-0480 Hours 1.00 Total 1.00 1 of 1 December 12, 2024 CITY OF LA QUINTA - FINAL REVIEW Permit No: BRES2024-0480 Interwest No.: LAQ24-0146 Non -Structural: 0-hours Structural: 1-hours City of La Quinta Building Department 78-495 Calle Tampico La Quinta, CA 92253 Plan Review: Address: SFD Alterations 51555 Madison St. • niv INTERWEST A SAFEbuilt' COMPANY Interwest Consulting Group has completed a FINAL code compliance review of the following documents on behalf of the City of La Quinta: 1. Drawings: Electronic copies of following: a. T1 through A4.1 dated 9/20/2024 by MAD Studio. b. S1 through S4 dated 8/22/2024 by First USA R.E Inc. 2. Structural Calculations: Electronic copy dated 8/22/2024 by First USA R.E. Inc. 3. Energy Compliance Documentation: None. The applicable provisions of the 2022 California Building Standards Code were used as the basis of this review. Plan review comments follow on the attached list. Enclosed, please find the above noted documents bearing Interwest Consulting Group's plan review stamps indicating the documents have been reviewed for code compliance. Please do not hesitate to contact us directly with any questions. Sincerely, INTERWEST CONSULTING GROUP Martha Diaz, P.E. Plans Examiner mdiaz@interwestgrp.com 909.719.0249 1500 S. Haven Ave I Suite 220 Ontario, CA 91761 909.295-3142 INTERWESTGRP.COM adidai CALIFORNIA Considering Becoming an Owner -Builder? Important information you need to know BEFORE pulling your permit! The term "Owner -Builder" can mean three different things: "Owner as Worker", "Owner as Contractor" or "Owner as Employer" Understand each has Benefits or Risk, and it is possible to combine them! Hiring a California Licensed Contractor means you do not personally perform any of the construction work, the permit is not taken out in your name, you are not personally responsible for the construction and you are not an Owner -Builder. Instead, you become a "Customer" and California law provides you the benefit of protection from poor workmanship, failure to finish the job and financial risk due to worker injury. Benefit/Risk: Highest Benefits and the Least amount of Risk Owner -as -Worker is a type of Owner -Builder where you personally perform the construction work, the permit is taken out in your name and you are personally responsible for the construction management, knowledge, workmanship, and completion of the job. You benefit by not paying others to perform this work for you and your risk depends on your own ability to complete the job successfully. Benefit/Risk: 'ossible Benefit with Low Financial Risk Owner -as -Contractor is a type of Owner -Builder where you personally act as your own General Contractor, the permit is taken out in your name and you hire California licensed sub -contractors to perform portions of the construction work. WARNING: The benefit of protection provided by law when you hire only California licensed sub- contractors can turn to serious financial risk if you hire unlicensed contractors to perform any of the work. Benefit/Risk: Possible Benefit and Significant Financial Risk Owner -as -Employer is a type of Owner -Builder where you pay any unlicensed individual to perform any construction work valued at more than $500.00, the permit is taken out in your name and you are personally responsible for their employment requirements, supervision, performance, safety and welfare while on your property. WARNING: Cost savings benefit can turn to serious financial risk if you fail to deduct payroll taxes or provide workers compensation insurance for each worker. Benefit/Risk: with Significant Financial Risk OWNERS BEWARE AND CONSIDER THE RISK BEFORE ACCEPTING FULL RESPONSIBILITY FOR YOUR CONSTRUCTION PERMIT For more information visit the California State License Board Website at http://www.cslb.ca.gov/ Page 1 of 4 Assembly Bill 2335 amends California Health and Safety Code, Section 19825, regarding disclosures and verifications required for all applicants seeking Owner -Builder construction permits. These new application requirements provide an enhanced level of consumer awareness and protection for property owners accepting the risks associated with Owner -Builder construction permits. "The Legislature hereby finds and declares that there is an urgent and statewide public interest in assuring that building contractors comply with the Contractors License Law...and provisions of law relating to Workers' Compensation Insurance for building construction, that property owners are informed about, and protected from, fraudulent representations, liability for worker's injuries, liability for material and labor costs unpaid by contractors, licensing requirements, and employer's tax liabilities when improving their property as owner -builders" THIS OFFICE WILL BE ENFORCING THESE REQUIREMENTS AS FOLLOWS: If Licensed Contractor is the Permit Holder Verify Applicant's License Applicability & Status (with CSLB) Prior to Issuing Permit Property Owner Protected by Contractors License Law New Construction Permit Application Who is to be the Responsible Party? (Permit Holder) Verify Property Owner's Identification & Signature Verify Property Owner's Designation & Signature on AUTHORIZED AGENT Form (if applicable) Property Owner is Legally Noticed by Owner -Builder Law 1 1[If Property Owner is the . Permit Holder Verify Property Owner's Acknowledgment & Approval to Assume Liability for the Construction Project, by Verifying Completion of the NOTICE TO PROPERTY OWNER Form Prior to Issuing Permit Page 2 of 4 CALIFORNIA Disclosures & Forms for Owner -Builders Applying for Construction Permits IMPORTANT! NOTICE TO PROPERTY OWNER 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 at 51555 Madison St LaQ°rota, CA 92253 We are providing you with an Owner -Builder Acknowledgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner -Builder. We will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION DIRECTIONS: Read and initial each statement below to signify you understand or verify this information. AM 1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner - Builder" building permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner -Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. AM 2 I understand building permits are not required to be signed by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility. AM 3. I understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. AM 4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. AM 5. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer" under state and federal law. AM 6. I understand if I am considered an "employer" under state and federal law, I must register with the state and federal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk. AM7. I understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed under contract with a licensed general building Contractor. AM $ I understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for any financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. Page 3 of 4 AM s I understand I may obtain more information regarding my obligations as an "employer" from the Internal Revenue Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors. AM 10. I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the party legally and financially responsible for proposed construction activity at the following address: 51555 Madison St, La Quinta, CA 92253 AM 11. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all applicable laws and requirements that govern Owner -Builders as well as employers. AM 12. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable for damages. If you obtain a permit as Owner -Builder and wish to hire Contractors, you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. Before a building permit can be issued, this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. Note: A copy of the property owner's driver's license, form notarization, or other verification acceptable to the agency is required to be presented when the permit is issued to verify the property owner's signature. Signature of Property Owner: Date: 3/20/25 Note: The following Authorization Form is required to be completed by the property owner only when designating an agent of the property owner to apply for a construction permit for the Owner -Builder. AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner -Builder Permit for my project. Scope of Construction Project (or Description of Work): Structural fortification to existing building Project Location or Address: 51555 Madison St, La Quinta, CA 92253 Name of Authorized Agent: Manuel Montalvo Jr Address of Authorized Agent: 46183 Cottonwood Lane Phone: 7605789949 I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. Note: A copy of the owner's driver's license, form notarization, or other verification acceptable to the agency is required to be presented when the permit is issued to verify the property owner's signature. Signature of Property Owner: Date: 3/20/25 Page 4 of 4 CITY OF LA QUINTA JOB ADDRESS 51555 Madison St, La Quinta, CA 92253 PERMIT NUMBER BRES2024-0480 OWNER Alam Khan BUILDER Alam Khan This form shall be posted on the job with the Building Inspection Card at all times in a conspicuous place. Only persons appearing on the list or their employees are authorized to work 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 stoopage of work and/or the voidance of building permmit. For each applicable trade, all information requested below must be completed by the applicant. "On File" is not an accepatble resonse. TRADE/CLASSIFICATION CONTRACTOR STATE CONTRACTOR'S LICENSE WORKER COMPENSATION INSURANCE CITY BUSINESS LICENSE Company Name Classification (e.g. A, B, C-8) California License Number Exp. Date Carrier Name (e.g. State Fund, CalComp) Policy Numbers (Format Varies) Exp. Date License Number Exp. Date EARTHWORK (C-12) CONCRETE (C-8) FRAMING (C-5) Owner Owner STRUCT. STEEL (C-51) MASONRY (C-29) PLUMBING (C-36) LATH, PLASTER (C-35) DRYWALL(C-9) Owner Owner HVAC (C-20) ELECTRICAL (C-10) ROOFING (C-39) SHEET METAL (C-43) FLOORING(C-16) GLAZING(C-17) INSULATION (C-2) SEWAGE DISP. (C-42) PAINTING (C-33) Owner Owner CERAMIC TILE (C-54) CABINETS (C-6) FENCING (C-13) LANDSCAPING (C-27) POOL (C-53)