0009-193 (BLCK)LICENSED CONTRACTOR DECLARATION
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
f. uj Professionals Code, and my Lie„ense is in full force and effect.
O :3 C.,) License # Lic. Class Exp. Date
UJ
473216 �'r. (—^ i�$ 112i
ZDateSignature of Contractor-
r-
J
U OWNER -BUILDER DECLARATION
HW r- I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
Z_ ( ) 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).
( ) I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
cY)() I am exempt under Section B&P.C. for this reason
N Date Signature of Owner
ON
rn
Q WORKER'S COMPENSATION DECLARATION
CL
C) :E Z I hereby affirm under penalty of perjury one of the following declarations:
LID H p () 1 have and will maintain a certificate of consent to self -insure for workers'
X w �= compensation, as provided for by Section 3700 of the Labor Code, for the
mJ Q performance of the work for which this permit is issued.
Q () (ycf I have and will maintain workers' compensation insurance, as required by
p C)Q Section 3700 of the Labor Code, for the performance of the work for which this
Il rn H permit is issued. My workers' compensation insurance carrier & policy no. are:
ob z Carrier F t?
ao 5 td1aNT INS CO Policy No. 44036
a
J (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 provisionsrof.Section 3700 of the Labor
Code, I .shall forthwith comply with.those provisions.
Date: 1 Applicant , ! i '
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 representat(Vesjof this City to enter upon
the above-mentioned property for inspectioh purposes..,.
Signature (Owner/Agent) l Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT TRACT
09/264M S3,7�i.*r'.00
JOB SITE
APN
ADDRESS�...,r�30tl,'t�d�.0�31REGI N
�l��i'� �.�
OWNER
CONTRACTOR / DESIGNER / EN (NEER
Buff i Ma HoPilJ 1449"
JOE SUK0 l.`ONS`IRU CON
42600 COOX. Ff. SUM 120
78-545 IliTARLIGHT LANE
PAM DESMr r CA. 92211 t
UOWMADURES CA 92201
(760)360.6118 MT -0. 3002
USE OF PERMIT
0MCK 2AL BUS 17Ii40
-
72 Ll, OF 6' C ARDEN'b ALL
40 L,F, OF 4' GARJJ Z"N WALL
53 L.F. OF 10' GARD N WALL ORCO STANDARD
Coon
6 FT, FALL 53:00 11F
4 F1'. WALL, 40.00 LF
6 FT, WALL. 72.00 LF
Effrn"M) COST, OF COIi3M'C7 MON
3,765.00
L.' NSTRUCTION FEE 101.000.419-000 $63,00
SUE-' AT CommT7� CIC1W AND PLAN 0*'CX
$63.00
Ov IM 3 PRE -PAD FM13
$0,00
2 g =%% TUFAL aKLZWI.-FEn DUE NOW
X3.00
SEP
Lt
RECEIPT
DATE
BY/' f
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
Steet `" a
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Vb,ap
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 b C
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
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)
t--H.ere'Y, September 6th, 2000.
Here: rs what we decided for the lots on,the,,corner of:Obregon and Monterrey.
We are going to put up a 6' garden wall on ache North side .of t1e-lots next to the
existing. house: `Along the back, we would like aR5'4" garden wall on top of a
J
maximum.4' refairung wall, The top ofthe retaining wall should be approx. 4" above
tie level of the curb:
measure from thecenter ofreach lot The garden walk on the
n�,rth side will°step-down to 4' at approz `40' from curb face.
P
= MaXimum 4'/6' =,6'; Gard en:.only
RetaininGarden
- 4 . Garden Wal! only 3,
7 GnYA
oy+•, t p? �`;, l�j " ¢; . cj
Prop ne .Tank y-
enclosu o is 4' hight aril
Wall steps down -to 4
a= l 8'X4' inside''in the clearL„
garden wall at, approx.
40' -from -.curb ;face..:
o ��
cc property Ime::. s
W
OIL
SL
2,( —. — _property .,. —
_ --
t2' i
curb'.