0304-147 (BLDG)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
Ts :Ir A 01vi 1112(
r.r a
Date t r►;:Signature of Contractor 1A - ��A
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. 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).
( ) • I' am exempt , nder Section B&P.C. for this reason
Date Z 1A 01Signature of Owner I /1
_ V
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:.
Carrier N�S.i'It�Al l• t�21tE 1}�:? Policy No. WC240106:27
(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 3700 of the Labor
Code, I shall forthwith comply with those proviso s.
t1.)`1 Applicant I �1
�..I V _ ev
Warning: Failure to secure Workers' Compensation coverage rs 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 inspection purposes.
Signature (Owner/Agent) t�'1.. 4f -'� Ut_-Date
BUILDING PERMIT PERMIT#
030.4-147
DATE ; �' �, VALUATIONf LOT TRACT
e s
ADDRESS 53-260 A,`�f,1�(yfAi A Ci.���IGON JOB SITE
APN
BRIAi0.1aUd7t�C3
53.260 A` I NTD A, ORPMG0114
LA QTJWTA CA 92,233
USE OF PERMIT
FIREPLACE PER. APPROVED PLANS
VALUATION
rRACTOR / DESIGNER / ENGINEER
R 0. BOX 628
.LA QU71TrA CA 92253
(760)771-3593 But, 5830
1,000,00 L-1
ry� yp�. F c yy �/a�`pgESy''�['I-A:T.1ID COST or 0110 $'Si'.RUC1110N.
MWr
PLAN CHECK FRI; 1.01.000-439-318 $16.26
e:ONTP RUCTION FEEE 101-00:7--418-030 $25.00
V�.
d ..
LuLLAPR 14 2003 ,� U �''r�'��'Y OF LA QUINTA
NANCE DEPT
RECEIPT DATE / BY h! .
A9D F°LAN CHECK
ITIFFE"? DUE NOW
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
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
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
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
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)
COMMENTS:
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9.60.045
9.60.045 Barbeques, waterfalls, fou ntains,'.freplaces and similar structures.
A. Applicability. Permanentiv.insialled free stan'ding,barbeques; waterfalls, fountains, fireplaces and similar
structures such as permarienfly installed -.tables and benches, etc., may Abe constructed on a residential lot
containing a primary residence.
B. Standards.. Freestanding barbeques, waterfalls, fountains, fireplaces and similar structures shall comply
with the following requirements:
I . Said construction of•structures, except freestanding fireplaces, are allowed within the required front, side,
or rear setbacks, including adjacent.to'a.property line: In s)d'e._yard areas, a single clear passageway of five feet
wide shall be -provided: '
2. Allowed construction of structure-sahall: not be attached;to property line walls or fences. and shall meet
all required distance clearances-(i;e.. for barbeques, fireplaces).',
ofthe closest wall or fence. if no wall or.ten_ ce exists, the construction 0rAeature:shall not exceed the height of
the wall allowed,along the property'line in question.
4. Outdoor fireplaces shall not be closer than five.fe'et 'from a propert_y'.Iine, except when adjacent to
permanent open space such -as a golf course, common landscape or hardscape area; drainage channel., etc., in
which case it maybe within`'threeJeet. of the property, l ne 'The height `of the_ chimney may be up to six feet
unless.required to be higher to comply with b'uildingcode requirements. lh such cases, the�height shall not be
higher than the minimum height required: ' y
9.60.' 050 Storage and other, accessory buildings.
A. Applicability. Accessory buildings, such as storage or gardening s} eds;;are permitted on a residential lot
containing a primary residence subject to the: requirements of this section: (Carports and• garages are regulated
separately by Section 9.60.060, patio coverslbySection 9.60.040, swimmin-.pools and spas by Section 9.60.070,
and recreational vehicle parking .by Section 9:60.130.)
B. Drainage from Roofs: Accessory buildings shall be constructedina manner so as to prevent rooftop
water from draining.onto anyadjacent parcel.
C. Lot Coverage Maximums. The.placement of accessory,.Ibuildings on'.a lot shall -not result in violation of
the lot coverage maximums set forth in Section 9.50:030.
D. Standards.
Setbacks and Maximum Height. Detached accessory buildings, shall .conform to the following setback
-standards: y `
Roof Area of
Structure
(sq. ft.)
0-100
101-200
201+
Table 9-3 Standards f6r Detached Accessorv,.Buildings .
Mitiimum Setback (ft.)
Maximum Separation .
w,;from Main Front Yard Interior' Exterior Rear
Height ,,.-. Side Yard Side. Yard Yard
Building
10
5
20
10
5
20
17
t0
(Ord. 299 § I (part), 1997; Ord. .284 § 1 (Exhs. A, B) (part), .1996):
9.60.060 Garages and carports.
3.5 l0 �.�
5 10.
Same as -for main buildin'o
A. Height. The maximum structure -height shall be fourteen~feet. fora detached'carportand seventeen feet
for a detached garage, except that garages may be, up to.twenty-eight feet in height'` fa second dwelling unit
complying with the.provisions of Section 9.60.090 is located above:.the.�arage:`:
B. Setbacks.
(La Quinta 3-02) 238