9806-096 (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
'.?t}Ii /1 8 8/31/99
Dat, • 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. 7044, Business & Professionals Code).
( ) I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Businesses Professionals
1/
Code). '
O I amrexe t under Section B&P.Cf. )fit t�.is op;,,,,*
Date 1 G Signature of Owner ! r'
WORKER'S COMPENSATION D CLA ATION
I 'hereby affirm under -penalty of perjury one of the following declarations:
() I ha�arid will maintain a certificate of consent to self -insure for workers'
compesatlon, as provided for by Section 3700 of the Labor Code, for the
pert (mance 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 ST
F } (� Policy No. y p 1� ,��
.`'3'I`1��3`S!FUND 1 73 f Y:Y4-5W
(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 provisions.
Date: 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, 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 thatel have read this application and state that the above information is
co�reS�Aagree to comply with all City, and State laws relating to the building
co}struction, and hereby aut oF' reprefse tatives of this City to enter upon
ih'e above-mentioned propecij If r sp"ction p po�s S. m}
Signature (Owner/Agent) ;�°t 1 Date { r
Sy
PERMIT # CONTROL #
BUILDING PERMITS
DATE •s�;t4g� VALUATION �+2,°P�i9 1�a� LOT ".� TRACT 919
�.
ADDJOB SITE
RESS 77-895 A. ENIDA-M.ONTEZ01A
OWNER
CONTRACTOR/DESIGNER/ENGINEER
R11CkiAE t. A FiSCUR
CONISMUC"t'ION :
IN 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
_JP
v /
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
OX 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:
EXISTING ........... +;
:.... .....
(I J�NI
BUILDING
ENCLOSED TRASH
ENCLOSURE PER
CONCRETE WASTE MANAGEMENT /
FLAT YVORK SPECIFICATIONS
GRASS ALL PARKING SPACES
9'-O" X 19'-O' /
b' -O' HIGH CONC /
BLOCK WALL
G (IJ 4'-0" WALKWAY
CONCRETE
FLAT WORK
/
W.I. GATE
C (1)
T
EXISING
BUILDING
F (4)
F.
W.I. GATE
—�
9 1 '
i
B (5)
6 i+ s.� L117.
e
PROPOSED SIGN E (5)
LOCATION
..• r�
1
•1
D 0)
y �
D f7)
k TREE (TYPICAL)
AND ALL APPLICA8LE DEQ_
10�61� BY
MOO
EXISTING b' -O" CHAIN
LINK FENCING
16" PLANTER
HANDICAP PARKING PER
CITY, STATE d' FEDERAL /
REQUIREMENTS
b'-0" HIGH LONG
BLOCK WALL fLA
W.I. GATES
GONG BLOCK
WALL WITH
570000 OVER
(SMOOTH FINIS
E (3)
D (4)
15-10" 1 21'-10"
SITE PLAN
SCALE I' ■ 20'
OVERALL LINEAL FOOTAGE
OF b' -O' HIGH CONCRETE
BLOCK WALLS = 109'-b" APPROX.
PLANT LEGEND
A Tacoma Copensis (Cape Honeysuckle)
B Plttosporum Tobriro (Mock Orange)
G Ficus Rubiginosa (Rusty Leal' Flg)
D Myopourm ft"Ifolium 7Myoporum)
E Salvia 6reggil (Red Sage)
F Lantana Montevidensis (Tralltng Lantana)
VILLAGE PARK
ANIMAL HOSPITAL
77-8q5 MONTEZUMA
LA QUINTA, CALIFORNIA