RER (0203-199)77465 Loma Vista
0203-199
'796459 BMCI j 06130tic
Date? '' ' Signature of Contractor✓ ✓`/
f OWNER -BUILDER DECLARA40
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 under Section B&P.C. for this reason
Date Signature of Owner
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. M workers' compensation insurance carrier & policy no. are:
Carrier STATE FUND Policy No. 22"20023566
(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 t?/the workers' compensation provisions, , of Section 3700 of the Labor
Code,I hall foAwith comply with.tijose provisios. »
Date:,t}% 2"Z/2 Applicant
Warning:"Failure to secure JNorkers' 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 -nspeetion purposes.
f
r Signature (Owner/Agent)S f l l.w w ^- Date 112),'
BUILDING PERMIT PERMIT#
0203-199
DATE VALUATION S2AW.0C1OT TRACT
JOB SITE ADDRESS `17.4 1,C)MA V A
APN
OWNER
CONTRACTOR / DESIGNER / ENGINEER
Cil n-49 SIMNSON
M143014 DEMEW ISNT
17.465 LOMAT IFF
44-306 NTSQ0n7e DR
LA QUINTA CA. 92253
1N.M/AitMMILS4 CA 92110
(760)773-4487 t ffi 6645
USE OF PERMIT
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REPLA(M 1':1111 NO MdUYTHATION WITH CfWS 01.1VK (SAME
°JdxL[3.A!' H 4100,01, LS
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ELECTRIC.ALFRE
15
P1.iiMt3tNG HEL 101-000-419-000 $21.C!O
PLAN C K FEE 101_-000.439-:316 $35,110
C ON yTRdCT10 ? 10 000-41 0 SiXt
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8W1`C► SAL C()Ail':3'1 VIC'1`T01,i AVD I- AN Cl `M - K
$126.85
TOTAL IPFMN=FEES DUE NOW
$126.85
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RECEIPT
DATE / ✓
BY
DATE FINALED
INSP§ -W
I
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
•QZj
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
1
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
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Water Piping
16
Heater Final
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
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
e,
(N) 2X8 WAil
TO REMAIN
MUST BE EtED
"SUITABLE FOR LOCATIow
6f91' -GLASS BLOCK
((fdj N -MOPPED
$HO R PAN _
H Sw
(}tN DOWER
BENCA
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NEW
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(Sr- C51x*vk
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(N) TLM D
SHIOUV9` ENCLO URI; {E) E. sAf{
HER BATH
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EXISTIN BATHROOM!
1 TO REMXIN (ELECT,MECH.)
I %
GFI
FLOOR PLAN NOTES 1
1: WATER PROOFING AT ALL SHO'AERS TO BE DOW
BY ROOFING 00WRACTOR,
2: HOT MOPPED SHOWER PAN SNAIL BE MPECTED
UPON COMPLETION OF NOT MOPPING AN SmA
BE FILLED WITH WATER FORIHSP6CTYDN..
4 USE WATER RESISTANT GYP. BOARD IN TUB AND
AND SHOW R AREA TO A HEIGHT OF 7V ABOVE DRAIN
INLET. PER UBC 807.1.9.
6: nLE LINED TUSK & SHOWERS SHALL CONFORM WITH
AMPO STD.. 2.82 & 4.B2.
$ ALL `OR EQUAL' SUSSnTUT10M MUST BE SUM MTTED
AND APPROVED 9Y THE CITY BUILDING OFFICIAL PRIOR
TO INSTALLATION OF THE ITEM.
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DATR -3 Ito OZ BY
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FLOOR PLAN
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EXISTING YWW
TO BE REMOVED
EXIST940 TUB & YLR
TO BE REMOVED
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