RPL (0304-206)54855 Avenida Madero
0304-206
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 anis
Professionals Code, and my License is in full force and effect.
License# Lia Class-•^"`""'"'•^=--, Exp. Date
02118$ 1st bo 11 f
Date "V,/L • /.j. 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, 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.
`( f) 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.ATE COp4P Policy No. 701937S1.01
(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,, OOsof the Labor
Code, I shall forthwith comply with those provisions. /..
Date: pplicant " r• f- ^' -•
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 applicator 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-mentionedt property for inspection purposes;
OSignature (Owner/AgentCN = Date /6 V-4
,BUI41PING PERMIT PERMIT#
' G-
VALUATION _ LOT TRACT
'DATE W162
JOB SITEAPN
ADDRESS 54_&155.,4 .A ki AUERO
-
OWNER -
CONTRACTOR / DESIGNER / EN INEER
PAG>1Ta N 1wVVANS
PAUIDEI:4 EVANS DESIGN W.C. '
P.0. 'ROX 621 r `
P.0,'B OX 621
li 1E CA
RIVERSIDE C.A. 52501
(760)831-2000 CB1.0. 6246
USE OF PERMIT
x'741. lilCJl;t xfi,
.
PO*.. USAA. 1UARMSlM2121FRS'.",,H:A1.l.,130. IN PLACE -AT PRE -PLASTER.
W9PECT1ON, EQz1 1'ME+►.'T DICWSURE NOT INCLUI'7A
P001. A NWOR SPA 10 ODn.fifi Y,S
US'.I'c17ATBW COST OF C -009M MON
lA,tMEfl fliD
Imo RAW rkT4. 6CII.1MARY
PLAN C14FXX FEE i.01-000.439.31 s mos
.
CONSTRUCTION ITS 9:31-00-418-000.. M-7.00
MECHANICAL ANIC1AL KE =- POOL 101.000-•21-000. 4x4,00
.
ELECTRICA1..'IME .o POOL 1011-000-420-000 $45.00
KUM1 ING SEE •- POOL. 101,•Wb,419_1000 429.04
.'
WM-TG` °!'A& C01v-2.T,TCMON A,WD. Pi,AM OX -LEC -K,
$289.05.
1Y.03 PRE -PATI) FEES
X0:(70
TOTAL I°7,-RMr. !?'FT—S 33M .!`SOW
9x€t9,U 5
RECEIPT
P
DATE
/ //
BY }yam
DATE FINALED
INSPEC
//
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
Steel
POOLS - SPAS
Set Backs
Electric Bond
le
Footings
Main Drain
or if '
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
- -
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
-10
. 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
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
3N11 MOl3END"
NIYV %t 3dOlS, '
• V ,
--
NOVO. 13S
CITY OF LAIN IA --
f 4 J
= BUILDING & SAFETY DEPT* ,
c 4 a gPPR VED
s • FO coNSIR
• a 'DA • N I b O • '
wlj
IK
lldM:A0018NMOdBR HOIH 0-
',' ' „,
CL
U
d
W
a..
3N11 MOl3END"
NIYV %t 3dOlS, '
• V ,
--
NOVO. 13S
CITY OF LAIN IA --
f 4 J
= BUILDING & SAFETY DEPT* ,
c 4 a gPPR VED
s • FO coNSIR
• a 'DA • N I b O • '
wlj
IK
lldM:A0018NMOdBR HOIH 0-
',' ' „,
(3)24p SQ.x6'-pp
5' METAL GATE
MASONRY COL.
METAL SLIDING =5'-p
GATE - i S Q p 1 N o
TLL.j
— —
z 16' -pp - -
4 WATER PROP TY UNE 75'
w I SERVICE SID ALK
Lnn 481 C1C WAAU BROWN
DATUM POINT
MID -POINT OF LOT
DRIVEWAY APPROACH REQUIRES A SEPARATE,
PERMIT AND INSPECTION FROM CITY OF LA
QUINTA PUBLIC WORKS DEPARTMENT.
10'N
i
AREA:
= 37.59 HOUSE 3068 SQ. FT
-GARAGE 517 SQ. FT.
/ ILLUMINATED ADDRESS NUMBER
ON PHOTO CELL PER CITY OF
LA QUINiA MUNICIPIF CODE
54-855 AVENIDA MADERO N
ZIROP-0' HIGH BRM
ME
LOCK WALL
TANK
.m
H (774.=264=028 v
LEGAL DE X54-tB55r AVE -{meq _
IPTlOI k NORTHt1/2=0F LOT 1-6`&'LOT--17,
SANTA CARMESA AT q QUINT. BLOCKTM2 '