PAT (0207-099)77143 Calle Mazatlan
0207-099
LICENSED CONTRACTOR DECLARATION Fes,
I hereby affirm under penalty of perjurytthatd,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
^ J
J 0I'M
D to%✓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: l'
( ) 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. My workers' compensation insurance carrier & policy no. are:
Cartier Rj,PATE FVHD Policy No. 044.01-0019497
(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,'arid agree that'if I should become
subject to the workers' compensation pro`v'isions of Section; 3700 of the Labor
Code, I shall forthwith comply with those provisionss 11 "_,'."
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,:representatives of this City to enter upon
the above-mentioned property for.nspectlo purposes.,' <a
Signature (Owner/Agent)t r r ' Date 4210-1
r ' ' BUILDING PERMIT PER MIT #
DATE07/f W.GC VALUATION S7981W LOT TRACT
f
JOB SITE ADDRESS -77-1413 CAIX a B"' AML
APN 0 - -M)9
OWNER
CONTRACTOR / DESIGNER / EN (NEER
MK & MRS VAN Ord)RN
VfARX 00148TRUCL`. OR CCa,
777143 CALM Ml?,2'Al..`1 IT
GARAH—D IfE
LA. Qt )TA. CA 92253
PALN3 I: I r7. T CA _92211
1
(760)343-9711 MR 790
USE OF PERMIT
PA170
SFJ S; PATIO PER /9 PPRtNED KANS. S14PRaXW%B; AI. TO IsZRbh!T
' 1 §• 3 "adv,
14
PORCI MATIO 60.00 P3'
y, •
MMUMAMED COM' C& CONSIEUMION
?W100
Pl.PMl MCK 1118Z 101-000-439.318 t37f
CONSTRUCTION FILE 103 -000-41 &.000 VIA
STRONG G 310'#' a.ON FFM - R921D i 01- 0.-A,1-000 C50
8TT1A-TQT. LCO XJ,110*1A! ".33Pl CIM
$35,75
LESS 1?'i;T RPAID IMM
,
$0700
FUMT ,r IS DWI' NOW
1315715
,cau ca
C1 pNCEDE '
R EIPT DATE f j
BY
DATE F ALD
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 APPIROVALS
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
Sourer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
tTemp. 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:
LAN CHECK #1
.... .... ..... .. ....
r I.Factor: 0.800
_J
V
EXISTING FLAT ROOF
J.
.... ..... ....
rUFIlor.00-800.800
T.T.
PJAN::CliEQK #1 _C i
. .........
MR
A
4
ELEVATION
7
. . .........
OPEN
U actor: 00 0.8
0800
PLAN CHECK #1 r s W
0:
CLAY ROOFINGi
0 #4202)
TILE
I
TILE LC B.O. #4202)
NEW ROOF TILE
Jo MATCH EXISTING
—M ,
Qj PLAN CHECC #1
K #11
.... ......
- - ---------- —
. . ..... .
............
(A61- L-%3 Rf,'F,(Lf -
-EXISTING FLAT ROOF
12
2-)( J'Alyl tX qx
All
EXISTING
I
EXISTING FLAT ROOF SLOPE
ROOF
jz
04^
.Jk
FYI STl NG "S COPE ROOF.,..
OCHOA DESIGN ASSOC 7607736605
-771
G'd S l/fir-✓
J
r
06/24/02 04:010m 'P: 004
CITY OF LA QUINTA_
BUILDING & SAFETY DEPT.
APPROVE®
FOR CONSTRU TION '
&a
1,iLrL m
S1bE n (z.oNT VIEW c
V" ORO". "Tpf CM0
- R
r
, ,
t,
r
06/24/02 04:010m 'P: 004
CITY OF LA QUINTA_
BUILDING & SAFETY DEPT.
APPROVE®
FOR CONSTRU TION '
&a
1,iLrL m
S1bE n (z.oNT VIEW c
V" ORO". "Tpf CM0