RPL (0210-270)LICENSED CONTRACTOR DECLARATION
F til hereby affirm under penalty of perjury that I am licensed under provisions of
t— Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
N W Professionals Code, an_ d my License is in full force and effect.
=) ch License # \3 Lic. Class Exp. Date
Lu 736920
8 Z Date Signature of Contractor
H OWNER -BUILDER DECLARATION'
W W I hereby'affirm under penalty of perjury that I am exempt frorn the Contractor's
~ U) License Law for the following 'reason:
Z_ i( ). 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).
co ()'I am exempt under Section , B&P.C. for this reason
NDate ” 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.
(Q� 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 STATE IFUND Policy No. 1576.102-20021
(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 a
Code, I shall forthwith comply with those,pi�ovisions. r
Date: Applicant��
Warning: Failure to secure We Kers' 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"r
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) C� Date
" r /B.UILDING PERMIT PERMIT#
/ t1
DATE r `�7 ,LU4TIONas�(% LOT «TRACT
JOB SITE
ADDRESS}
APN
>OWNER
CONTRACTOR / DESIGNER
'ROW,LTaT .1:7
p/'ENGINEER
4. T3OX 3141
i iJwi'�4 CA 9=3
:I: A QUU � a
5 ffir 1404, -,BTA 6VO
USE PERMIT
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'yr '
1?ofiusY>iG..ATL+Rm,.,A%.�=ZR_3' fi,NALL S7';.IN P•LrplCV,, AT 1�'i.IF-PIASTIM,
II'�t;��.�7'It3�r• jti'iiPF!�tfttiY''uPts�La�Sil��'13ir� INi�I.lf�:�k�l.� e
POOL ANWOR RA U
�,y'Iy�.C. .firm 9 fw or 4"onstacreo , -
9.00D.00
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qy(( ppi�pp ��88qq''11•��jjv,l rr��,��� ,7� �•� ♦ ryry���{�y� pr_ti
3.��'#DY Ai'd1Rlu•+YD. �1'IsJ;e�f 01,0000-' 39,31 3t �dl Mib
CONS'i RUi","['IC,IW1:tUI 101-0000 416-003
WMANICAL FEE -- POOL lip -000"421-000
ani.,0.T"morge) FE'... rocn, 10 —000,419.900 1`S27109
•�"��Q
NOV
FINANCE DEPT-.
ET.Pa=�" .Hca, `,. dpi .qui tai d 3
$7,74,20
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
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
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
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
Set Backs
Electric Bond
U
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
., PLUMBING APPROVALS
Gas T
ElectricsFinal
Wase Lines
Heater Final
W�,Piping
Plumbing Final
:!fin ing 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
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G. F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
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NEW 6 HIGH BROWN
BLOCK WALL
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PROPERTY LINE 72.0'
A.P.N.: 773-275-022 4
ADDRESS: 52-350 AVENIDA NAM,ARRO
LEGAL: LOT#18 a 1s BLOCK 1W,[NIT#
SANTA CARMELITA @ VALsy LA QUINTA
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GRANDE i WATER RETURN • ti
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PAD: 0'-6" ABOVE CURB MEASURED @'
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P14NS PREPARED BY'
LENIPEL VENTURES, INC.
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LEAH DESIGN GR
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PROPERTY LINE 72.0'
A.P.N.: 773-275-022 4
ADDRESS: 52-350 AVENIDA NAM,ARRO
LEGAL: LOT#18 a 1s BLOCK 1W,[NIT#
SANTA CARMELITA @ VALsy LA QUINTA
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:DECK 4. N SPA
PAD: 0'-6" ABOVE CURB MEASURED @'
„ +.I
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CENTER OF LOT @ AVENIDA NAVARRO rT . - O ±'r,
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COLUMNT�1 BLOCK WALL PUP F
12
P14NS PREPARED BY'
LENIPEL VENTURES, INC.
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LEAH DESIGN GR
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PROPERTY LINE 72.0'
A.P.N.: 773-275-022 4
ADDRESS: 52-350 AVENIDA NAM,ARRO
LEGAL: LOT#18 a 1s BLOCK 1W,[NIT#
SANTA CARMELITA @ VALsy LA QUINTA
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�6 HIGH
` �'�`' �• BLOCK WALL
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' WATER• .� f
GRANDE i WATER RETURN • ti
•RETUR
'AUTO�;.�.� 2
F.F.X-0" ABOVE THE CURB :..;�y: OL :F �+ ' • _ TE BOND BEAM
:DECK 4. N SPA
PAD: 0'-6" ABOVE CURB MEASURED @'
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,�, ••�• .:• '�• .a•. .f' � .i,j ,.&KHMER« •'.{":
'••�•. : •� w.• ; •a4., ...•' • '. !••i,'.,r .:,� ;. , i ATER•
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;.� . 5' HOGH-- POOL
. .
.' �' '' , .. . 4' •.. BLOCK�� EQUIPMENT
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.•:'•,,.'�%,..•t r %� �� .'18x18" �5'HIGHBROWN �
COLUMNT�1 BLOCK WALL PUP F
12
P14NS PREPARED BY'
LENIPEL VENTURES, INC.
.. • ! dba
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LEAH DESIGN GR
�91V
AVENIDA K`,'rNVARRO
DRANK
A.R
CHECKED
S.L.
DATE
10-24-02
SCALE
1l8"-1'-0"
SHEET
1
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a$a
0
V �
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wk let
V'
DRANK
A.R
CHECKED
S.L.
DATE
10-24-02
SCALE
1l8"-1'-0"
SHEET
1
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i
A.P.N.: 773-275-022
ADDRESS: 52-350 AVENIDA NAVARRO
LEGAL: LOT #18 & 19, BLOCK 103, UNIT #
SANTA CARMELITA @ VALE LA QUINTA
qS PREPARED BY,
L VENTURES, INC.
dba
DESIGN GKOUP
A.P. LENCH D
PRESIDENT
DRANK
A.R
CHECKED
S.L.
DATE
10-24-02
SCALE
9iEET
L
) n
WATER LINE
POOL
WATER LINE
p
DRAIN
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SECTION
POOL
SCALE: NONE
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e LONGITUDINAL SECTION
SCALE: 'b"=1'-0"
A.P.N.: 773-275-022
ADDRESS: 52-350 AVENIDA NAVARRO
LEGAL: LOT #18 & 19, BLOCK 103, UNIT #
SANTA CARMELITA @ VALE LA QUINTA
qS PREPARED BY,
L VENTURES, INC.
dba
DESIGN GKOUP
A.P. LENCH D
PRESIDENT
DRANK
A.R
CHECKED
S.L.
DATE
10-24-02
SCALE
9iEET
L
0'
WATER LINE
POOL
p
DRAIN
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SECTION
SCALE: NONE
A.P.N.: 773-275-022
ADDRESS: 52-350 AVENIDA NAVARRO
LEGAL: LOT #18 & 19, BLOCK 103, UNIT #
SANTA CARMELITA @ VALE LA QUINTA
qS PREPARED BY,
L VENTURES, INC.
dba
DESIGN GKOUP
A.P. LENCH D
PRESIDENT
DRANK
A.R
CHECKED
S.L.
DATE
10-24-02
SCALE
9iEET
L