0403-017 (RPL)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
f= Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
N W Professionals Code, and my License is in full force and effect. 4'
=) ch License # Lic. Class `Exp. Date
t` 0 LO '� }
w� r-_ 634981 B {' t f 1 n 1104
:o Z r-- Date Signature of Contractor
0.
J_J '
U c:> OWNER -BUILDER DECLARATION
W W I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ it
U)License Law for the following reason:
Z_ ( ) 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).
CY) () I am exempt under Section B&P.C. for this reason
LO
O N Date Signature of Owner
rn
EL Q WORKER'S COMPENSATION DECLARATION
p � I hereby affirm under penalty of perjury one of the following declarations:
0 () 1 have and will maintain a certificate of consent to self -insure for workers'
X W �: compensation, as provided for by Section 3700 of the Labor Code, for the
m� Q performance of the work for which this permit is issued.
Q U ( ) I have and will maintain workers' compensation insurance, as required by
d U Q Section 3700 of the Labor Code, for the performance of the work for which this
dLOH permit is issued. My workers' compensation insurance carrier & policy no. are:
Z Carrier STATF FUND Policy No. 1342037-03
J (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
3 subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions.
,'Date: ApplicantN 1
• 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 anld Safe`,
for a permit subject to the conditions and restrictions set forth hrs
application. 61 , i✓
1. Each person upon whose behalf this application is made & each persoh at
whose request and for whose benefit work is performed under or pursuanttfo
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 anclwoidAf."-
work is not commenced within 180 days from date of issuance f�SU�t}�
permit, or cessation of work for 180 days will subject permit to cancelation.
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.
�1 >'' Signature (Owner/Agent) -% Date
,BUILDING PERMIT PERMIT#
DATE VALUATION LOT 0403-017 TRACT
JOB SITE '
APN
ADDRESS w -97s AA.C-=A Yr1Azamim
-
OWNER
CONTRACTOR / DESIGNER / EN (NEER
' CI"3k�iNi"si. T 3 t C��k' ItI:ll
COliONE11, C OkYS 1'iM"CF1011T
1:'C` F 0f 3 89
51.1105 VIVIDA `i iT-1 to #t 01
L& QTANrrA CA 92253
1 1� Qln-MTA Ok 92253
c76Q; 564-4604 Mx,µ 2261
USE OF P,�EEyRT1MITpp
���q����, e/f�tt, S.M.:1.1, t1LYJr7 4. R }.'�di
POOLfSP'.A.. AL,A-FFt�AWBA.:(1..};.M2S SPLAI,,' , 8F, 1N PLACE AT PRE -PL ITER
INSPECTION, L7QUI.i ?Jlar"AS: �Yt�I.C�:1d+P.� 2�C)'i' IPiCIaLdiJ1+;1�
POOL AND/OR SFAeV,,X) us
�x'rvm c er oir co.ramT7cmum,
81004100
PLAN CHECK .r -r 101-000-439-318 SAM
C,f. NS:CIL1.ICTI N n0l' 901-000-418-000 $93.00
,
MECHANICAL I: -E -- POOL 101.000.421-000 $24.00
&LI=111CAL POOL 101-000-420-000 Wool)
PI.iM131"80 RM __ POOL 101.000.419.000 WIN
U
r
MAR 0 `Y Loo 1 , ,
1,1014AND
'
CITY OF LA QUIN T.4
FINANCE DEPT
8 M-'1MAL CCOIN.� P:v: AH 41MICK
$259.35
nrSSxzB...�`ay�3$M EBEi
00
S M1wryEKES AV.E11 \.J YtF
�$0.
b+.L�rR o�fA3w
l/
RECEIPT
DATE
By" �
DA FI NAAD
INSPEC
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
i
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
_
I
Final
Final
POOLS - SPAS
,
BLOCKWALL APPROVALS
Set Backs
Steel
Electric Bond 7
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
y"
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
i
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
y
COMMENTS:
j
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)
f.
df
f df
5ETBo&ZK * 154 13'-0i ��'- " III'-)"7
dF 6VmACK • 0
�"13G1"1 T
AC cxm t✓M=or h�
I ae a O
30,
aea+s
■
�r f co .
_-----_-_-
f'r �44
I �
fff 1
Iu 1.1 6C7}2 ACAd�G�Ca4!
r `
�{ w rLGCIL r11114 R�+ MALAMU
lur------------------1 r----=-,-�
I I I If
nr aa■ fGo s c a,4" kogl + I I p I
vu4m + V 4 •r I I I I
A •-' M
■ i4
w
mama
■ � � oAL. �TJ9KF1
AH4Jof y�il.�n�+�+1ir�� 1T r�A/'Elly
7wE 611�EET "mr"
r
am cffC.lPLH KAWMAL 4 fU ]�' aOrS {xlCri
1 L111R rY 1r/Wi] 1'LfoLUK r L0Y947E
t■'-4r
y ■
I } USA%
■
• ru w wx . cu 9Tlcr9wLli F
(WOUTrr M ACAC-6 r
- eEre"te Aro ae�tr�
Ft?t f'TTT' d# L ■ a.aeA MAKJO,
i WC�# OPIISII'1Qi}
I
6ExK f ID'
ADO GOV"
owwrrm cum
PAD M"ATXW OW
i
r�ors� ��aun roosrrr�r '
f�l7rlf T�LOd-1 [�.ivJ4TIC�lI Ili•
irM#1� Ro01R TQ prt rr
u�re: a..T+n rowNr �r Tcr of
CUM AT M%7MM CW Un.)
AVE I DA CARRAN A
SITE A
SCALE: V8",-1'-O"
.
Ln
Ln
In
Itt
41S+M a
■ Y81Yid n�Ni iMi�
� _
&W WK rb
* T-W LETtll' 7WI
Ik LO& 1[ldlir
Em
20'-CN
6EK*IV
e
7z
SHEET INDEX
1
SITE PLAN
6N
GENERAL NOTES
2
FOUNDATION FLAN
5
r-LDOR PLAN
4
EL£vATION9
Fj
9ECTION9
(o
ROOF PLAN
�j
ROOF FRAMING PLAN
�
TITLE-24 REQUIREMENTS
9
ELECTRICAL PLAN
L0
MECHANICAL PLAN
.al
EI N R L INFO TION
1 CON1I 'I ENT }
O I EL EI w{ I SE
51-n AVDIDA VILLA, STE.101
LA 9JINTA, CA 92253
LEGAL D 5CRIPTION: LOT5 NO.11412
�}�'yry.�r I{I{ raw fj} F�y)■T■T�^�.�.�� APNI: ��■Z�4 - I D{y5�, {-024 Y
r" iOVECT ADD1 E5$.- / .V1"1�
LA CINTA,
CA $2 53
ZONE: R-C
OCCUPANCY: 1tJ LE FAMILY
TYI v NON-fWED
AREA TA LATION5
RESIDENCE 1,948 SOFT.
GARAGE &93 $QPT.
COVERED PATIO rL 36 SOFT.
TOTAL STRLACTURE 2,ro11!BQ T.
TOTAL 517E $QFT.
TOTAL LOT COVEIA'E 21�f'
v Ir
IILE A1OBA
CALLF- CWILLON
VICINITT MAP
.T•.
ool.LEmn 62Mf
PL" pocrnr"1
1