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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 and
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
,DateSignature of Contractor �Pw"
t
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.
I have and will maintain workers' compensation insurance, as required by
Sction 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 T.ATF PU14D Policy No. 046021300%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 Calif orni-,..agdd agree'bthi jIf41 should become
subject to the workers' comp
s tiaD„pfovisior sof Section 3700 of the Labor
Code, I hall`forthwith comply with those'prov�ns. #
Date: R M-� Applicant - -G 4% } ;
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 auff-r3 epresentatives of this City to enter upon
the above mentioned pt.Qpefo„r iFt'spection purposes.
-,'Signature (Owner/Agen() �" � -Dated1.
P
BIJILDNG PERMIT PERMIT#
DATE VALUATION LOT 111-301 .-Ish TRACT
JOB SITE! ' APN
ADDRESS RA - -
OWNER
CONTRACTOR/DESIGNER/
MOT,M'1i UF,,N"ITIN, CA 921561
C/60)349.9825 MW 33,s5
USE OF PERMIT
VO 0J,, ANNO?? RA
POOL. ALAVMS1S,f3;RR1FR3 SKA3,.L VE IN PLt.C:f" .l3'! n t, MASTER
Tr6VWTIOR DOWIPM E':N'T 'f�,Aid":LIOWRE NOT INCLUDED
POOL .A?+BTaIOR GRA
K000.00 LS
199MAM Vogl, OF WMI) RUCTION
F'P s+ZN ;HECK WE 101-000-4.39-3 18% $3.11,9$
CUNSf;tUCTION W, 1 1-(=-418-000 iii LOO
4ACTY TCAL FRE -- POOH. 101.00(3-4.20.000 S45.0
PLUM1 39` O ME -„ POOL 101-000-419-000 .0-M
JAN 13 2UU3 L
CITY OF LA QUiNTA
:.f-TpT/Si. Ci71�i CTdt)1F PLAN t~J=�f X813 RR&I?AX PR KS
9
RECEIPT I DATE I BY
INSPECTOR
16 1f3AXI
$354.1
$0.00
V54.15
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms 8 Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
0. K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 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
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
,Sewer Lateral
Pool Cover
'Sewer Connection
Gas Piping
Encapsulation
_
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)
PROPERTY LINE 50.9. —\
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NOTE: PLOT PLAN SHOWS
REVERSE FROM FOLLOWING
PLANS ATTACHED
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'LINES
CONCRETE r_ :� • ••''I
DRIVEWAY ' .• i ` .Y•:
-- --� --
PROPERTY LINE 50.0'
z WATER SERVICE
X
QUEEN PALM
15 GAL. OR EQUAL
MIN. 11/2" TRUNK
``
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/ / i ( I '— CURB `�
DRIVEWAY APPROACH REQUIRES A ' ' ,
SEPARATE PERMIT AND INSPECTION DATUM POINT @
FROM CITY OF LA QUINTA PUBLIC MID- POINT OF LOT 3/8' ROCK PALM SPRINGS GOLD
WORKS DEPARTMENT GROUND COVEREDPLANS PREPARED BY*
EL VENTURES,
54-880 AVE N I DA CARRANZA LE CH DEdba N JJI
A.P. LENCH II
LONGITUDINAL SECTION
SCALE: NONE
M SECTION I '
BENCH DETAIL
—Al o .11—
UNAUTHORIZED USE WARNING
THESE DESIGNS ARE THE PROPERTY OF
LENCH DESIGN GROUP. REPRODUCTION
IN ANY FORM WITHOUT WRRTBN CONSENT
IS EXPRESSLY PROHIBITED. UNAL"HOR¢ID
USE EXTENDS TO ORIGNAL MID MODIFIED
DERIVATIVE PLANS AND IS APPLICABLE TO
INTENTIONAL AND LNNTENTIONAL
INFRINGEMENTS,
T '
PLANS PREPARED BY.
FDEL VENTJAMS, INC.
LENCH H
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PLANS PREPARED BY.
FDEL VENTJAMS, INC.
LENCH H
;ESIDENT