0208-244 (RPL)T LICENSED CONTRACTOR DECLARATION
I hereby affirm underApenalty 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
736,920 Q 311112 C
Date / rr Signature of Contractd�,'
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
Sec ion 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 STAXE ?U14D Policy No. 1576082002
(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
supject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply wiose provisions.
Date: r� -fia 7 Applicarit :
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.
tea,,.,.<:....,..•... - r
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.
Sig ature (Owner/Agent) �`'� Date/
f .,, ,,
�,
PERMIT#
131JILDING PERMIT
0"-244
DATE/2VALUATION l cro LOT • TRACT
a19
JOB SITE
ADDRESS :?� -%_5:7 �a,�.���u'r'�Z)A� �S�.I.�YcTO
APN
OWNER
CONTRACTOR / DESIGNER / EN (NEER
P.0. ! OX 114.1
S 1370 AV.P-M ADERMM&S
LA QeMT1°A 6.¢iA 92253
L.hi, q,u�'Pv I.'A CA 92253
(769)566-1404 CR7h 6255
X
USE OF PERMITr
POOL:WWt" X WA;
POOL 014L`It 140 IdEti,A,'@`lR, .r•DiLARYt1VW 'RI ERS fSHl-Lll HX 1,4 PI-kcE P -POOR
TO PRE -PL �;D',6vrt TWSI'I;G' ION 5
POOL ANWOR SPA UN A 1Z
R: K8TD +. 3 Cosi OF ii3ONFIRUCt170N
!.'PX1&Zr MT SUMMARY
FLApl CI CK FEE 101.00.4'v.9-318 264,35
C0143T'RUC"I'1CdN l�1v 1�f1-()r'a�'1t -tI70 95i:G0
iLLE;TRi'ALFEE =-POOL 161 F000,420-000
PLIIrA81140 RES o. POOL 101 X410-004
eiir, 191002
C4V0F LA __' q.
f°
FI�VCEDEPT,
' IMl7.:Y AViAL!w'G.✓N7fRWLA 10 A.31.`D A:SN1,,, CHG1-L
$235.35
_ LE'S3. PRE -PAM ;I�.;�
$0.00
- TaXAL 1W. I-�.IT F" -S DOE NOW
$23535
'r
RECEIPT
DATE
�, � `":� . i1 Com.•
BY
1'f,f°{�
DA FINALED �J
�- -�J
INSP C OR
INSPECTION RECORD
OPERATION 7.
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
steel
POOLS - SPAS
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation—G
Gas Piping
Gas Test
Appliances
Final
, 2
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G. F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
_ EXIS.(OLD) 5 HIGH NEW 6' HIGH
WOOD FENCE' BLOCK WALL o
O F1bz
in M WATER
POOL URN..
POL DECK
EQUIPMENT T 0
1'-
3'-T 2 0" 2'-6" IM6R 6 3' S'DESFep
i POOL
AUTO
FILL
O LIG
J
a$
0°
PROPERTY LINE 50.0'
WATER
5'-0"
RETURN
40'-0"
ROLL -UP GARAGE DOOR
WATER
RETURN
O BE
SET BACK
Q�
DRAIN -
U60
o
I.
_j
.
LU
WATER
/
RETURN
,SIDEWALK'
O
A.P.N.: 770-161-022
ADDRESS: 51-955 AVENIDA RUBIO
LEGAL: LOT#11,BLOCK#33, UNIT#2
SANTA CARMELITA @ VALE LA QUINTA
�
5'-0"
�
40'-0"
ROLL -UP GARAGE DOOR
5'-0"
to Y
SET BACK
- W
i
Z
U60
I'
I.
_j
.
LU
d
I
agw
,SIDEWALK'
O
�z
X�
W OJO
•
LU
0.
THE BREEZE ADOBE, I ,
j.SEfBACK
I
I
I
BA -1 Y
iF.F.:1'-0" ABOVE THE CURB ..
PAD. 0'-6"
ABOVE CURB MEASURED @
CENTER OF LOT @ AVENIDA RUBIO
FZl
C
UNAUTHORIZED USE WARNING
LENCH DEMON GROUP. REPRODUCTION
IN ANY FORM WITHOUT WRITTEN CCINSENT ,
IS EXPRESSLY PRCHIBITED. WNRFIDR®
USE EXTENDS TO ORIGINAL AD MODIF ED
DERIVATIVE PLANS AND IS APPLICAME TO
INTENTIONAL AND
UNMBiRONAL
INFRINGEMENTS.
a
NEW 5' HIGH BROWN
�
BLOCK WALL
ROLL -UP GARAGE DOOR
jL( U
8
z
- W
i
Z
J
I.
_j
re
Wz
LU
d
I
agw
,SIDEWALK'
O
�z
i
LU
0.
J
00
I
I
I
FZl
C
UNAUTHORIZED USE WARNING
LENCH DEMON GROUP. REPRODUCTION
IN ANY FORM WITHOUT WRITTEN CCINSENT ,
IS EXPRESSLY PRCHIBITED. WNRFIDR®
USE EXTENDS TO ORIGINAL AD MODIF ED
DERIVATIVE PLANS AND IS APPLICAME TO
INTENTIONAL AND
UNMBiRONAL
INFRINGEMENTS.
a
�
I
I
ROLL -UP GARAGE DOOR
jL( U
z
BLOCK WALL
_j
LU
,SIDEWALK'
_ .CONCRETE w`.:
DRIVEWAY ' N
NEW 4' HIGH BROWN
BLOCK WALL
0.
o
PROPERTY LINE 50.9^
1
URB
/Ef
51-955 .AVENIDA RUBIO
I<
I
�
r
I
t
I
� 3' GATE
•:
'
ROLL -UP GARAGE DOOR
jL( U
1.4 NEW 5' HIGH BROWN
BLOCK WALL
_j
LU
,SIDEWALK'
_ .CONCRETE w`.:
DRIVEWAY ' N
NEW 4' HIGH BROWN
BLOCK WALL
0.
o
PROPERTY LINE 50.9^
URB
/Ef
51-955 .AVENIDA RUBIO
T
U IZ
UT1oREDUSYwMN1N0
THESE DESIGNS ARE 7HE PRCPERfY OF
LENCH DESIGN GROW. REPROOUCTION
IN ANY FORM WITHOUT WRITTEN CONSENT
IS EXPRESSLY PROHRTITED. UAMnHORIZED
USE EXTENDS TO ORIGINAL MID MODIFIED
DERIVATIVE PLANS AND IS APPLICABLE TO
INTENTIONAL AND WNTE4f10NAL
INFRINGEMENTS.
1 LONGITUDINAL SECTION
SCALE: NONE
BENCH DETAIL
SCALE:. NONE
A. P. N.: 770-161-022
ADDRESS: 51-955 AVENIDA RUBIO
PLANS PREPARED BY.
LENPLEGAL: LOT #11, BLOCK #33, UNIT #2 ; LVENTUYtES,IN
dba
SANTA CARMELITA @ VALE LA QUINTA LENCH DES GRo
• A.P. LENCH 11
PRESIDENT
L
3'/"
y ,
N
18
BENCH DETAIL
SCALE:. NONE
A. P. N.: 770-161-022
ADDRESS: 51-955 AVENIDA RUBIO
PLANS PREPARED BY.
LENPLEGAL: LOT #11, BLOCK #33, UNIT #2 ; LVENTUYtES,IN
dba
SANTA CARMELITA @ VALE LA QUINTA LENCH DES GRo
• A.P. LENCH 11
PRESIDENT
L