0203-055 (RPL)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
51503 B C27 07/31/?(
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:
( ) 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.
4Q) I have and will maintain workers' compensation insurance, as required by
Sef6tion 3700 of the Labor Code, for the performance of the work for which this
permit is issued. My workers' compensation insurance ca'frier & policy no. are:
Carrier MID-Ct�t• 3TURY Policy No. AQI S-60-57
(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
Code, I shall forthwith comply with those provisions.
Date: 'A Applicant"" � .1.
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest•and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes nuVand void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. J agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) '2 Date 2,
BUILDING PERMIT PERMIT# �.
f'�•;
DATE •.: •. VALUATION tOT . , TRACT
JOB SITE
ADDRESS ji—'� i�.�jI9's?at�9 �4C�
APN — —
OWNER
CONTRACTOR / DESIGNER / EN (NEER
JAMMWItTROZ
D;>a=q!T C",.C1 118 CUN1'1.€P.UCrICI '
'53-125 AVE 1 i1?l!, RiJf310
41555 YUCCA LANE'
I.fi Q T.CAI'$°l1 CA 92253
B....1 fUD.9kDUNYS CA 9 201
(7t50)360-4400 MIR 1046
USE OF PERMIT
P001, AMYOR SPA.
Z CXX AN[) SFA ONLY. 'NO PffEA9rELI Ar A•:F+flVHAR I.VRS SHALL BL IN
:PLACE: PRIOR ` O P1 &PT.kASTK4 IMP FCT10H. 05 LF OF S' PiT.CK
WALI, CITY 5T.P.7P31 ARD.
POOL ANDIOast SPA 00100 1.5
5 FT, WALL 95.09 LF
1?;&' iUT C05'T OF C:C1WSMIUCITOV
:1.€leo-6. Is
FERN' )MV &IThWtE3.d.Y
P11Ml CHECK FRr? $81.9.0
,
C014STRUCTION FE'le 101 -NO -418-000 026.0
t�
ILECYIZCA.L FZ; 9 -- POOL 10+1-000-42,0-000 50.00
1@1,CJMBENG PMV -- POOL 101-000-419-000
.f
M 'AJ 03
$219.90
JI&MS PRE -FAM IMM
*U,00
tW
RECEIPT
DATE
BY
DTE FINALED
INS
PI�
:, .1 t.
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 APPROVALS
Steel
POOLS - SPAS
Set Backs
Electric Bond
Footings
Main Drain
f"
?_
Bond Beam5B
Approval to Cover
_
5-7
Equipment Location
Underground Electric
S •t To
Final
Underground Pibg. Test.
Gas Piping'(
cJ/
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
Sewer Connection
Gas Piping
Pool Cover
Encapsulation
Gas Test
Appliances
Final
v ZZ G Z
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Routh Wiring
Lau Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
+OR -32'
NEW 5' HIGH
BLOCK WALL WITH
(SSLF-TLFO�SI�NGSELFVVAY
L�A�TCHING [GATE
POOL AREA 366 SF
PERIMETER 94'
CONCRETE AREA 457 SF
I
CITY OF LA QUINTA .
BUILDING & SAFETY DEPT.
\ APPROVED
FOR CONSTRUCTION
DATE
STREET
,-- CURB
ff . &WZE� �
y� m
51-0"
7'-6"
rn
N
10'-9"
1 '
T co' 3'-6" R
in
A/
1 "=8' SCALE
i
EXISTING WALL 2' HIGH /
WILL BE RAISED TO 5'
+36" BOULDER WATERFALL
6'-0" R
PROPERTY LINE
BENCH
-NEW-5-' -BLOCK--WALL �--
OR WOOD FENCE
4 -JETS
EQUIPMET AREA
WISE MAINTENANCE & CONSTRUCTION COMPANY
5 QUINYA = ,
_ r CITY OF LA TY DEp1.
- December 28, 1999 BVI��ING O� ED .
,T ~ ,
City of La Quinta AP�00110N
La Quinta, CA. 92253 �R CON
Attn: Building & Safety
Re: 53125 Avenida Rubio
Doi
To Whom It May concern,
The following is a list of items and detailed explanation as to the work to be performed at the
above address.,
'Sewer hookup: abandon the existing septic system, backfill tank and pit, lay 4" abspipe and connect from
house waste line to street lateral. Pump tank and pit. '
r
Y.
Electrical: Demo existing overhead 125-amp service. Trench and install new underground pipe for new
proposed 200-amp service, TV, and phone.
Framing: Brace up existing patio cover, remove existing horizontal 4x12 beams and replace with new 4x12
exposed rough sewn beams. Attach beams to existing 4x8 columns using Simpson's 12x12 1h12's on both p '
`sides. Attach existing 2x6 roof/ceiling beams to new 4x12 horizontal beams using Simpson's a-35's
w Construct and pour new footings 16x16 x12 around existing footing and tie in with #4 rebar:
Construct new columns around existing support columns, using 2x4 conventional with pressure treated _ ^ , NP
bottom plates. Base plates to be shot pinned to new footings. New columns to be sheathed with '/z ply and
3coat stucco with lath. (�=
Plastering: Remove existing trim from exterior of house and attach lath over existing exterior wood finish.
Apply 3-coat stucco.
Roofing: Demo existing rock roof, engineer for new lightweight tile, apply 2 layers of 40# tile liner and
soft jacks over all penetrations.
Windows: demo existing single glaze windows and sliders and install new dual glazed window ins v " fJIF
r7Y-
Garden wall: Fabricate new garden wall 22' x 30" with 2 end columns 12" square x36" tall.'
; a
Drywall: Rock garage interior using 1x3 backer s _ ro o ,
Fencing: Fabricate and install new 6' 1x6 dog-eared slat fence around perimeter of property 1901f.
Concrete: Demo existing asphalt driveway and pour new 4' concrete drive slab using steel mesh and broom
finish.
A/C: Demo existing package on roof A/C system. Install new 4ton split system with unit installed in attic
' space and condenser located in rear yard. R2pvlp� �ISCOtEU" �QNU� �1��
AQ C, FAv FWtPt9eMW1'5 8E UIRP-) Fiw
1W (CeLp
P.O. Box 1767, La Quinta, California 92253-1767 - Bus (760) 771-1180 • Fax (760) 564-7412 - -
State Ucense #664238 Class B e !