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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
692234 B luc / U?I 112C
Date ��f,% �:� 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.
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 9TATr FUM) Policy No. 044.02-0014319
(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' 7 Applicant i�
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 providad 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, indemnity
& 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.
,
'—Sig an lure (Owner/Agent) f"� ,JDate f
d BUILDING PERMIT PERMIT#
DATE VALUATION LOT 0309-24.5 TRACT
09/18404` $640.00
JOB SITE
APN
ADDRESS . ..��34 Cm u :B14 C1'3.O1 A
OWNER
CONTRACTOR / DESIGNER /EN 1NEER
LA QVlyFryRJIL LLC
C Ft G CV}SL{JC1fyY
78-034 CA1;.d,ERARCEL)ODIA
965 NORTH SECOND AVWLTE
LA Q1 iiN'r'A CA 42233
UPLAND CA 41786
. (909)982.9965 CBL4$ 3539
USE OF PERMIT
GWIM AL BiT1' DING
40 LF 42" k1r,71.A1N3t+ROWALL AROUND PLANTA+iI't.AREA, PER CITY
STANDARD AND MD APPROVED PLM48.
4 FT, WALL 40.00 LF
ESE TWATED COFr OF CONSTRUCTION
1340.00
PMWIT MMN[IA"y
CONSTRUCTION FEE 101.000.418-;000 $19,00
a a
p
SEP 18 2003
CITY OF LA QUINTA
FINANCE DEPT.'
SM -TOTAL CORSTRIJCTM. AW) TaT.,.PX C,NVM
$MQQ
LESS PRE -PAM FEM
$0.00
TO�'Ai,1°3�:tZ1VLC1' A"�,F 9Lt ,A"01iV
$19.00
RECEIPT
DATE
BY
DAT INA /[�
V " ,,�
INSPE
.,,
..r
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
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
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)
PROPOSED
RE7EN110N BASIN
BOTTOM = 46.01
100 1'R W.S.
49.5 E = 46.83
48.3
' FG
fS
? - - 48.
FG
FF.= 49. 0 0
P D= 48.5 48.9E
� J
48.50
FS
r
WHOM
48.70
48.75 48.96 0 48.96
FS FS FS -
FS
507004 FG / FUTURE OFFICE BUILbING
(5900 SQ. FT
YR W. S
46.52
1\s7
,a
EXISTING 4'
BLOCK WALL
PROTECT IN .)M CE
i
45-
44-�
PROPOSED
RETENTION BASIN
BOTTOM = 44.9
i
nx/
�47.60FS
�INSTi
Pvc
/ INS)
/ PVC
_L9. -90TG
43.00 INV
24 �
0 (46.60)
� ' 1
aN\,,1
FS
47.20 / s
FS �:oi'
47.80\\
8. 0 \
47.7 \
a 22 FS 23\\
100 YR W.S
EL = 44.90
EXISTING
(FF=4
EXISTING DRAIN Gf
FIELD VERIFY DRAM
46.78FS)
4L_Ml - EXISTING WING, WALL-' ti
PROTECT IN PLACE ---- 46---
48.20
6-------48.20
FS 44.90TG or 48.61 FS
43.31INV.
0 11 48.53T
48.00 MIN
100 YR W.S.48.63TC
QY"1 44:90
48.63F5
p
48.0 47.80
FG FS
4.
20 ;:
-
--� - --
A-
48.87FS
- 6
8
2% 49.
- ®._ -
1 �
II Q 48..
EXISTING BUILDING 2
I
i TO BE
REMODELED 2'
1:L
AS OFFICE SPACE
U
(1800
SQ. FT)
_
I
(FF=48.45)
48.88FS
--
it
(48.41 FS)I
_
3
-!
EXISTING
WALKWAY
29 48.1
I -'
IL_RY2.
\ 20SA I
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