0308-118 (BLCK)LICENSED CONTRACTOR DECLARATION PERMIT#
U) I hereby affirm under penalty of perjury that I am licensed under provisions of B1UNLI) VG PERMIT
H Chapter 9 (commencing with Section 7000) of Division 3 of the Business and04
DATE VALUATION LOT TRACT
W Professionals Code, and my License is in full force and effect. WMW0i:,g
O 5 ch License # Lic. Class Exp. Date
t\ (:y tr) JOB SITE APN
LU f4"05 C29 0ilsllaC ADDRESS 57-51.5Bt ACK DTAM OND - -
Zr Ile
Date ' Signature of Contractor - OWNER CONTRACTOR / DESIGNER / ENGINEER
(0
J F- OWNER -BUILDER DECLARATION W.�.;1�'t OPFPA��i` RS SSC/R ASC ��
H WI hereby affirm under penalty of perjury that I am exempt from the Contractor's 80.070 C:� M`i`�CIT R 4) 6255 �i ILCE170 FI RREF, M!-1
License Law for the following reason: LA QUTA TA CA, 4225 Y 1jAU4 DESERT CA 92260
Z_ ( ) I, as owner of the property, or my employees with wages as their sole (760)674.0666 CMA 6214
compensation, will do the work, and the structure is not intended or offered for
sale (Sec. 7044, Business & Professionals Code). USE OF PERMIT
( ) I, as owner of the property, am exclusively contracting with licensed ClrRKMk :C.,1�DUXX9G
contractors to construct the project (Sec. 7044, Business & Professionals
Code). :38 ,L.F. 6' DARD'EN WAL1..� l'7RCO SYSTEM
('')() I am exempt under Section B&P.C. for this reason
N Date Signature of Owner
ON
rn
a Z WORKER'S COMPENSATION DECLARATION
C) 2 Z I hereby affirm under penalty of perjury one of the following declarations: ,�
Lo F2 O () 1 have and will maintain a certificate of consent to self -insure for workers'' �O 4�.1'
X W �= compensation, as provided for by Section 3700 of the Labor Code, for the
00 � J <_J
performance of the work for which this permit is issued.
Q O (,) I have and will maintain workers' compensation insurance, as required by
O U Q Section 3700 of the Labor Code, for the performance of the work for which this
11 L Z permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier w9 coR.1' op igrm Y Policy No. 1� 90(?tfD142 F5iT VWZF_D COST (INP CZPIN&TRt7'C000
ob 5
J (This section need not be completed if the permit valuation is for $100.00 or less). CONST' UCTIOIN FRE 101.000.41800 i WIN
( ) 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. _ ti
Date Applicant-�
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 SUB-TOTALCCM�ST,R1,rCTION ANDD M CTIEC
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 +`� T'RL-PATD =3 U,tjO
& 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 ifD e ' ` �° ¢► ^It•E"ENDWO L~7C9W
work is not commenced within 180 days from date of issuance of such 9,
permit, or cessation of work for 180 days will subject permit to cancellation. AUG 2003
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 CITY OF LA QUINTA
the above-mentioned property for -inspection purposes. FINANCE DEPT.
RECEIPT DATE r • BY N L INS TOR
.Signature (Owner/Agent) f ----- . Date �'
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
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBINGtP OVAL
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
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 (Penn)
COMMENTS:
08-08-2003 10:12 FROWIVIDS CONSULTING 7607714073 T-758 P.002/003 F-470
�^+ DAY LIGHT UNE
Adj 61.28'
°h6c�v 462.30 TW 44TW 462.82 ,
455.30 TF 455.82
0.5% 0.5%
MIN. :r�. MIN.
E�
15.00' 15.00'
0.40%
e VCP
18" DIP WATERMAIN
-
-- — — — —— i------- I-----
3B
.D
6..
FF=457.8
e
z
PAD=457.3
A
0
..�
THRU THE WALL DRAINAGE
E D
(TYPICAL - SEE DETAIL
c
SHEET N0. 1)
¢
THRU THE WAI-L DRAINAGE
o .
(SEE DETAIL SHEET N0. 1)
r =
®
462.30 TW
455.30 TF
455 9
G8�
�t5;00'
GF=457.3
�..
�
5
l90 1W
6.C1
15.00'
.90 TF
110.00'
4111'
0.40%
e VCP
18" DIP WATERMAIN
-
-- — — — —— i------- I-----