0303-193 (AR)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
E144548 B IUM.C27 Tei � OW 1/2(
Date 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 exclusivelrontracting 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 L
WORKER'S COMPENSATION
I hereby affirm under penalty of perjury one/6f tpo following declarations:
() I have and will maintain a certificate of conseritto 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 issufed.
r )� Lhave and will maintain workers' compensation insurance, as required by
qe ton 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 NrATp -U14. D Policy No. �,�1WpER4g33,7R02
(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 orthwith comply with those provisions..
Date:'w F1 ` Applicants
Warning: Failure to secure WorkerskCompensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City,of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date'" of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby'authorize representatives of this City to enter upon
the above-mentioned property foe inspection purposes.
_
/Signature (Owner/Agent); ` •. 7 Date
s . `
BUILDING PERMIT PERMIT#
493
DATE VALUATION �.1 LOT . TRACT
88 - 23268
JOB SITE
ADDRESS -� M&M OM)
APN
6 0 4-2X$-(XV5
OWNER
CONTRACTOR/DESIGNER/EN INEER
14�.�4N W -- e 1�.A71Z3�3S
ROYAL M04TF'WN1YCE.134C.
78.635 B Ail" RD 01k
101
42-600 CAROLNE COURT0101
LAQU"i,1:3TA CA 92253
P.M.MDERERT CA 926I1
C16O}`776.5107 CzLf," 5308
USE OF PERMIT
600 ROOM) PER
AP'PRO`iiED PLANS,
TRACT CONSTRUCTION 600.00 91:
ESIVIVIATF-0 MW OF CONS1'9,2UC,i ON
32F590.011.
PIMAIT T FEE 9Ii1M1L1fA ISY
CONSTRUCTION P'CE '101-000-418-000 5304.00
.
PLAX CHECK I;TZ 101-000-439-318 5?S7.49
141ECRANICAL FEE 101.000-4.21.000 SWIM
ZLICC71111CAL PEP, 101-000-420-000 $36.00
PLUIVII31NO FEE 101.000.419-000 $64,90
STRONG MOTION FEE - RESID 101-000-2,41-000 $3.26
ORADING f?Eje". 101-000-423.000 SIS.00
rT___;.51�-T09AL; i✓t9ud7'1,1T1. ow AIS PL", C.T Com.
V40-25
�s ', 0. E '' 'I, 1XISS PIM-PAID
�Lfl'.
$0.00
RECEIPT
DATE
BY
DATc.ciue1 ;:nINSPE_CTOR.
_ !J �. 0 :
.,�.1 ✓ .
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
- p
Exhaust Fans
O.K. to Wrap
—
F.A.U.
Framing
Compressor
Insulation
i
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
I I
Gas Piping
PLUMBING APPROVA
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:
cl
n,
-
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring — 7
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
08/05/2003
14:36 7607777011
LA QUINTA
CONCORDE CONSULTING GROUP, INC.
ENGINEEERING & CONSTRUCTION MANAGEMENT
3505 CAMINO DE L RIO SOUTH,# 350
SAN DIEGO, CA 92108
PH: (619) 516-3177 FAY: (619) 516-3388
MEMtORANDUIli/FAX COVER SHEET
TO: FROM:
ROBERT PITCHFORD KRIPA
PAGE 02
COMPANY:
DATE:
ROBERT PITCHFORD, ARCHITECT
07/14/03
FAX NUMBE11: �!^
TOTAI. NO. OF PAGES INCLUDING COVEll
1
PHONE. NUMBER: _
SE.•.NDRR'S REFERENCE NUMBER:
02-147
YOUR REFERENCE: NUMBER:
RE: JENKINS RESIDENCE
X URGI?N"C X FOR REVIEW X PLEA51: COt.,INIE,'NT X PLEASE REPLY 17 PLEASE RECYCLE,
notes/Comments
DEAR ROB:
ATTACHED PLEASE FIND TWO COPIES OF CALCULATIONS AND SKETCH FOR
MODIFYING THE EXISTING GLB WITH AN ATTACHMENT BEAM TO SUPPORT THE
LOADS
KRIPA
Na. y
S26.�r7 7►r
exp. sMom�
09/05/2003 14:36
5
7607777011
of
LA QUINTA
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PAGE 04
08/05/2003 14:36
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7607777011
LA QUINTA
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