0306-096 (RPL)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penfilty 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
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 exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code). y f
( ) I am exempt uhder Section B&P.C. for this reason
Date e / 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:
Cartier Policy No.
(This section need not be completed if the permit valuation is for $100.00 or less).
(ti) 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: 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
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 for inspection purposes.
Signature (Owner/Agent) t r/� Date
-BUILDING PERMIT PERMIT#
DATE T+ VALUATION LOT ca°pit C�� TRACT
t�Lw'`�.i6MX SOI '."i l
JOB SITE
ADDRESS
APN
OWNER
CONTRACTOR / DESIGNER / EN INEER
MR &W.21—NUTLE
.A.c.,4'.17m 1\ C -0R -Z53
USE OF PERMIT
POOL ANDA'A EPA
Cr'h`w 1APA. SINIIAI,g 'RX "M PLAM ,' f'R24'PI 413178.
e
ioOOTI ,AND IO.R SPA
2003
pU1NTA
OF
CIFINANC
DEPT,
C,'OST OF (1 .0 R6'rW1CYR-CX3N1
C;Lii a d'i{l y�: i'T e MIR � i; i ., �E�� -4 $ Lf� f3��I $162. a
'�.:;i;+fl.4'�j'�St`�IY�',3.��-f'�;sOL .3C�3�aF.�3•4a�'•'�:t}>� 13a.,�►�'
11F193 PRA -1+11w)
S 0 NO
Ww
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
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 8 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
PLUMBING APPROVALS
Gas Test „ J
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 (Perm)
COMMENTS:
\
CITY OF LA QUINTA StUB-CONTRACTOR LIST
JOB ADDRESS `�/ 7y S %�>'�''/�� f�1'✓ r wG-/�-,� PERMIT NUMBER i OWNER BUILDER
This form shall be posted on the job with the Building Inspection Card at all times in a consgicuous place. Only persons appearing on this list or their employees are authorized to work
on this job. Any changes to this list must be approved by the Building Division prior to cominencement of work. Failure to comply will result in a stoppage of work and/or the voidance
of building permit. For each applicable trade, all information requested below must he rmmnleteci by annlirant °nn FiIA° ie not nn +utile ro—.,�s
Trade (Classification
Contractor
- --- -- -- "1'"."-'--
State Contractor's License
-1 "rr•••• VVV'./lUU1Gr IVJ'.l VIIJG.
Workers Compensation Insurance
City Business License
Company Name
Classification
(e.g. A, B, C-8)
License Number
(xxxxxx; ,
ExF. Date
(xxixx/xx)
Carrier Name
(e.g. State Fund, CalComp)
Policy Number
(Format Varies)
Exp. Date
(xx/xx/xx)
License Number
(xxxx)
Exp. Date
(xx/xx/xx)
EARTHWORK (C 12)
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FRAMING (C-5)
_
STRUCT. STEEL (C-51)
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MASONRY (C-29)
S"�o/j�,>_ G ' s Y-
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PLUMBING (C-36)
2 <- C,
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LATH, PLASTER (C-35)„
DRYWALL (C-9)
HVAC (C-20)
"
ELECTRICAL (C-10)
ROOFING (C-39)
r
SHEET METAL (C-43)
FLOORING (C-15)
GLAZING (C-17)
INSULATION (C-2)
-
SEWAGE DISP. (C-42)
PAINTING (C-33)
CERAMIC TILE (C-54)
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5 8'OL
Olen
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CABINETS (C-6)
FENCING (C-13)
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LANDSCAPING (C-27)
POOL (C-53)
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e.
OWNER/ BUILDER INFORMATION
Dear Property Owner:
An application for a building permit has been submitted in your name listing yourself as the builder of.the property
improvements specified.
For your protection you should be aware that as "Owner/ Builder" you are the responsible party of record on such a
permit. Building permits are not required to be signed by property owners unless they are personally performing their
own work. If your work is being performed by someone other than yourself, you may protect yourself from possible
liability if that person applies for the proper permit in his or her name.
Contractors are required by law to be licensed and bonded by the State of California and to have a business license
from the City or County. They are also required by law to put their license number on all permits for which they
apply.
If you plan to do your own work, with the exception of various trades that you plan to subcontract, you should be
aware of the following information for your benefit and protection:
If you employ or otherwise engage any persons other than your immediate family, and the work (including materials
and other costs) is $200.00 or more for the entire project, and such persons are not. licensed as contractors or
subcontractors, then you may be an employer.
If you are an employer, you must register with the State and Federal QovernmentIas. an employer,and you ire subject
-several-several-obligations_incIuding. State and� Federal income tax�withhglding,. federal social security taxes, worker's
�-tee F,
compensation insurance, disability insurance osis and unemployment compensaciori co`ntribucions. -
There may. be financial risks for you if you do not carry out these obligations, add these risks are especially, serious with
respect to worker's compensation insurance.
For more specific information about your obligations under Federal Law, contact the Internal Revenue Service (and, if
you wish, the U.S. Small Business Adminstration). For more specific information about your obligations under State
Law, contact the Department of Benefit Payments and the Division of Industrial Accidents.
If the structure is intended for sale, property owners who are not licensed contractors are allowed to perform their
work personally or through their own employees, without a licensed contractor or subcontractor, only under limited
conditions.
A frequent practice of unlicensed persons professing to be contractors is to secure an "Owner/ Builder" building
permit, erroneously implying that the property owner is providing his or her own labor and material personally.
Building permits are not required to be signed by property owners unless they are performing 'their own work
personally.
Information about licensed contractors may be obtained by contacting the Contractors' State License Board in your
community or at 1020 N. Street, Sacramento, California 95814. - �
Please complete and return the enclosed owner -builder verification form so that we can confirm that you are aware of
these matters. The building permit will not be issued until the verification is returned.
Very truly yours,
CITY OF LA QUINTA
DEPT. OF BUILDING AND SAFETY
78-495 Calle Tampico
La Quinta, CA 92253
(760) 777-7012
FAX: (760777-7011
OWNER'S SIGNATURE/DATE
'41 - 70 5
PROPERTY ADDRESS
0306 -OF
PERMIT NUMBER(s)
AREA 247 5Q.FT.
AREA 1705 5Q.FT,
L
V.n
V'
LAYOUT NOTES
1 ANY DEVIATION FROM THE5E PLANS WITHOUT THE APPROVAL
OF THE LANDSCAPE ARCHITECT WILL RELIEVE THE LANDSCAPE
ARCHITECT FROM ANY RE5PON515ILITY FOR PROBLEMS THAT
MAY AR15E AS A RESULT OF THESE CHANGES.
2. ANY CHANGES, DEVIATION OR DISCREPANCY IN THE PLANS OR
SPECIFICATIONS SHALL BE BROUGHT TO THE IMMEDIATE
ATTENTION OF THE' LANDSCAPE ARCHITECT FOR HI5
CLARIFICATION. NO CHANGES SHALL BE MADE TO THE
HARD5GAPE OR GRADING WORK WITHOUT THE APPROVAL
OF THE LAND50APE ARGHITEGT.
3. 24 HR. NOTICE SHALL BE GIVEN BY THE CONTRACTOR WHERE
APPROVAL OF THE LANDSCAPE ARCHITECT 15 REQUIRED IN
THE FIELD.
4. PRIOR TO THE POURING OF CONCRETE ON 51TE APPROVAL SHALL
BE OBTAINED FROM THE LAN05CAPE ARCHITECT OF THE
HARD5GAPE LAYOUT FOR LINE AND GRADE. THE LAND5GAPE
ARCHITECT RE5ERVE5 THE RIGHT TO MAKE MINOR FIELD
MODIFICATION.
5 THE CONTRACTOR SHALL CONFORM TO ALL RULES AND
REGULATION OF ALL GOVERNING AGENCIES HAVING
JURISDICTION IN THI5 WORK.
G. THE CONTRACTOR WILL CONTRACT ALL UTILITY COMPANIES
TO FLAG THEIR UNDERGROUND UTILITIES PRIOR TO THE
COMMENCEMENT OF HIS WORK. THE CONTRACTOR SHALL BE
HELD RE5PON51BLE FOR ANY AND ALL DAMAGE DONE TO
SUCH UTILITIES
KEY N OTE �)
1. 15' WIDE GONG. POOL EDGE. SEE 4
L3.0
2. 1" THK. FLAGSTONE PAVEMENT 1
OVER 2" SETTING BED.4 SEE L3.0
3. EXISTING G' -O" HIGH CMU WALL
4. WATER FOUNTAINS. SEE 2
L3.0
7' DIA +
5. 5" WIDE CONCRETE BAND. SEE 3
L3.0
G. 70 MM CONCRETE INTERLOCKING PAVERS.
SEE NOTE ON DETAIL
7. TRELLIS ABOVE PATIO.
5. 7'--0' X 3'-0' BUILT-IN 5.5Q. GRILL
W/ MARBLE COUNTER TOP.
5
SEE
L3.0
9. HOT POOL. SEE L3.
10 POT. SEE L3
11. WATER OF CASCADING FEATURE SEE DETAIL #10
9SEPy -1
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