0207-172 (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
-56126 C53 MC 08 16431/0
.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).
( ) 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
Seciion 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 J%9T&.CC: 'I;';HSAT1 Policy No. 044000610-01
(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 it I should become
subject to the workers' compensation,provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those., provisions.
r:Date: r Applicant 4- sc�
Warning: Failure to secure Workers' Compensation Fcoverage 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. EachNperson 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�i spection purposes.
Si nature (Owner/Agent) - le � R '- Date -7 •� �i
-BUILDING PERMIT - xPERMITJt
DATE VALUATION Us r�y��{5 LOT TRACT
JOB SITE"% r/ C- %.
APN
ADDRESS 61. .lQ j :JARWf,IaS4AS
_
OWNER
CONTRACTOR/DESIGNER/EN (NEER
TRAN WE.ITr HOUSING 790.
CA,TOORMA :r;'OOU <b RPAS (: P MAN CO:
7a-401 Ti 14101-IFd+a Y 111
7 4.725 JON'S 1' R11/.,I<,"�'l,`,rA2OA
LA QtiWA CA. 92253
PX:11+i DE-IT09* 1 CA 92260
(7iw)m0.9000 CIP11A 00355
USE OF PERMIT
J 400L rdtie�iC?TR
P0'01gSP.A.. K1V.A.A.I.9tTtf1A`."i1FS SitfJll�°,.,`' aF�r91,I� fl•.i✓ III PLACZ A!f
P�%�t,x�:�7'��.116"r� s.k�L�;f''f�lt?iJ, i3�171'1��r�.2�T I+���:'%.�?f�1.�,c� 1�C5`.i 1.1`9CT,1,ll`.�:�i;•,s.
FOOL t?IN; IOR SPA WDD.9D LIN
IST'Tltt�.".�;aC> COST OF C0146r';11:UCTIVIN
2: 1111T 400
PERMf FER SUMMARY
PLAN CHECK FEE 101 -000-439-3 18 $152.10
-.
C0VSTKUCT3CFN.fZLe 101•£iC0t 41S1_000 $2M.010
M&C` I NNUMLf F&& - POOL . 101^000-421.000 524,00
Z1A?C1F11JCA.L VIEF .. P0041.1 , 101-000,420-000 41.5.60
PI:~ lSSIDINO Ff,?•&-- POOL 101.000.419.000 �3'�•Dm
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CITY OF LLA QUINTA
FINANCE DEPT.
RECEIPT
DATEGc ,F' f
BY
DATE FINALED
INSPEC R
ZP.
INSPECTION RECORD
OPERA -ION
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
Set BacksElectric
POOLS - SPAS
Steel
Bond 02
, t �j
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
Encapsulationo—O
_
Gas Piping
Gas Test
Appliances
Final
2_
Final
l Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Condlit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Ex' srior Receptacles
G. F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
GJ 0 - 0 2 f�
v 0�1— �5
NoTEs : -
I. ALL PA.IPT. F°P- PLA,5TE(L o �E ELAST°MEj21G.
-2, VF -P -I FY LO.cPT 1 c N 'IF GA -5 'KEY' W/ L, A •
3, FI(ZEPL.AGE + (3E INSTALLLo w/LoGs oAS FLAME 6MITTEFL -vERIFY
-A. tMefLOWGY 6A5 LuNF. SHUT- OFF..'IA-LV& Nt U'c^TE;o UNnER 40A5 rOFLIL.L
CITY OF LA QUINTA
6'-6•
Ile_
BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
i
1'-3' 1'•6' 0 V-3'
1'-p' V-6'
y
r
DATE
I f�(Z6ES'(�2
1
— CLAY FLUE
t
TEX.EXT.PLAS ER.
8• CONC.BL TYP.
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4' CONC. SLAB.
FIREBRICK
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#4 BAR HORIZ. CONI.
4Evep..
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4 -BARS HORIZ. @1 O.C. TYP. S_
t
2' CONC BLOCK.
T! P COURSE ONLY.
AW CjjT- AS
4'x4' STEEL L .
. #4 BARS @ 18' O. . TYP.
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#4 BAR HORIZ.CO
.TYP.
BARSVERT: @1
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O.C. T.YP.
'!#4
BARS HORIZ. TYP.
HEARTH
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#4 BARS @
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18. O.0 TYP..
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�—TEX.EXT. PLASTER.
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PATIO SLAB.
NOTE:
#4 BARS @ 12' O.C. EA.WAY.
SOLID GROUT. All CELLS
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8
WITH STL. REINFORCING.
FIREPLACE DETAIL. '
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SCALE
3/8"=1'-0'•'