0009-228 (BLCK)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
CI14pter 9 (commencing with Section 7000) of Division 3 of the Business and
Professionals Code, and my License is in full force and effect.
License #AA p Lic. Class Exp. Date
[� y
7�0q O B
Datey ///%'! Signature of ContractQC., ,
OWNER -BUILDER DECLARATl N r
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:
Gamer Policy No.
(This section need not be completed if the permit valuation is for $100.00 or. less).
O I certify that in the performance of the work forwhich.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 sh 'TI forthwith comply w,ith•those f0; s'oRs..
bate:::i Applicant`..
Warning: Failure to secure Workers' Compepsati n 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 represent9tives of this City to enter upon
the above-mentioned property for igspection purposes. p
Signature (Owner/Agee "' �"d `�"�' 4' Date
BUILDING PERMIT PERMT#
DATE VALUATION . LOT TRACT
f-%+�
237 y 1 D
k S"�f n n C /G`VnSi09 ,j ,6 3-4
JOB SITE _ Q r
APN
ADDRESS
OWNER
CONTRACTOR/DESIGNER/EN (NEER
CQ41"UR!Y =%TlLL 1-1101MMIMMU,�:
f 117Ai ff f'RCy1i . 1 �, e9c� t71 �'S
1535 50. *7 SWE1', 9YK 02100
1535 Y50, aD' M ERY, GM, 0200
SAN'BERNARDINO CA 9U08
SA RF"AIRD.INO 'CA 9N
(909)381-6007 MIX 2120
USE OF PERMIT
�ZYFIC?P AT, 13UID:sAN0
4�1 .�yy.lyyyP�'.1>MINQ'i7��8I.. A.S PER APT�1°.OVIM) RN`C;t"�f E.,,L!'�D .
'��3q'7.,
���eyj�39 /d.y��qp
.i" IA.'I'.111 I& 4IOT N
r
4 FT, WALL 89,00 tv`I{
W811MMTED COST OF CONGTRUCITON
CONSTRUCTION M 101-000-4184M V6.00
STXB-TaS;A , +r".iqM!'IiUC1 014.@il+i-b PLAU M; CK.
4S.Ctii
p
RECEIPT
DATE{
BY
DATE FINALED
INSPECTOR
";, �r
INSPECTION RECORD
OPERATION
1
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
Final
_
Underground Plbg. Test
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
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: -
RETAINING WALLS
Cantilever Retaining Wall with Footing Away from Fill
Max. 2
slope Grade sloping
1 [ or level
v4 Cont.
1 2'Cli: 4
8t' Conc. talk j
Max. -\
slope 2Grade
sloping or
! level
=4 Cont.
++4 n 48" o.c, Y bars �
continuous 2" Clr•
H =4 r' 48" o.c.
2" Clr.• I continuous Y bars
-1 1 8" Conc. blk.
H '
Omit head X bars ' 6" X bars
joints Omit head
1 12 Conc. blk. joints '
04 Cont. 2„ L
H, 2 2" Cir. - - ,4 r 24"
�+
e a4 24" - Omit if no key
Omit if'no key 12"
1L #4 Cont_ °4 Ccnt.
• • ' D , if Cont. Omit
•6" Hook '4 Cont. D if no key
D 3" Cir. Omit if no key I 3" Clr.
1 J � 6" Hook
0 3" Cir. • 12" e4 12" 2"
q 2„ ROF'ESSip/. Cont.
Cont. B k� 3, SO,%/ V B
Section A
No. 24069 ;�j Section B
�''
• SOR 12-3 1-2001
$Dr CAL�OP l
-rwnr ir 2 <A nrcrr_N nFTAtI C A1Vn STEELREOUIREMENTS
v
Section
H
H,
B
D
X bars
Y bars
L
A
8'0"
2'8"
5'0"
1 ' 9„
#5 @ g„
=5 @ 16"
—
A 714" 2'p" 4'8" 1' 6" 4 4 @ 8" x5 @ 16"
—
A
6'8"
1'4"
4'2"
i' 3"
w5 @ 16"
4:5 @ 16"
—
Grade sloping
maximum 2:1
A
6'0"
1'4"
3'8"
1' O"4
@ 16"
:t4 @ 16"
—
B 5'4" -- 3'6" 9" 5 @ 16" t4 @ 16"
2'6"
behind wall
B
4'8„
—
3'0"
6"
04 @ 16"
-;!tel@ 16"
2'O"'
B
4'0"
—
2'6"
3"
w4 Ca) 24"
#4 @ 24"
2'0":
B
3'4„
—
2'2"
—
44 @ 32"
x4 @ 32"
2'0,'.
A
8'0"
2'0"
4'2"
10"
45 @ 16"
=5 @ 16"
—
A
7'4"
1,4"
3,8„
7"
x4 @ 16"
=5 @ 16"
—
Grade level
behind wall
A
B
. B
6,8"
6'O„
5'4"
1,4"
—
—
313"
3'2„
2'9"
4„
4„
—
44 @ 16"
45 @ 16"
-t4 @ 16"
44 @ 16"
--5 @ I6"
44 C' 16"
—
2'O"'
210"
B
4,8,.
_
2'6•'
—
-94 @ 24"
-14 @ 24"
2'0"•
B
4,0„
_
2'2„
—
:4 @ 32"
94 @ 32"
2'0„'
B
3,4„
—
1191,
—
04 @ 32"
#4 @ 32"
2'0"•
*Lap splice may be omitted and reinforcing made one piece trout touting 10 top of wan
(Pa
tlf J I t,
(Pad= 93.4) I ��.�` i (FF=94.70)
=94
.. o (FF=93.90)
EXISTING I
BLOCK WALL 00w w w
I�00'00'20" E 479.76' FG i.
-tomAM
126.51' ��° �,� ° 0 83.50' 9��G �o°i 103.33 66.97'
o /1pp^• o
CN
/ N _
v
J
/ 8 ? 2:1
/ 97.20 3 -
_ OFESS/
/
cr
°�° No. 24069 x
Q EXP. 12-31-200
00
o N 9 // p b pp 34.56' CML v' ,
9�oFC rO4 Pad=
9k.20 i 0� p�F �b 1 2 6.0' o
p ® F.F.=1
TW 103.67 FG I FG ��-' Pod=98.0 ��E0. 21'.46' PLAN
TF 93.67 9y pC I \
FG 94.30 'o �� F.F.--
98.50 be ✓✓✓
�� / to
PLAN 3A(R) o -� I y X7.0
TW 100.3geo / of n
3 6
POOLTF 93.67�0 OS
FG 94.60
--•
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61 s�J O i ,p 0 103.:
o FL
—o ory/ ' I ,° �o /0.5x57.0
iTEP
95.88 h� �' F� 0 , 91.5 fG FOOTING 0
L= 6 N rn I' ��` °�5 C O �O� 0.59
FS
h \/ I l
O w °' 4G /•iy. \ fly 96S gg6 tJ� iOrn
X0.10
OURT 9s`J`� �/ It 14.2' O
OEEPE" 5.510
f00 �c O 1°p G 3 �
_ w F
77 3 95% 96.58 9� hG i ° f N z a
O TC f�- G� �.NY
50 02-4EoI a
11 '
00
0 I
ZiON
RETAINING WALLS
(BY SEPARATE PERMIT)
N. T. S.
/•1� 00
rPVo. 24069
Z
EXP. 12-31-2001 mM
CML OQ�
OP CAU'