9805-132 (BLCK)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
.tki4It►
vDate 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
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:
Carrier Policy No.
(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
Ceode, I shall forthwith comply with hose provisions.
„Date: r ` Applicant n % • �-
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) (—dzfr� ate—C —%+s 4-
BUILDINGPERMIT PERMIT` CONTROL#
DATE �'ice VALUATION��� `LOT TRACTJOB
SITE
ADDRESS i 011AARX .L.ANC (HUAitt!A )
APN
OWNER
CONTRACTOR/DESIGNER/ENGINEER
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LA Qt,ifNTA. CA, 1
LA QLfKIA (A O?2%3
f'rtt11377 71,11 CRIX J" `,1
USE OF PERMIT
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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 & 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 - e `�
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
COMMENTS:
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
i4
1
Final
Otilify Notice (Perm)
C29 19'4.9.'25" 58.50' 20.24' 10.22' 11 "lvv w yy /0-00
T-3 N89*39'47"E 193.26'
tel 16 4#V %;4 -56-.50' 11.71'
C30. -1 5.-88'
-,t -47
'C-31 0 7! 474 1 91.50' 1:2.44' 23 T4 N8939'47"E 33.00'
T5 'N00'20 13 IN 3.23'
C3 -551V. 91-50 51.00' 26.18'
4!t4. C33 06.24!1,e 15,7.5o,. 17:61' 8.81' T6 NQU 20'1 5"W 3.33'
-019- 13.3 T7 N8T35'4r E 193.26'
C34 OV4,01V.- 157'.50" 26.58' 2# T8 NO(T20'1,rW 76.68'
101.1 C35" -14'57'18" :1.24.5.0' 32.50' -16341
ss, C36' 0 t, 61- 1 - 1:2*; -50' 2.43' .1.22' T9 N . 89*39#47" 7.14'
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39 29-0 1.” W(PCC) 0.02 AC
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1 15.00 13.01
Cil
NOU 20'1 3"W ysL.
C 12 15.00'
33.87' 203.47'
'
CRY LANE 668.45 - PRIVALOT ACl
7.
ET R. 27728
LOT "C" MB 249/1-13
TR. 27728
iB 249/1-13
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Ao 7.'2.36
4—�
I 1/2 -SQ. TUBULAR STEEL POST
/ 8' O.C. EMBED POST IN 12'X 18,' CONCRETE FOOTING
SI-OPF TOP OF FOOTING, AS SHOWN TO DRAIN.
TOP & BOTTOM P"AII_S. r'
l Ilii '1•
3/4" TUBULAR STEEL PICKETS -.P S" O.C.
CENTER PICKETS ON RAILS. PROVI.QE•
ARROWHEADS ON TOPS OF PICKETS.
FENCING CONTTRACTOR TO PROVIDE
+ SAMPI-ES OF ARROWHEADS. TO LANDSCAPF
ARCHITECT FOR APPROVAL PRIOR'TO.FABRICATION
�— COMPACTED SUBGRADE
�rFENCE DETA
6-
PILASTERS 48' O.C.
30— SQUARE PILASTER W/
STONE VENEER FINISH. SEE
DETAIL.
."NOTE: FENCING SECTIONS TO -BE
—EQUALLY BETWEEN• PILAST
`CONTRACTOR TO SUBMIT S
DRAWINGS TO LANDSCAPE
FOR" APPROVAL: PRIOR TO f
SECURE FENCE TOP AND BOTTOM RAILS TO PiLAS'
METAL•FLANGE. CONCEAL FLANGE UNDER STONE 1
NOIt:
1 11T F H
1. GRIND AL WELDS SMOOTH
W"jj
'���� COAT ZI C CHROMATE Pfl
e1 CSF ? 1 lwy , �-� S EXTERIOR GRADE
F AT BLACK,
a cv i o�:� ION
[ pP�.
���' ei•:✓ 3Cia�� i Iviy P3`R
p
_ AND ALL APal 1CAS
E ccaEs
11
I
COMPACTED rl
SUBGRADE
w, 91
2. 1/2" THICK. POURED IN PLACE CONC. CAP
SCOPE TO DRAIN. INTEGRAL COLOR BY L.M. SCOFIELD
TO BE- SELECTED BY OWNER.
1 /2 OVERHANG TYP.
8*'x8-x 16 1 ` CONC. BLOCK. GROUT ALL CELLS SOLID
PILASTER TO MEASURE -.24 -SQ. PRIOR TO . VENEERING
STONE VENEER- TO BE SELECTED BY OWNER
PROVIDE," METAL MASONRY TIES .AS REQUIRED
.."BY LOCAL -BUILDING CODE.
ZA
4 -*4 -BAR VERT. t- f EACH CoglvEq)
*4-BAR'SO. HOPIZ. (TYO.)
6-
FINISH BPADE
, F.,
PILASTER D
POURED CONC. FOOTIN6
BUILDING & AF TY DIEPARTMANT
CC IN D! T1 -t,X-JIAL ILY
ACCEPTED
SUBJLf TO I N S
�
;--. . �0j%ji S PER
AND ALL CODES