0208-341 (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 fullc;:ee and.effect.
License # tic. Class Exp. Date
69271.x4 P -171[C 07/3112
Date Signature of Contractor t:.. ,.
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 J'± ATE FJJNY+ Policy No. 0014-01-00143111
(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 forthwith comply with those provisionsl�J.,
ISate: -; 7 j• ems` Applicant ^a`L.i.r
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building;and Safety
for a permit subject to the conditions and restrictions set forth on his
application. P q
1. Each person upon whose behalf this application -is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of.La Quinta, its officers, agents and employees. j
2. Any permit issued as a result of this application becomes null and void if -]
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.`
I certify that I have read this application and state—that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby -authorize representatives of this City to enter upon
the above-mentioned property for inrspectio{npurposes. 4
Signature (Owner/Agent) LLL Date e
r
BUILDING PFRMIT i' PER,
DATE VALUATION lsdYYy hki4D LOT TRACT 50651
F�J
JOB SITE
ADDRESS NT t. , w *--pgo,nca' a, tter-
APN
cr
OWNER
CONTRACTOR/ DESIGNER / EN INEER
fir AMY RAArCK 1W.
C & C4 t::o2$q.t.'.aucrflok"
If)RRY LN
965 NCYR71'0HD AVEXdC
yIA QJ�VTA 0kk 92213.
qd6
fPLvi4PA91
(.1009)9!32.-9965 MLb 3539
USE OF PERMIT
C'1vXF�e 4111111MXG4, 1
31) I if 4' .TI:f:TAilidINU W,fi.L • Y IZ C.'fTY .`"i°.I`AONEXI . tD. CDD a?Lf3triRt' "A1... HY
4'I'AX IIAWA m0BI.I.1LDWALL PRIO'k TO SYD PERMIT I`a`�UA'I CE -1.
4 F'!'. WJ,16 30,00 LF
4?
Gl'7'M° S°IUTC 110N FEE 10.1-000-418-000
' � r
£I' 3-'7'�!i'A . Ci 'Ti' ttlC: k�! �i�i3pp� PLf�Ct1LL'����� XYY�:t�'}}�yyC.
$15.00.
��j��p���SS
L&W Y. R Gb'T'AI � d'•.L:d:e 9
$0.00
?1278 DIM NOW'
o AUG. 2 q`pi1[�2
s
CITY OF LA (Aui%TA
RECEIPT
DATE
BY_^,e
FI ALD
IN
CTOR
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
Pa Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
-
steel
POOLS -SPAS
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
Electric Final
Waste Lines
Heater Final
WaI r 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
poliances
Final
Final
Utility Notice (Gas)/��"
ELECTRICAL APPROVALS
Temp. Power Pole
,derground 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:
,0%11
i�
/j
9/ %�p
THE- OARRY
A T L A. CZ U" I N T A
- City of La Quinta August 28, 2002
Planning Commission
78-495 Calle Tampico
-` La Quinta,, CA 92253
Re: permission for retaining wall construction
Dear Commissioner,
- . This letter represents a request for permission to construct a retaining. wall in anticipation
of the issuance of a building permit for a single-family residential home. The home in
4 question is, at 79-860 Remington Drive, which is in the Quarry at La Quinta. The
uilding and .Safety Department has told us that they expect to issue a building permit
within a week. However, a small amount of retaining will have to be done before we can
actually begin construction of the home. The total length of the retaining wall in question
is approximately 30 feet, and at the highest point we will be retaining 4 approximately four
feet. We would like to begin construction of this wall immediately, so that our
construction of the actual structure will not be unduly delayed after the building permit is
issued. Thank you in advance for your consideration of this request.
Vey✓ travours12
F'
Representative