0009-229 (BLCK)LICENSED CONTRACTOR DECLARATION
hereby affirrn-Junder penalty of perjury that I -am licensed under provisions of
L, -ter 9 (commencing with Section 7000) of Division 3 of the Business and
,riofessionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
7 4 1 C38 I w3 1 /v
DatA??V -Signa,tu-re ofContractoc—..
OWNER -BUILDER DECLARATION
I.hereby affirm under penalty of perjury,that I am exempt from the 'Contractor's
License0Law for the following reason:
i,4as.owner of the property, or my employees with wages as theii� s6le
compensation, will do'the work, and the structure is not intended or offered for
pale (Sec. 7044,*Business & Professionals Code).
as owner of the property, 'am exclusively contracting with licensed
contractors to 'construct the project (Sec. 7044, Business & Prcifessionels
Code).
O I am exempt under Section. B&P.C. for this reason
Date Signature'of Owner
WORKER'S COMPENSATION DECLARATION
.1 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 hiive and will maintain workers' compensation insurance, as.requiredby
Section 3700 of the Labor Code, for the performance of the work forwhichthis
permit is issued. My . workers' compensation' insurance, carrier A 'policy no. are:
Cartier Policy No.,
(This section, need: not be completed if the permit valuation is for $100.00 or less).
I certify that in the performance of the work for which this permit is, issued,
I shall'not employ any person in any manner so as to become subject.to the
workers' compensation laws of California, and agree that ifIl should become
subject to the workers' compensation provisions0f Section 3700 of the Labor
Code, I shall ort7h'ith comply w h ho
2/ r
Date, '*VApplican
..Warning: Failure to s ' ecure Worker's' Cuiripy.risation coverage, is unlawful and
shall subject an employer to criminal penaltie's'and civil f ines'up to.$l 00,000, 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.
,11.. Each person -upon whose behalf this application is made &-each,person at
whose request and for whose,benef it work is performed under or pursuant to
ariy permit issued as a result of this apolicaton agrees to, & shall, indemnify
& hold harmless.the City of La Ouinta, 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.relati.ng to the building
construction, and hereby authorize. representatives of this City to enter upon
the above-rhe.ntioned-p
P—!'r-
Lin�spec. tiorpurposes
Signature (Owner/ ge);/�. .
.
Dat
"BUILDING PERMIT PERMIT#
DATE VALUATION9
LOT TACT
n 19 23'773.4
JOB SITE_ S7
APN
ADDRESS
49;-�Mff W, Ay
OWNER
CONTRACTOR /DESIGNER/ EN INEER
1535 so, QD` 1KRE11 M-11 ME, 41100
1g3 130. "D6 UIR MXT, OTE, 4200
,,Ax BERN. Iii ax 9Z409
SARMNARDNO i CA 92A-08
(909)381-6007- C 'AlIff 21211)
USE OF PERMIT
GIMERIA& MULDNG
3t • 41 r. 1.10 LF RZTAINIVU WALL AS, P112, APPRIOVEr) reW0.1mumJ21
PLAKSLOT 14
,1M 'WAU I 101 Of) JIF
217FRdAM COST OF CONWIRUCTIOR
1.7m.w
FIERMTEFRIF SUMMARY
CO'"HIMUCTION PEE 101 8-0-00
M-11MAL K-MMETE PLAN 01.11P
SXX
$41.00
UM4 11TUE-11AM "MV
$0,00
110TAA1 PHRWFITIES DEVE NOW
$4 LQQ 0
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate. Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain .
Bond Beam
���la(o1j it►� n,rr,
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test .
Final I Z�ZZ\�D
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances .
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
IV
10
Ul 20.
.\
.103.06 Pod= 102.6
Fs F.F. =1 03.1 0.
Agg PLAN 3B(R)
\\
1.
17.6' 103.76 o\GB 107.80
0gFL-GB 01.80
6
103.1
✓� FS— 1 T, d J ld 33
E?9q o 103. 7
A.
�e z
N�
\
10
�o •' � • `QA. G0 0 9 � s�
a. �. 9
4 Sp o� �c 9 \
1 1.43F �, \� 105.6
w'0.5%
F104. A I
E 19 ,oma
,/
Pod= 105.0
Co
V
`m pJ3 F. F. =105.50 1 F� ♦ l O2.60
�\\N
7)v 110 3 \� �$ 6
DEEPEN PLAN 4A paa0 rF,o36j
FOOTING 400 G �� f G "
0656 r\ \ 111.00 .::•`'
5. 0' 05%
Y. ::.;•✓ :�
0
tW 1172
(110.5) 1
o..::
7 'SFool
TEP
1 ^�
-,�111• ...:: ` 20
% E 1W 11 p0 ; :.. a
05 -�'- 111.50 1F All.
✓� 2�:0o
FG
el
., r-
(
( IN FEET )
I inch = 20 ft.
X - �
a
FG=111.50. co swole Pod=111.5
o h �70s
Ki
10'
1 ..77
Pod= 105.0 swole x'0
mo
x �- SECTION C -C .
,. 2 2 �
pso RETAINING WALLS.
(BY SEPARATE PERMIT)
N. T. S.
QROFESS/pN
S -3 -so 9`�2
• G`
- C No.24069
EXP. 12-31-2001
ST CNIL �Q
q�OF CA<_1F
9. Z�-aD
i
,
1
RETAINING WALLS
Cantilever Retaining Wall with Footing Away from Fill
Max`'2
slope--Gade sloping
1 j.� or level
a4l Cont. Max.
slope 2 Grade
slopit 2 --CIC t / 1 level
ng or
` 8t' Conc. q
i lk
1
4 @ 48" o.c,
Y bars•. a4 Cont.
continuous 2" Clr.
H a4 r 48" o. C.
2" Clr.- 1 continuous Y bars '
1-1 8" Conc. blk.
X bars H
Omit head 6.. X bars
joints Omit head \ 12 Conc. blk.
joints
=4 Cont. 2„ L
2"
H' 2" Clr. — a4 r 24"
a4 @ 24" = Omit if no key
t` Omit if no key12•• t 04 Cent.
i 2 44 Cont.
. .H D . if Cont. Omit
6" Hook '9 Cont. � if no key
D 3" Clr. Omit if no key 3" Clr.
6" Hook
3" Clr. • a4 J�l 2"
u4 2„ QPpFESS/p�� \ Cont. B
Cont. BQt� 3. sOivFJ/�
t1) N0.24069- tt i,, Section B
Section A , EXP! 12,31-2009f'L'1
OFCA
'rAnr P z AA nFCIrN nF.TAIL.S AND STEEL REQUIREMENTS
'Lap splice may be omitted anri reinforcing made one picec, Ii oil, touting 10 lop vl w„1.
Section
H
H,
B
D
X bars
Y bars
L
A .
8,0„
2/8/f
51(Y,
1, 911
-#5 @ 8"
=5 @ 16"
—
A 7,4., 2,0„ .4,811 1' 6" -94 @ 8" #5 @ 16"
—
A
6'$"
1'4"
4'2"
1' 3"
w5 @ 16"
= 5 @ 16"
—
Grade sloping
A'
6'0"
1'4"
3'8"
1' 0"
#4 @ 16"
-4 @ 16"
—
maximum 2:1
behind wall
B
5,4;,
—
3'6".
9"
#5 @ 16"
#4 @ 16"
2'6"
B 4,8„ — 3'0" 6" 4 @ 16" #4 6"
2'0"'
B
4'0"
—
2'6"
3"
#4 @ 24"
#4 @H 4"
B 3,4„ — 2'2" — 44 @-32" : 4 @ 32"
2'0"*
A
810"
2'0"
4'2"
10"
z5 @ 16"
s5 @ 16"
—
Grade level
behind wall
A
�;4"
1,4.,
3,8.,
7"
#4 @ 1'6"
=5 @ 16"
—
A 6,8,. 1.4., 3,3,. 4" sz4 @ 16" #4 @ 16"
B 6,0„ _ 3,2,. 4" 45 @ 16" =5 @ 16"
B 5'4" — —#4 @ 16" #4 .@ 16"
B 4,8„ — —#4 @ 24"#4 @ 24"
02';6".
B 4'0" — #4 @ 32" z4 @ 32"
—
2'0"*.
2'0"*
2'0"*
2,0„*
B
3'4"
—
'9"
-
#4 @ 32"
#4 @ 32"
2'0"*
'Lap splice may be omitted anri reinforcing made one picec, Ii oil, touting 10 lop vl w„1.