0207-163 (RPL)I�-
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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 irf full force and effect.
License # Lic. Class Exp. Date
6�JSit +i r C27 30131i?C
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).
( ) j, 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-.
( ) 1 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 Codei for performance of, the, work for which this
permit is issued. My workers' compensation insurance tamer & policy no. are:
Camer 1111:)Z;MPITY YNS CO t Policy No. NWC613171410
(This section need not, be completed if the permit valuation is for $100:00 or less).
( ) (,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 c?mply with those provisions.
Date: `�" R�'`t iplicant
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 totheDirector 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 abo ,mentioned property for inspection purposes.
Signature, (OWr er/Ag dj''�� Date
BUILDING PFAMR` PERMIT#
W07-46:iDATE
VALUATION LOT TRACT
JOB'SITE
ADDRESS 5:-Q0 DE1 , 0-'= DR
APN
_ ..
OWNER
CONTRACTOR / DESIGNER / EN (NEER
A%.M .140P 1;3
NA'C1IM4 3. i UN1;(
52-620 DEL 0ATO DR -
42.2 0 73EACOV, !°fT.LI.,; D3
LA QIJE TA. CA 9225S -
PA(.0 DE9X(cr CA 92211
(760775-'1564 CKJL 3549
USE OF PERMIT
POM AND/OR OP A
.I7" [)EEP INFT ftTY PZIU-O CA N Prt.R iL)+Pii;C V91) PL -A S.C:t)i'v PLLANCE
WITH AU "DER.41, &. STATE I AWS, INCG13PWO'l`HE F:WDANGER.RI)
SPFP-10 ACT OF IM (16 U.S.C. § 1431, ET S}?Q.) W
1001, A1,4 VOR SPA 10100,60 L ,
A0.(3 0.00
fs IAN Cilf?.CK kti'k 101 - \10 0-4 39.318
CONSTRUCT VEX 101-000-418.000 vfl 1-7,06
EL.ECTRiq,AL n* -- P001, 101 -OW -420.000 %45.5►4
PLUMB1111 f fZF, POOL, 101 -OW -419-0 t,`. 1 $17,00
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C ,QIITA
,W-kt: f�tA(VION 41)P]Iff]���,f1+y 0Ii7Fryfr�:�R'
T(Y.€'At P''Yki ES DATE NOW "
x,265 AS
RECEIPT
DATE _., ,f
BY
DATE FINALED
INSPECTOR
i
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 Wail 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
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 Covar
Sewer Connection
Encapsulation
Gas Piping
Gas Test
.Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Lbw Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
NOOK.
�CITY.OF LA QUINT/
BUILDING $ SAFETY DEPT
APPROV
FOR CONS
nATC 7123. �—
T. PA T.W.
DINING \
` .I
P
PA
130
PA
\..\1\7A
PA
5'
m
TP
PLs�.0 R1+�'vtwltw oicc�
SEE PLAN FOR STEEL SIZE, O.
WATBF RO= MYNOTE LH WAU
-PROVIDE ELASTOMERIC WATT
WATERPROOFING SHALL EXT'z
POOL WATER FEATURB
FOUNTAIN TILE AND INTERIOR.'
LANDSCAPE ARCHITECT.
•HYDRAULIC DESIGNS FOLNTAR
FOUNTAIN CONTRACTOR SUBf
HAPD6f:APE SIAL NOTES
@ALL CONCRETE SHALL. BE A•'
TYPE II PORTLAND CEMENT..
ALL C7N=4QETE COLORS TO!
PRIOR TO POLRNG WITH SAN
•INCLUDE PENETRATING SEALi
LANDSCAPE ARCFNTECT' MJ8'
CONCRETE i3Ell" POURED..
*ALL GRADING AND DRANAG
A SCORE JOINTS CGNTRACTOf
CONSULTATION WITH_LANDSCA
90 T14AT NO MORE. THAN 400
EXPANSION JOINTS - FVDVID
COMPOUND AND SANDED JOI .
OR COLUMNS OR WALLS.
= IRRIGATION 3LEEVWm TO AU
UNDER WALKWAY - SCHi_DULE.
(RECORD FIELD LOCATIONS)
PA PLANTING ATEA.
Tau ToP OF WALL
POB PONT OF BEGINNG
•STPLlC7URAL DES43N BY OTI-
*THIS PLAN 16 INTENDED TO F
'WATERFEATURE CONTRACTOl.
PRIOR TO CONSTR=, TION
#DIMENSIONS INDICATE C t"rr
UNIFOFM CURVE AS SHOUN_C
LAYOIJT$' PRIOR TO CONCRE
*CONTRACTOR TO COO}ipINA
IRRIGATION PLANS.
RATW M WfflarM
I . CANTERRA STONE VENEER F
3 1/2' THICK CONCRETE BASE