9812-089 (GRES)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
H' Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
04 W Professionals Code, and my License is in full force and effect.
O =) ch License # Lic. Class Exp. Date
w ��337 Ci 313V00
o Z r` Date - ( Signature of Cont actor—
(O 0 r'�
J U C:) OWNER -BUILDER DECLARATION
HLU r` I hereby affirm under penalty of perjury that I am exempt from the Contractor's
U) License Law for the following reason:
Z ( ) 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).
C0 () I am exempt under Section , B&P.C. for this reason
O N Date Signature of Owner
rn
WORKER'S COMPENSATION DECLARATION
CL
C) 2 Z I hereby affirm under penalty of perjury one of the following declarations:
U-) F2 O () 1 have and will maintain a certificate of consent to self -insure for workers'
X W L= compensation, as provided for by Section 3700 of the Labor Code, for the
O J Q performance of the work for which this permit is issued.
m Q U ( ) I have and will maintain workers' compensation insurance, as required by
O V'Q Section 3700 of the Labor Code, for the performance of the work for which this
Il � Z permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
0o0 t.• , , FUND
+t
J
(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
work ergcompensation 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 provisions.
Pate: Applicant
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 pursuanhto
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.
Signa ure (Owner/Agent) Date
BUILDING PERMIT PERMIT#
DATE �{yy VALUATION S,Z0,000.041 LOT TRACT
JOB SITE
ADDRESS 49-220 AV�Lt� 101 EL N1 1DO APN ,
OWNER
10E S'IIMMTit,i
49-220 AVENWA E1, NIDO
LA QUINTA.
USE OF PERMIT
6214 R R.AL "R -1 i1LL i-90
CONTRACTOR/DESIGNER/ENGINEER
K.EINN tiff 1V[MER
42-353 WASHIN� YM4 ST. STE. F H384
CA 92253 PALM DESERT CA 92260
,160)772-t)U46 Citi.,# 2371
ADD 160 S.F. pO EXIST:i O CRtRPaR i', t" ONVT3C INTO C;AitNCH A;l13
iN01) EN11RY t't'JEMM
0
iV.>>1..`v.M1ON
24,001.00 L3
,�ra ; �� �03T Oji, ga r;8712 .�r. ��IO�c ;). . o
KkN4..1. a FER, SUIM MARY
V%AN CHECK FEE •iu.t-(!(3t3 1139�31.1t $��f.E�
t t1N.Tr;3,1X,'PK)N;. M^;i-#etif)-Qi-lt(nn1YC9 4)0Q
i; I,eS'C'�'_CiIOUIIE 101-Mii-420. n0t1V
Si,W -000241-Ow
6�
,`I.f7d`F.�'A:t.
C,;t'1fS"1`jti,K"("$Z IN A) Pt„t�)v* t'tT;CieEi4
55
`
LESS Vf-P,,V`J€EES
$0.09
� 1998
`l'cA'1'AA.
P ,14MIT Ar.R±:UIS lMl+;N(AV
$369.55
pE� 1
RECEIPT ''4
DATE
BY
!
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs I de Z
Underground Ducts
Forms & Footings
Ducts
Slab Grade A>
Return Air
Steel aCombustion
Air
Roof Deck
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Griffis
Fireplace T.O.
Fans & Controls
Party Wali Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final t4 16
BLOCKWALL AP ROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. 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 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.-
.F.I:Smoke Detectors
Smoke
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
Alcumbrac P.O. Bax 473 - Thousand Palms, CA 92276
_101 Architects Phone (760) 343-0048 fax (760) 343-3637
DESIGN CRITERIA
Uniform Building Code, 1994 ed. and U.B.C. book of Stds. The lateral load minimum
requirements of V=ZICW/R as defined by section 2312 and Lateral Force Commentary,
Seismology Committee of S.E.A.O.C. asic life safety design criteria and not specific
property protection
GENERAL
Any discrepancy or changes between these calculations and the actual construction site
conditions or drawings shall be brought to the immediate attention of the Architect for
clarification.
These calculations shall not be altered or reproduced without the express permission and
knowledge of the above Architect .
SPECIFIC STRUCTURAL SYSTEMS
Specific structural components such as Trusses, Pre -cast concrete, Truss joist, and other.
product materials or systems shall be engineered and submitted to the Owner and
Government Agencies for approval by the Product Manufacturer.
Product approvals and engineering are the exclusive responsibility of the Manufacturer.
Shop drawings shall be submitted and approved by the Owner. or Contractor for the
specific product used.
ARCHITECT'S STAMP , Robes S
These calculations shall be Allcumbrac
stamped, signed and dated Na C'
with an original wet ink signature `'
by the above Architect to be ,off
considered valid and complete.