9604-077 (SFD)LICENSED -CONTRACTOR -DECL-ARATION-
I hereb,,t affirm under penalty of perjury that I am licensed under provisions of
Ct,vpter 9 (commencing with Section 7000) of Division 3 of the Business and
Professionals Co .M' y License is in full force andeffect.
License # LiL,ic..,1Claiss f Exp. Date
*n4cs.-I
vDate 7.21. 416ignature of. Contractpr. / /
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt fror�vt'he Contf`actols
License Law for the following reason:.// / "f
( ) I, as owner of the property, %f 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 � dam. MFy_workers' compensation insurance carrier 3&Npolicy no. are
Carrier 60 Policy No. I09V
(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 tat if I should become
subject to the workers' compensation provisions of Se lion,3700 of the Labor
Code, I shall forthwith comply with,1t __Se/proAs
Warning: Failure to secure Workers' Compensation cove a Is�7imlau�f��il+ancl
shall subject an employer to criminal penalties and civil fines up to $1 000, in
addition to the cost of compensation, damages as provided for in ection 3706
of the Labor Code, interest and
attorney's fees.
IMPORTANT Application isthereby made to the Director oyBuilding and Safety
for a permit subject to the conditions and restrictiorns 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 represe tives of this City to enter upon
the above-mentioned property for inspectio ur,pes.,
.Signature (Owner/Agenf) Date
BUILDINGPERMIT PERMIT# CONTROL#
3790
DATE 7129M VALUATION 3I147ftl# LOTTRACT
JOB SITE S1_4" A WAJUAI =
ADD Es
NERi
CONTRACTOR / DESIGNER /�ENGINEER
pHELDON R ZEMEN INC
tENDEL VENTURES
Y
fV P.O. BOX 450
9361 Y1CKM ST. SUM 30
LA ACA, 92253
SAN D1900 CA 92111
5"13(56
6195641366 CE" 839
USE OF PERMIT
W YLE FAMILY DWEL,l.IMJ
PERMIT 111*110113 3 120 LF (1N REAR AND SIDE YARD WALT. AND 7101.E OF POOL WALE.
FM1.4 MIRE. PO(X, PFAMFT W) IF ORTAIHI? I-EPERAMY
t
wAer "mm"now 1.87201 SF
P(Ntt'"ATIO 40.40 SF
0ARAGEA.'`ARK)RT 43001 SF
4 Fr, WA1-1. 70.00 LF
4 i'1' WALL 120.99 LF
W1'111111 ED CXMT OF C'C)1NNSITRt.1C1fJ() 1
I1:5,7'9ir.1s
PERMIT FEE SUMMARY
(Y ►N!1'1'tltu'1'tf►NFi?I� 1[!j-IMl�-�iR.-(11)(1 41,954►
111"U4 0111-x% Ila" 101-000-431-318 M, zr,
Hiji I:N j4 11'1' 42V1.00
hf{.0114ANK'Al. VEE 10141(10-421-000 Sia 54
1.(-rRN Al F'R' 101 4NN1-42(1-01111 $11767
PLUNMIN(.7#iI; 101 (W419-000 $166.00
3111W1 Mc)TI0N PUt - ItWStt) 101-U(t-241-ow S1111.59
r 1K At 10I N41 P FSE 1()14X00-42:1-01.11.1 sl!10.110
INVRA'CIVIk '11 IRF VII -V ►?5-(Mll!_441 V111 %?,476 71
1` 111,1 131" I'LiV4 101 000-4.11 -t15 s25 (K)
,%R't IN 111101,li' PLAI-1.S - I(li:Sit, A)1-t10U-2,iSAft s3y.d8
:'UtS ' X)TAt. ('CINSFRU('110N AND PLAN (102K
54,211.94)
( I.&'&S PRE -PMI's FEES
4250-00
L
'All,
i PFRMIT FEES DfIr NOW
JUL 2 9 1996
Ry
[RECEIPT
DATE��-_
BYI
DATE FINALED
INSPECTOR
INSPECTION RECORD
, OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
92M
Underground Ducts
Forms & FootingsIA.
Ducts
Slab Grade
Return Air
Ste4I
Combustion Air
Roof Deck
Exhaust Fans
OX 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
1A IJA Al
Drywall - Int. Lath
Final
Final
POOLS = SPAS
BLOCKWALIZAOPROVALS
Steel
Set Backs
j 1 .094
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
OX 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
Final
Utility Notice (Perm)
l�
r
OCT -22-96 07:34 PM TRANPORTATION FACIL 714 360 4196 P.01
URBINA & ASSOCIATES a370 anvil lake ave. san diaoor California 92119 4
PLANNING a ANCHIT CTUAN _... d
4
a
October 210 1996 a
a
Dear Skip,
The structural calculations for Plan 2-6M show that the loads
for seismic action on the structure are marginal for using ply-
wood on the exterior walls. This makes it acceptable to apply
the shear panels only at the full height walls and not over
doors or windows. Plywood may be omitted over doors and windows.
Hopefully this clarifies the situation. Please feel free to call
if you have any further questions.
ZS'nderelyvier Urbina
I
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