0302-085 (RPL)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 full force and effect.
License # Lic. Class / Exp. Date A
12 /V
f31 a
Date _olk I Signature of Cr
ontracto,.,('2"h,
Y
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.
fO4 --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 3Y'ATR.WUND Policy No. 32;- 09 1ri,374tl0
(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 thoserprovisions.
Date: J3 Applicant—
Warning:
J�.%jnN
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 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 1 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.
Signature'(Owner/Agent) f a �±` �'"'� Dateq,
-/r
BUILDING PERMIT PERMIT N
v� 4."'5
DATE�ALUAI'I�iJ LOT TRACT
JOB SITE I
ADDRESS :1015 AVdNXIA yARTIM
APN
OWNER
CONTRACTOR/DESIGNER/EN (NEER
"VaLZ M s2 k� ;f+�
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P.O. BOA P d34, -
4I w78%,) aM2: IT.l: G.T,'YA
;::.r".. Qt7: YCA C A 92253
13YA"M UTJA1)"WORS CA 92,201
(160)408.1528 CM0 3724
USE OF PERMIT
POOL, ONJ,Y..A.f A.N...M .Alt?R'iERS S4Ad. L 8E IN '!r'LAM .AT PRi PLI..A STT
FOOLANWORSPA ix
PLAN CHEIOX. RZ 101 -WO -43.9-318
CON:a`iTMCTItjP 10-F49 101-000-419-0m
ELECTRICA1, FRE. — POOL 101.000. 0.000 24UP
PLtMBINDr fAr.3' FOOL, 101-000-419-000 $47.00
IND
'50.20
? I&I'M EM. -FAM 11�IS
$0.00
MAW -6 NE 3YUK now
FEB 13 2003
CITY OF LA 6lUINTA
FINANCE DEPT.
RECEIPT(
DATE
j
BY
5,7
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATEINSPECTOR
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
Set Backs
steel
Electric Bond
POOLS - SPAS
,p a
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 Linds
Heater Final
'dater Piping
Plumbing Final
Isumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
"ver 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:
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IPOOIL EQUIP.
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—•—.PROPERTY
____
ADJACENT LOT t 9- i
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ABOVE SUBJECT PROPERTY i
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POOL 22'X 12'W/1 H.P.PUMP
----------------------J
MIN. 11
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AVENIDA MADERO
12 13 14 15 16 17 18 19 20 21 22
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a :CiNCRETdCONSTRUCTION DETAIL ................
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\---NEW 5' STUCCO
A.P.N.• 773-203'016
COVERED BLOCK WALLAi
c -�`' '+:z ADDRESS 75 52-QAVE
3 QUEEN PALM NIDA JUAREZ
15 GAL. OR EQUAL —�] � , x
MIN. 1 1/2" TRUNK WATER SERVI E _
LEGAL:
.. ., • ..:.. LOT # 5,
BLOCK # 6, UNIT # 1,
M3 18, PG. 46
URB j SANTA CARMELITA AT VALE, LA QU,�4TA
DATUM POINT Q
MID -POINT OF LOT DRIVEWAY APPROACH REQUIRES A �
SEPARATE PERMIT AND INSPECTION
FROM CITY OF LA QUINTA PUBLIC
WORKS DEPARTMENT
Y,
52-075 AVENIDA JUAREZ
7DATE
AR
HECKED i
In
SCALE
SITE PLAN
---------------------
--------------------ADJOINING
ADJOININGPROPERTY t9"
BELOW SUBJECT PROPERTY I
L-------------------------
---------------------/--'NEW
/--'NEW6' HIGH
WOOD FENCE I/ EXISTING 6' HIGH WOOD FENCE
.____•—
—•—.PROPERTY
____
LINE 50.0'
POOL 22'X 12'W/1 H.P.PUMP
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12 13 14 15 16 17 18 19 20 21 22
I
11 la
8 7 jai
\ 52-075
AVENIDA JUAREZ I
do, I a. r. - • • :.. ,, - t . ... " '. 'I — - — . w r... v 1� %^ I 1 %%j \.71.7 r �••••r"1�� V ............... • ....
a :CiNCRETdCONSTRUCTION DETAIL ................
1 i
DIv�vva- .......... D-1
L)�� �,� �• �• ,�` ELECTRICAL/MECHANICAL
bdLi -
m
W O, • • NEW HIGH BROWN
BLOCK
t
T-6" GATE .. ;
• r PROPANE TANK
A r • «. PV4NTINGS TO SCREEN
PR r
ERTY LINEOPANETANK
50.0
\---NEW 5' STUCCO
A.P.N.• 773-203'016
COVERED BLOCK WALLAi
c -�`' '+:z ADDRESS 75 52-QAVE
3 QUEEN PALM NIDA JUAREZ
15 GAL. OR EQUAL —�] � , x
MIN. 1 1/2" TRUNK WATER SERVI E _
LEGAL:
.. ., • ..:.. LOT # 5,
BLOCK # 6, UNIT # 1,
M3 18, PG. 46
URB j SANTA CARMELITA AT VALE, LA QU,�4TA
DATUM POINT Q
MID -POINT OF LOT DRIVEWAY APPROACH REQUIRES A �
SEPARATE PERMIT AND INSPECTION
FROM CITY OF LA QUINTA PUBLIC
WORKS DEPARTMENT
Y,
52-075 AVENIDA JUAREZ
7DATE
AR
HECKED i
In
SCALE
SITE PLAN