0305-193 (MISC)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 '
Date le 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).
( ) 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 issued. My workers' compensation insurance carrier & policy _ no. are:
Carrier `j.,, 1i`Cit�'S Policy No. MEWS
(This section need not be completed if the permit valuation is for $100.00 or less).
(
'J'*] 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 those provisions.+
Date'"'ll •„ ' Applicant-
07
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 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'puroses. j
',Signature (Owner/Agent) ` `-%L+ _V -!, Dates /, " ,� �r
` PERM'T#
BUILDING PERMIT,".
0305-193
�
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DAT% � � � VALUATION LOT TRACT
4i f l .Aa Y l�
JOB SITE
APN
ADDRESS . —720 XP1?t, NAVAN _0 .
OWNER
CONTRACTOR / DESIGNER / EN &NEER
-
u �` �44;O����l!iiAACA,.
�, ,� �.>�
8 1 AV WIL`s.% 0
aA tie a
�q��-900
DA,. "qq
2 0
M,)r 7x -2S
USE OF PERMIT
ST7tt!CTURAL,WAiF;:•:N.Sa"•AI,1., IRoll 4UPPC`R7 F0 R.
tdilHRH, ,0i4K1 Pi:rA,TEAT 900TH WALL O �,/l::P,:�i FIR 6VEY- `0,Oki PE'R
'w�LUATIOR 260.00 LO
. . � �,1j A11111ji 1b'fi KI' Q. 1-lr C011MM'UC`,1MA _I
24W.06
CC►13S1^I1.UC`,iION AM 101.= 1WAHt-000 $1.5;
'JUN ' 16 2003,-
C11 Y, v" F LA QUINTA
` FIPJAN.CE dEPT.
1:{J,7" .l' •✓S.P.i"S;.n Ci A,/.E•tls7 LA;; Lrt A ?'iJCY i>� iJ A'A..AN:VI:fide�31Y,11_.
CI t1
• s% TOTAL ..E' i'w.ili�!•Y �•.C+ i'`.UHS I'My., JN70v'1{
RECEIPT
DATEf�I !',1r
BY 'tDATE
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
OX to Wrap
F.A.U.
Framing
Compressor
Insulatior?
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
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
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
'Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.FJ.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
'
�-
A
X
Bi'' # �
I�
Ci of La '
City Quinta
Building a Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Petmit #
D3o5 ��3
Project Address: 3 _�20Ave NWoepto
0%%-ner's Name: lCqWD S Gl '
A. P. Number:
Address: 53 -110AV15 fA2Ro
Legal Description:
Contractor: 0ZQcS
City. ST. Zip: LAIII
V CA C{'M 5 3
FTelephone: _
Address:
1XPrcject Description:
City. ST. Zip: ~
G s Aa�ta�, t.A
Telephone:
AI -t- 9E VA-s5e-
State Lic. # :
Cin• Lic. #:
Arch.. Engr.. Designer:
Address:
City. ST. Zip:
Telephone:
State Lic. #:
Name of Contact Person: Ate)(
Construction Type: Otccupancy:
Project type (circle one): New Add'a Alter Repair Demo
Sq. Ft.: # Stories: s;
Telephone # of Contact Person:
FEstimated Value of Project: -Z,99 71
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
lQ
Item
Amount
Structural Calcs.
Reviewed. ready for corrections
Plan Check Deposit
Truss talcs.
Called Contact Person
Plan Check Balance
Energy Calcs.
Plans Oicked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2nd Review. ready for correction /issu
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
SAI.1.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'" Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
Pub. Wks. Appr
Date of permit issue
School Fees
A
Total Permit Fees
54
4
-tea
Building & Safety Department
OF Tt�9 78-495 Calle Tampico
PO Box 1504
La Quinta, CA 92253
(760) 777-7012 voice — (760) 777-7011 fax
To: Bronz Young
From: Greg Butler
Re: Repair to Support Overhanging Bottom Plate
P/C#: 0305-1.93 / 53-720 Avenida Navarro
Date: May 21, 2003
Bronz,
Here is the proposed fix for that bottom plate problem we discussed on the
telephone a couple of weeks ago. It is the house where from a reentrant corner
to an exterior corner, over a distance of approximately 25 feet, the bcttom plate_
of this loadbearing wall overhangs the slab edge from 0" to 2".
Is.the enclosed design an appropriate fix?
Thanks,