0307-176 (RPL)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
I- Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
N W Professionals Code, and my License is in full force and effect.
O =) ch License # Lic. Class Exp. Date
w 6.44x'81 B `t 1!3 i /tit
Z r- Date Signature of Contractor 1�
0
r- 1-C> OWNER -BUILDER DECLARATION
W W 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
LO
N Date Signature of Owner
ON
0)
Q WORKER'S COMPENSATION DECLARATION
C) CL
2 Z I hereby affirm under penalty of perjury one of the following declarations:
U-) O () 1 have and will maintain a certificate of consent to self -insure for workers'
X W �= 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.
C13 Q C) (}) I have and will maintain workers' compensation insurance, as required by
O U Q Section 3700 of the Labor Code, for the performance of the work for which this
rn F- permit is issued. My workers' compensation insurance carrier & policy no. are:
19t Z Carrier $'1'A 'M F':, lf) Policy No.
co D
r` p
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
workers' compensation laws of California, and agree that if I should become
3 subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions.
wr Daie: ADDlicant
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 purposes.
,Signature (Owner/Agent) Date
PERMIT #
PERMIT
.BUILDING 0307-i =6
DATE VALUATION `Spt#0,(19 LOT TRACT
JOB SITE
ADDRESS 77-530 CALLR CHTL1.Off
,
APN
OWNER
CONTRACTOR / DESIGNER / ENGINEER
C0k0N UL h9MR11R!3F,,V
C -.,;, 3 TEL
ro 1= 389
51-105 AVn-0.61/11 LA 010 t
LA.Qtmm CA 92213
LA QUINi1. CA 92252
(76(S)%A-4 IMLP . 161
USE OF PERMIT
P001,1XVoR DA
Y VUIJ i3f .I?. .ta.Y.t ,i�Cil.M kltt t.r �Al�11.Y •y%.1 t1rirL ltt.• . i•. vftwlu: A� k 1 A..1', Y
11ISi KC'rYL'�N. EQIStPMKI�tE' �tdCi�t�5itFtY,N��'P tar�l�t;l..�c,
POOL AND)OR SPA 0,0(10.00 W
M ]CMAT: D (:nPU OF C(?R'S'n?TJC'1:S0N'
PLAN CHECK P`'E 101.000.4:99.313
COR.T rt+;tic:1IGH utPIE 101 -OW -419-004 oafI M
MKS}�CIHAWWALs�tPH--Pwt.'O1 X7.41.0 SS0 K.
�,1
1 /000 �1{1/1,00
1t
PLVMi`0401'K1; --POOL '0 f -000.419.000 't7: 00
�v
1
Y 41
%J
"'JIBf0f.A1: C� +td8!'F t 0FiC tT.f'NI lx',.AN r.JLR.CI
Y.tEM r'1 E-1;AW 1' ; l 41)
4 a. (yJ
nA
'CO':TAL P1";.P.1 W 1EK8 AUS, NOW
SEP Mj),EPT.
CITY OF
F111bg04
RECEIPT
DATE
BY
DATE FINAL
INSPECTOR
U -1
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 Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
Steel
POOLS - SPAS
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
r;
Equipment Location
`Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
f
Gas Test
Electric Final
1Vaste 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
Encapsulation1,7
—07, p Y Ar -
Gas Piping
Gas Test
Appliances
Final
- C/
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:
_
* C)ATUI 1*0tNT
POOL 21'X 12' W/ 1 H.P.PUMP SPA W/ HEATER
CALLE CHILLON
mWord
ffmAim mfl�i
20'-V
5'BLOCKWALL
ill
WN
F INDEX
m
1
51TE PLAN
CAN
GENERAL NOTE5
2
FOUNDATION PLAN
FLOOR PLAN
.4
ELEVATION5
�
&ECTION5
(o
ROOF PLAN
ROOF FRAMING PLAN
TITLE-24 REQUIREMENTS
ELECTRICAL PLAN
10
MM5E HANICAL PLAN
GEN
OWNER:
CORONEL ENT.
P.O. BOX 389
LA. QUINTA, CA.92253
564.-4604
LEGAL DESCRIPTION:
LOT NO, 12
A.PN,: 114-161-024
PROJECT ADDRESS:
11-530 CALLS CHILLON
LA QUINTAI CA 92253
ZONE: r
R.C.
OCCUPANCY:
6INGLE FAMILY
TYPE V NON -RATED
AREA TAE3UL AT I ON5
fRE5C)ENG;F=
1,514 &CPT.
GARAGE
53(o 60PT.
TOTAL STRUCTURE
2,22(o 50.FT.
TOTAL 51TE
4,V4 5aFT,
TOTAL LOT COVERAGE 45.3%
CALLS ARROBA
uj
_j
CALLS CHILLON
r r-
mA
,SHEET