0403-034 (RPL)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
F- Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
C14 UJ Professionals Code, and my License is in full force and effect.
C =) ch License # Lic. Class Exp. Date
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b�:1:18 F5 Y'�G ala 1!{u�1
Z Date r Signature of Contractor l
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(D 0.
J U CD
(D OWNER -BUILDER DECLARATION
LU LU I hereby affirm under penalty of perjury that.1 am exempt from the Contractor's
CL
0 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 isnot 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).
C'r)() I am exempt under Section B&P.C. for this reason'
O N Date - ' �' ' Signature of Owner
0)0- Q WORKER'S COMPENSATION DECLARATION
p Ir I hereby affirm under penalty of perjury one of the following declarations:
U-) H O () 1 have and will maintain a certificate of consent to self -insure for workers'
X W LL compensation,. As provided for by Section 3700 of the Labor Code, for the
mJ Q performance of the work for which this permit is issued.
Q L)(, ,)' 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
d H permit is issued. My workers' compensation insurance carrier & policy no. are:
It Z Carver STATF' t C�^�f1' Policy No. 7 9170 4t
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C3
g (This section need not be completed if the permit valuation is for $100.00 or less).
O I certify that.in the performance.of.the work for which this permit is issued,
I shall not employ any person in'any mariner 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
3 Code, I shall forthwith comply with those provisions: f�
Dd e-: " Applicant�--
r
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.
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 p a 'ses./
.Signature (Owner/Agent) fr2 �`. r - /r Date �~
,BUILDING PERMIT PERMIT#
DATE VALUATION LOT 0410a-0351 TRACT
f $6,141.(Ki
JOB SITE
APN
ADDRESS C'.•oj.y'P"a�a
OWNER
CONTRACTOR / DESIGNER / ENGINEER
PA(D.:i&N LVANS b.2I(A N ING.
PAUTJ�T':N RVAN'S, ilES-11 :1?'i INC.
Roz Dox, 62 i
F-0, BOX 621
iu J vF LID11 C.i. J .i fi)
3�t�iL•"1'tFM_r. CA 9i3 r) y
(760)831.-2000 CEAS 162/46
USE OF PERMIT
POOL, ViA'0rCr.1'MATURI? 91.�M�%Ii.�RRiL'RS��ilSi.,Ltils'tA! J'f.,A+:E.ri7
Ni, Pfrl� 11 f? i4a:I��C:'iiC�hf. I;;Qt)ff'hflsNT iAMUDED
1/�iL[J �1'lt?1M Od4?,00'„2
1r1,17T MATED C olliT OF C"t5.l S RTM.110H
61141 -00
PLAN CHECK REE 1-01 -60CU-439.31$ $ 1e.Sii
CONST IRUCTiON FEE i r11 _000-4 6 _000 $90.60
MECi-1#+,' AGAL FEE -- P-'3t7L 101.000 421-000 $24.013
ELECTRICAL POOL ) 01-000-420-000
PLW411Pt10 ffR -- F10011 1 C11 oCtrlC �►�t!t1I3 /1 $ `�
0 3
MAR 2004
CITY OF LA QUIN.TA
FINANCE DEPT.
3TYP-'1(Yf..AL COR T.VOTl0M ARD PT../'R 0-1-M.M
VA4.50
LESS PRE -FI AID YJOY,S
M010
TOTAL 11.E]3_V�fY .FT ��" DUIL 14 OW
$241—S0
RECEIPT
DATE
BY
DA FINAL D
�e
INSPE
OPERATION
DATE
INSPECTOR
OPERATION
DATE
• INSPECTOR
BWLDINO 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 Wali Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
POOLS _ SPA►S
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
Neater 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
UU14 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:
i
GROUND COVER
Ir "PALM- *SPRINGS GOLD",
OR EQUAL
MAIN LINE
PLANTING TO ' SCREEN
PROPANE TANK
1 •
` SEWER UNE PROPANE TANK
SLOPE• 1/4"
■r.� ■■ w■w� w■ �w�•■ w,■w.wdft .+ww■ ■A www• A. �•.i.■
POOL.
EQUIPMENT
QUEM PALM 15 GAL 01
EQUAL MIN, 1 1/2" TRUNK
1.0'—Otl L ADJACENT LOT �' + 1'•—f�'
HIGH CONC. BLOCK WADI. ABOVE SUBJECT PROPERLY
O�
' 20' 0" ON 3 SI ES
70 —on
. -• •. ...:,_,_„ �f 100.0' PROPERTY
w■w�rr+w.ww�.wwr w L.1�11 LINE
.. }'� _ ' - r �� w■ w �y �r w w■rra■ r � ��ra■ w w wrww ir. r �■■ w.w
A 1% MIN SLOPE
Ell
LINE
.. 1 9FDlROOy 3
e"0001 t
1XNINQ
wONC.
_ •r•+ww•rww■www■
1�Ay J +•+wmrww
1 ffllii /•
�.-
Vol
Oro
--0" HIGH GATE
1 \ • • \ • 4� Nom. • • t • � . � ♦ 1Ium
1►. r i,J1 a t • • . • • • �r .• j ••
,75
• _ f
Y • ,•, ,....•,.10"i- II p� i x1.25
%% yl • `�. / • ` ' 111,, ;'! -L..'. •� • • -/Y .041Or
53• �bf AVE - cmtwAg
BEDROOM 2
RAIN
� :I► ; = �'t�t .� r ♦ �t.?.U'.M`a. .+e•,..�a•.r ��. �-1`�i.z� ♦ t �� � w i��» may• y;+ � �� :� �,�\
I . . , I . . . .� T T
PROPERLY 1.NE 80:04'
20'-0 "
ww • r.
H ••
CONC. STEPS 0 GRADE
EXISTING CONC. CURBMASONRY WALE.
• ur�R . � ' ooTN SIDES COLOR o PLOT PIAN
GROUND* .COVER MATCH HOUSE STUCCO TYP 'SEE DET sm 1/f'o1'-0
0 YARD "PALM SPRINGS GOLD"
.,.YARD
.
OR :EQUAL
L1k4_;_.0
101oF00�
Ta.! ►H�l
,.OS F
o
NC.
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