0210-307 (BLCK)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 it) iia - �- Signature of Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I amIexempt 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 STATE FUND Policy No. 1242Y24-02
(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 thos_e,provisions.
Date: 14 14-1 Applicant-----
Warning: Failure to secure Workers' Compensation coverage sunlaw ful 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 applicatlon and state that the above information is
correct. I agree to comply with all City, and State laws relating to the bullding
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for Inspectlon purposes...—
Signature (Owner/Agent)--"'} "� Date__.Z_/,1 10 lr /t
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 0210.107 TRACT
JOB SITE
ADDRESS 79-440 f".t3RPQZdAT : CkXr.RF_T)RTV9
APN
_ ..
OWNER
CONTRACTOR / DESIGNER / EN 1NEER
AVM PAUL
C} J. 137 J:-iEn
55.525 0-31.RRY MLLS
77.570 ffiRRMCIFTHTZIAINE, 3UIl M
1.,A fZi arfA CA 92253
PAiIn1.23U5`E; T CA 92213
01150}360.6632 CB11i 1394
USE OF PERMIT
CF)1AL Bi3'iI.DR40
90 IA? 6'6" BLOCK WAt.L PER DR*,'Z' 0141TAIL YOR TRASH ENCLOSURE
PBR +lPMWED PIAN
6 WT. WALE, 90,N) 11F
UTMINUD COST OF CON9111XYC' ON
2, WAYJ
PF'a12MT HM NU143MARY
O k4DTRU1.*:T10W FEY 103.000.418.0 0 S'�i.t30
ti
ONAND PLAN lupi LWK
*14.00
LF00 PRE -PAID FTS
Zoo
k°3+a FEES RITE NOW
$54.00
C� OF CIAEOEQr(. _
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RECEIPT
DATE
1
aY.
DA E LED
INSPECT R
L
..
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
BLOCKWALL APPROVALS
POOLS - SPAS
steel
Set -Becks `
Electric Bond
FootingsU
TZ
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final LvZ
Gas Piping
PLUMBING APPROVAL§
Gas Test
Electric Final
.Waste 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
Encapsulation
'Gas Piping
Gas Test
Applianc:s
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:
6-
4" THK. CONCRETE SLAB ,
3" - g•8, E 1 .3• r -
L - J
3° ELEVATION
„ m I_ 18" DIA, X 34" DEEP FTG.
I__
3 44 CONT.
6"X8"X16" CONCRETE -
BLOCK WALL
5/8" X 7" ANCHOR
BOLT TOP a BOTTOM
s4 BAR
2" X 4" X 1/4" STEEL F
FREESTANDING POSTS
1/4'X3' STEEL HINDE
WELD TO FRAME
1 1/2"X3"XI/4" STEEL
CHANNEL
11/2' CORR. METAL
DECKING GJ.
)ETAIL 'A'
\o
CURB
PLAN
8X8XI8" SPLIT -FACES
CONC. BLK. WALL
\/V viv
CONCRETE SLAB
_------- -----------------
2"X4" STL. TUBE. FREE-
STANDING COL'S. CURB
Q
'RECYCLING TRASH FACILITY
5'-0'
CITY OF LA QUINTA
13)AL))ING & SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
DATED' 30-�Z-BY ST
6"X8"XI6" CONCRETE
BLOCK WALL
b
Z6
NOTES:
o ATTACH GATES TO POSTS NS
MUST BE HUNG ON 4" FREE S'
c RECYCLING d TRASH CONTAINERS SH
WEATHERPROOF LDS PROMS SW
OENTFYING THE AREA AS "RECYCL
THE RECYCLING AREA IS SUFFICIENT
ACCOMODATE APPLICANTS ON SITE
4" CONC. WALKWAY
8" CURB =
I I
I I
I TRASH
IPAPER I I I
I
I I I I
I I ALUM I'GL
I
I I
I I ASS I
I
I I I
I I I I
— CONCRE
E SLAB
�FREE ST
4 X4" X 3/8"
GATES
TL. TUBE. FREE-
/ STANDING CO
.�
\/V viv
CONCRETE SLAB
_------- -----------------
2"X4" STL. TUBE. FREE-
STANDING COL'S. CURB
Q
'RECYCLING TRASH FACILITY
5'-0'
CITY OF LA QUINTA
13)AL))ING & SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
DATED' 30-�Z-BY ST
6"X8"XI6" CONCRETE
BLOCK WALL
b
Z6
NOTES:
o ATTACH GATES TO POSTS NS
MUST BE HUNG ON 4" FREE S'
c RECYCLING d TRASH CONTAINERS SH
WEATHERPROOF LDS PROMS SW
OENTFYING THE AREA AS "RECYCL
THE RECYCLING AREA IS SUFFICIENT
ACCOMODATE APPLICANTS ON SITE
4" CONC. WALKWAY