0205-130 (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
714,198 a .'101.3W0
Date • ' f 7 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.
S( I have and will maintain workers' compensation insurance, as required by
ection 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 t : .i' . Kjbg) Policy No. 1684021.02
(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 those, provisions:)
Date: 4-- cam - ,. Applicant '""► : # �. �: ,. �e '!'_ �.
i� v ,
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, indemnity
& 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 1.80 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 propertyfor inspection purposes.
Signature (Owner/Agent) ` 014 W. r 1I Date �5 -'/ 1 —1,V—
BUILDING PERMIT PERMIT#
-�-�`'�•-may
0216' 30
DATE VALUATION LOT TRACT
JOB SITEAPN
ADDRESS 1y19 -W .li}_��RIPWI71v�e�,q� fI1ENUM WAV
.,. .. -
OWNER
CONTRACTOR I'NyE�E+R
•
a��N PqIyY("_4001W Flu, C10gvL'NI'lyPs
CNKFtTREVAMMUTy�jjtr9Qq"p�MgM
1515 M qM S6.R.F.Y.A6 SdTa #200
ro/�DESIGNER
1pEyNp�5Myy
:Pw�' RiCJ4 8_P~. R dl• +SY A � l.Y+� •rd. tT4idA� '
&M RIMNARDINO CA 92409
SAN BER ARDWO CA V2400
(909)381-0007 031.�-y, Mo
USE OF PERMIT
150 LF 2V RL's;'ADMI* WALY.((."C')UR"PESY 1NSYk-CF4CVb0+ 20 U Soh T .
!MLA0 V0NVl LL QAMS'41.-43) Fft CRY STANDAM) & PA) AWR O .T7► ,
41M WALL, 20,00 LF
hdj�-1� :y � ltill�
CITY®FLAQUINTA
FINANCEUEPT.
• n
Ww
W PRE-11AH) FREIR
$0,00
I OTAL PURMf MRS DUR NOW
u�ra�4�a
..EGD
RECEIPT
DATE
BY
ATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION DATE INSPECTOR
BUILDING APPROVALS
Set Backs
Forms & Footings
Slab Grade
Steel
Roof Deck
O.K. to Wrap
Framing
Insulation
Fireplace P.L.
Fireplace T.O.
Party Wail Insulation
Party Wall Firewall
Exterior Lath
unwind _ Int I ath
Final
BLOCKWALL APPROVALS
Set Backs
Footings
Bond Beam
PLUMBING APPROVALS
Water Piping
Plumbing Top Out
Shower Pans
Sewer Lateral
Sewer Connection
Gas Piping
Gas Test
Appliances
Utility Notice (Gas)
ELECTRICAL APPROVALS
TemD. Power Pole
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Tema. Use of Power
Final
Utility Notice
OPERATION DATE INSPECTOR
MECHANICAL APPROVALS
Underground Ducts
Ducts
Return Air
Combustion Air
Exhaust Fans
F.A.U.
Compressor
Vents
Grills
Fans 8 Controls
Final
POOLS - SPAS
Steel
Electric Bond
Main Drain
Approval to Cover
Equipment Location
Underground Electric
Underground PI . Test
Gas Piping
Gas Test
Electric Final
Heater Final
Plumbing Final
Equipment Enclosure
O.K. for Finish Plaster
Pool Cover
COMMENTS:
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- PAD I
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(b G. F, of '
50.93 -
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t 51.50 � -
r TW 55.00 3;1
TF 50.33 FG- - 143.40'
TW 66.93 { 71.22' TW
TF
TF 60.23 I ( T
I TW 58.13
72.19'
TW 61.01 TF 50.76 TW'
TW 67.06 TF 50.33 TW 61.01 TF
'2.19' -
TF 56.33 o TF 52.33
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10� ' PAD 55.8 TW 61.00
T 58.80TF 52.33 I� I TW 58.13 53.2E
FF 56.30 TW 61.00 TF 50.76 __-, FS
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131 i GB -FL (� �3 fro GB -18 ,1
. 58.07 �o to c�
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56.62 55.45 0 54. 9 53.61 3'4' Q T /•r✓%��52.38 51.80 51.23
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END ENCS 13p Ll�G & SAFETY D PT. 52.22
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A ROVED BY COMMUNITY DEVELOP-PARTNIEi' i
ti 1 BY DATE 3
DATE S /.3'oZ BY EXHIBIT
CASE NO. '-4(4`2-
CITY OF LA QUINTA
Fs I SUILDIwG FEN DEPT.
46.76 45.96 SIDEWALK 44.23 .16
74- APPR0VED
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4.68%
0.50%
44.16 43.93
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46.76 44.87
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77.00' TF 46.73
TF 44.22
53.40
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$$9.39°�TW
46.73
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51.90
1
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PJ -\D 4810
46,5
T R AC -T N; 2 4 4 -7 '3
APPROVED BY COMMUNITY DEVELOPMENT DEPARTMEN+
I J 22 -
BYGAb C-;2GVVNtX DATE '5112>122 -
EXHIBIT
EXHIBIT
F
T-;4 /N, N 4ASE WA c - t.- & -4la-1
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T�214cT Al 241a7- 3
10 L. F. of 3' 4" '/ZIT. writ Lc_
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56.38 54.88 1 52.24
2 �- 56.9 56 C 9 I GB- TC TC 3.83 TC
i 6.9356.01 0 55.02 54.171
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57.61 11.81' 6.35 60. 2' &ZJ�7.93
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59.521 56.50 I 55.63
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60.76 UI� I TW 65.00 42 �� �I TW 61.01 FS
FS u� TF 56.33 0 lq TF 54.31
s" STEPPED �? 10, PLAN 5XA 7 .012.0-
OI20' 43
GARAGE CLASSICS PLAN 5XE
41 11413-
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:LASSICS
FL FL I FF 55.80
10 0' QQ
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F 60.80 FL 0.5% FL 1 ' 54.75
1 FL
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-
FL -(BY HERS) -
HP -FL N 5 o TW 6 .5% 55.
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TW 65.70 3:1 TW 62.35 3:1
72.00' 3:1 TF 59.67 72.00' TF 52.98 80.54L
�S89'39'40"W TW 67.86
�\:Tw 65.18 382.36' rW 65.18 rw 62.50
TF 61.16 TF 59.15 TF 59.15 TF 56.47
PAE)
APPROVED BY COMMUNITY DEVELOPMENTD PART NiEN 1
Bl(�SGUATA- DATE 'gl
EXHIBIT L
CASE NO. �I �t �1�� (eZb WaA
�r Al 214 117-3 '4-0 _r 5 .3� �3� �''���
70
C f of 2 S 1, rz_TA�A.11N4 wjlL�L
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2- r rZcr woo 1
PAD 61.3 �,,i 60.20 Tw
TF .
S/ T F S % S3 TW 66. 3 '
TF 60.
N85'31'360PE163.19- 72.9 - TW 67.06
-T- - - TF 56.33
WALL
r TW 65.00 (BY OTHERS)
TF 59.00 �_ TW 63.73
TF 55.67
0.5% r
PROP. 2'=$"_ I 55
-� - - (BY OTHE S)
0 59.66
FL
to
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37 � � 1 PRoP. 20.5��. M.oaL b o
58. T w sq. 5-3 0 57.601 1.
PLAN 2A 1� HP- L tF S7. S3 FL 1' 55.50
0
HP -FL
CLASSICS3` 1 TF 63 .67 "� 1
PAD 60.3 36 1
FF 60.80 I PLAN 3A(R) 1 'o
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60.76 I } TW 65.00 TF 57.00 N
FS ' 3: M F .69.89 PAD 58.3
06 51; 15 0' m FF 58.80 10`
ITW 63.70 -
FS 60.30 TF 56.96 3IM j 58S TW 61.05
! 59.39 �!'O I FS 57.41 1 TF 54.35
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to
46 00
34.3 0 rn
58.72
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TC FG 25.0'
58.17 29 32 28.09' 11
8' FS
58.03 7512S�)7TC F56.62 55.45 0
3.30. FG FG r
o� 57.41 12.4' 56.38 55.31
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APPR VEC BY COMMUNITY C➢EV�LOPNfiEN7 D�� - n Ln
EPfi.
;4 Rn BY 83�, SnATE P R V E D
EXHIBIT""�11.. FOR CONSTRUCTION
CASE NO. ��� " IG�tI WAIIJ __
I
5.00 51.50
0_33 FG_
72.19
N
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0
0.5%
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35
PLAN 5C
CLASSICS
PAD 55.8
FF 56.30
56.26
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