0206-173 (RPL)iol
"}' = ,LICENSED CONTRACTOR DECLARATION
.
I hereby affirm under penalty of perjury that I am licensed under provisions of "
H Chapter 9 (commencing with Section 7000) of Division 3 of the Business and i.
N W Professionals -code, and my License is in full force and effect.
=) M License # ,� Lic. Class --^—Exp. Date
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Z r-- /Dater" L ®-Signature of Contractor
5 2.
J H t OWNER-BUILDE,R;DECLARATIOW
.0 W �_ I hereby affirm under penalty of perjury thatxl"am exempt from the Contractor's
License Law for the following reason: �`�. �/'�
Z_ ( ) l,, as owner of the property, o,my mployees with -wages as their sole
compensation, will do the work, and the structure is not intended or offered f 11, or
sale (Sec. 7044, Business & Professionals Code).
( ) I, as owner,ofAhe property, am exclusively contracting with licensed
contractors to coristruct the project (Sec. 7044, Business &, Professionals
Code). . i=• I
" ( ) I am exempt under Section " B&P.C. for this reason
LO
N Date Signature of Owner
O .N -
U Q , �• WORKER'S COMPENSATION DECLARATION
2 z I hereby -affirm affirm under penalty of perjury one of the following declarations:
D M Y, P Y P l Y 9
O () 1 have and will maintain a certificate of consent to self -insure for workers'
< LI compensation, as provided for by Section 3700 of the Labor Code, for the
�
Q performance of the work; for which this permit is issued.
0 Q U (� I.have and will maintain workers' compensation insurance, as required by
Q Stiction 3700 of the Labor Code, for the performance -of the work for which this
H permit is'issued. My workers' compensation insurance carrier & policy no. are:.
"'t. Z Carrier STATE, FUND �x�' Policy No. 04020009691
(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>.Ca IIII fornia, and,,agree that if I should become
subject to the workers';compensation provisions of Section -3700 of]the Labor
Code. I,shalkforthwith comDly with tthose•d`rovisions.r°r
Warning: Failure to secure Workers�'C6rnpensation coverage is unlawful and
shall subject an employer to crinii a pennalties and civil fines up to $100,000, 1n • -
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 her"eby made to the Director of Building and Safety
for a permit subject,ct6' the: conditions arid- 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 underor 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 arid employees.
2. Any permitissued 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 -a d 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 epresentatives„ of,this City -to upon
the above-mentioned property inspection,pu`•P1 1poses,
Signature (Owner/Agent) 'I �° - %�Date,.-• - ,� �
BUILDING, PERMIT PERMIT#
iD�.6-11 i
`DATE '� ter VALUATION -krs.. S LOT`7• ^`% TRACT
JOB SITE. ,p,�� q�R� 1
ADDRESS `.'RS2.: 40 A'�d�./.�.Iyi A �. u�k� C01)
APN
OWNER F, ;
CONTRACTOR / DESIGNER / EN (NEER
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3', x C.�'I,z'I�y.�tt. cogi�.n-Wi :lom
1860 CHICAGO AYF_ M)= ?' 1
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RIV'L'`�IS't'C.'iE A 2SU7
MOT 'AM COT1,`'�• ,' CA 91561
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(')61)349.9825 ,; asul ?355
USE OF PERMIT y"
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POOL AND104 SPS 1 �z4A1}.04 'F iii
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1 PI A14 MCK FEE 101-000-439-3)?"
rrc rs'rRcrcNi rraNYlf: . . 101-000-418-00W ✓,.' 1 $117.0¢
ME.O..•1.A!,MICAlL rw% . - 1�00L ; ° ^: 101-;Qi}4s$F
ELEEIR1CaAL AFE .. Pbd : � r . • 101-K1 -WO-420-000
,_...••-P1At1MoIHG FK ..POOL . , ;J01 -M.419.000 � , 'r? ti-. :7.00
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-FINANCE
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$289-05
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR w':
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 8 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 Z
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
PLUMBING APPROVALS
Gas Pipin
GasTes
Electric RM
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 ,
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.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
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COMBO WALL t2'-0" RETAINING WALL
W/ NEW 6' HIGH BROWN BLOCK'
WALL ON TOP /---PROPERTY LINE 60.0'
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23' 6"`'. .'i .
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WATER
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SET BACK
CHIMNEY
SEVILLE PLAN
F.F.:1'-0" ABOVE THE CURB
PAD: 0'-6" ABOVE CURB MEASURED @
CENTER OF LOT @ AVENIDA VELASCO
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Z A.P.N.: 773-295-004 +
J l' NEW 5' STUCCO
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SLAB ADDRESS: 52-540 AVENIDA VELASCO COVERED BLOCK WALL
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LEGAL: LIT 0 21 , UNIT N 16 , BLOCK 150, MB 18, PG.99 \1 �
TA CARMELITA
SANAT VALE LA IUINTA
3-6" GATE
—PR dPERTY LINE 60.0'
\---NEW 5' STUCCO —�
COVERED BLOCK WALL
URB
AVENIDA VELASCO
NEW 4' HIGH
BLOCK WALL
PLANTINGS TO SCREEN
PROPANE TANK
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CITY OF LA QUINTA' • .
BUILDING & SAFETY Dom• -
APPROVED•
FOR CONSTRUGTIOW
t)A S7
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LENCII DESIGN GROUP
P.O. BOX 450
LA QUINTA, CA 92253
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ARCIIITECTURE @ CONSMUC17ON
LANS PREPARED RV:
Lr DEL VEN'T'URES, INC.
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L NCH DESIG ROUP
A.P. LEN
PRE ENT
SHEET # 1
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URB
AVENIDA VELASCO
NEW 4' HIGH
BLOCK WALL
PLANTINGS TO SCREEN
PROPANE TANK
i
CITY OF LA QUINTA' • .
BUILDING & SAFETY Dom• -
APPROVED•
FOR CONSTRUGTIOW
t)A S7
cce
LENCII DESIGN GROUP
P.O. BOX 450
LA QUINTA, CA 92253
rnor+u aen eua�ae +wo0ao xua�
ARCIIITECTURE @ CONSMUC17ON
LANS PREPARED RV:
Lr DEL VEN'T'URES, INC.
dba
L NCH DESIG ROUP
A.P. LEN
PRE ENT
SHEET # 1
2 SECTION
SCALE: NONE
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LENCH DESIGN GROUP f
P.O. BOX 1.50 4
rLA QUINTA, G1 42253
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ARCHUECI'11RE & CONSTRUCTION
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LENCH DESIGN GROUP f
P.O. BOX 1.50 4
rLA QUINTA, G1 42253
PllorlEi lid sN-It4G fAY,IIEq if SAl
ARCHUECI'11RE & CONSTRUCTION