0310-291 (RPL)_ 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'Licemse is in full force and effect.
License # Lic. Class/1//Exp. Date
805577 A MC
Date ��- ( Signature of Contractor 4 V "
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).
( ' ) - 1, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
( ) ,1 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 MEMPT Policy No.
(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 provis ons of Section 3700 of the Labor
Code, I shall forthwith comply with�hos , ro isions.
Date: Applicant
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation;'damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions. set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, -agents. and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for ins�p°ection purposes.
Signature (Owner/Agent) Date
BUILDING PERMIT PERMIT#
X10-291
DATE VAL'TTJSTI,ON - LOT TRACT -
JOB SITE
ADDRESS -t,$* A r A
APN
OWNER
CONTRACTOR / DESIGNER / ENGINEER
AAI7.i, Y1:.0NW
LA1T)L>W C'1`c;E EK .COZ<1'`a U'C"VON
5 3 -:696 AVERMA V1" MC0 '
28-321 110=0.1'}:1121)
LA QLTMT, A
CK173M)Rf, CITY CA 922.34
(760)275=-9779 01314 3254
USE OF PERMIT
POOL JWDIOR SFA
POOI, 40 LV. -S' BLOCK WAL4 CITY S'TAN'DARD.
ALAMISMARVEM SHALL, RE IN PLACE AY' PRE -PICAS S ER FHOPECl"IOA
POOL .t ND/OR SPA 10,0WA L9
S FT. WALL 40.40 LS
x6rM.A77M COST OF COMMij'G'.P ON
10,966.00
PEW= Fn WADA4Ry
PLAN C HWX FU 101.000-439x31€1 $81.90 .
CONSTRUCTION FEE 101-000-418-000 $126.60
MECHANICAL MR-- POOL 101.000.421.000 $24.09 .
ELECTRICAL FEE - POOL, ;,01-000-�"a10-0013 345.'00
PLUM:8i1` O FEE - POOL, 101.0106.4.19.000
D p �
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Nov 0.3 2003
CITY OF LA QuINTA
FINANCE DEPT'
WOO -TOTAL CIDIT9T1�C�T(�' 10,1.4 /A.4 D PLAN'.'"IC
$303.010
LESS PRE-P,AID WEI"r
$0.00
TOTAII, VMWr MS DUN NOW
$M.90
RECEIPT
DATE�/
�
BY�f;��
M.�''
DATEFINALED
INSP
l(�-
_ o
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Stab 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
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric1�
Underground Plbg. Test
O�
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
. Plumbing Final
P umbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
-Encapsulation
7
Gas Piping
Gas -Test
Appliances
Final
71 , Q
COMMENTS:
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)
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CITY OF LA QUINTA SUB -CONTRACTOR LIST
OB ADDRESS OAQ' PERIMIT NUMBER OWNER BUILD6R
�>tod
his form >dta9gon the ioh with the Buddha ibteoeetinn Card of el Tknoz a eaes�okwt h mea olar&: Orr}y persons appearing on this fist or thwr employees are authorized to work
n this job. Any changes to this list must be approved by the SuAding Division prior to eorridnerwernestt of work. Failure to comply will result in i stoppage at work andlor the voidance
f buildin permit. for. each a ieable trade, all Information Taquested below must be carnpileted applicairt, 'On File' is not an acceptable re ` se.
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------------------------------------------------------
CITY
--------------------------------------------
.CITY OF LA Wl TW ----
BUILDING & SAFETY DEPT.
cuRB FACE STREET APPROVED
FOR CONSTRUCTION
-------------------------------- ---
DATE Y
40'x 6 BLOCK WALL W/STUCCO
YLONEN RESIDENCE
53-696 AVE VELA560
LA QUINTA, CA
DATE: 10-22-03
,SCALE:
DRAWN BY: CHRIS 233/58
APPROVED BY:
30
DRIVEWAY
3'0 16'6 3'0
16'0 POOL
METAL GATE
4'6" WOODEN BEAM POST
SELF-CLOSING
SELF -LATCHING
' 707-695-6917
TO ,
DOOR
GATE DOOR
1.0 CIRC PUMP
POOL 300 SF HOU 5E ^
EQUIP CARTRIDGE FILTER /�% / V
�/�
250 BTU G _
,�.
ELECTRIC HEATER .'
YLONEN RE51PENCE
53-696 AYE VE LA5CO
LA QUINTA, CA
)ATE: 10-22-03
KALE: 1/8"=1'
)PAWN BY: CHRIS 233/58
�PPKOVED BY:
707-695-6917
Ir
40'x 6' BLOCK WALL W/STUCCO
/3'0. <
<
< DRIVEWAY
3'0 16'6, 3'0-<
5,0„lrolo <
POOL
METAL GATE
WOODEN BEAM POST
4'6° SELF-CLOSING
SELF -LATCHING
TO
SATE HOUSE
DOOR
DOOR
100 G. PROPANE TANK
0
H
POOL
EauIP
1.0 CIRC PUMP
300 SF
CARTRIDGE FILM
11 KW
ELECTRIC HEATER