0310-233 (RPL)LICENSED CONTRACTOR DECLARATION
U) 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
cel W Professionals Code, and my License is in full force and effect.
O =) M License # Lic. Class Exp. Date
5 11 C33
ZO P_ I.,Date d X42 > � �� Signature of Contractor
J U C:) OWNER -BUILDER DECLARATION
Hd r— I hereby affirm under penalty of perjury that I am exempt from the Contractor's
U) License Law for the following reason:
Z ( ) 1, 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
M () I am exempt under Section , B&P.C. for this reason
LID
N Date Signature of Owner
ON
rn
Q WORKER'S COMPENSATION DECLARATION
C:) � I hereby affirm under penalty of perjury one of the following declarations:
U-) FZ O () 1 have and will maintain a certificate of consent to self -insure for workers'
X W 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 U (,r) 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
rn H permit is issued. My workers' compensation insurance carrier & policy no. are:
"t Z CarrierPolic No.
ab:I':'�GI+ y
� d
J (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
3 subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions.
Date: J :Applicant 1!!!22. 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 (5ode, 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 inspection purposes
�,.-Gighal'uia (OmiciIAyeiii)' 1 a ,]i�r,. iJHle 4,) J
BUILDING PERMIT PERMIT#
DATE VALUATION LOT TRACT :•
JOB SITE APN
ADDRESS 7'7• t t."..� v:i':�!1�� _
OWNER CONTRACTOR / DESIGNER / EN INEER
-Ps & M (' 101PI i.R.Myr.tE
7A-070 G&LU CADPIZ
CA. 9225:31 UAB t) .t17`�b, ` J;— A:`A `4215 3
CUR Z q4
USE OF PERMIT
POOL ANDIOR WA
POV1, A.LA.!?!tA"iM,3Rr3:i ,4,'a SH A,9, L BY. f.44 VIAC:E A#X PRE -1
:i, (wMU11.;0M,
:itIGMI's�?�TXD CUM" (W. $101i11*Y1U?"JMTVN
PLAN CHRICK FE)"? 161�01X.1_5:39_31118 yJs,tt:5 .
I��++`gqi:�'��i�/ryS'P�j�tyUCy;'s 101?�PC11 •+ 10 1 ��:r�?�4;�1f 81-100 ��l ty, 70
y
ELEC>.R.C`AJ, .0 KE. •- I<<!0�•+2J . 1011 "'11100"��` 20110CIV �D`4��.0
OCT 2 3.2003'
J�}3a MPktuT�.l- £'i3..88,
10.10,*W1100
"ti, Ott
RECEIPT DATE BY r D7 FIEDI ` INSPE jj/�
f , r .? ,•r .I G fn,
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
Final
BLOCKWALL APPROVALS
steel
POOLS - SPAS
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
=�_;i_
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
0. K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
G
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: ,
I
I
!OTt18" I
ECT PROPERTY
' I
I
Cv
NEW COMDO /LL L 118x. RCT/UNIfdG
WALL W/ NEW B.' HIGH BROWN BLOCK
WALL ON TOP
SLOPE 11% MIN. PAD
FLOW LINE s YAM"
45W CONC.
/1 SLAB i'£ i.'
O
M
ED
AIC
z
J
M
a
l:.
NEW 5' HIGH BROWN —
BLOCK WALL
---PLANTINGS TO I
PROPANETANK
(Y.O.
Kt
------- ----------
ADJACENT LOT t 18"
BELOW SUBJECT PROPERTY
L -----------------
/--PROPERTY LINE 100.0'
— — — —.—.—.—.—.—.—,—.—.-
_ H.P. SLOPE -11 %—MIN.
FLOW LINE •
ET
rADDRESS LOCATED
ACK
I BELOW PHOTO CELL
CONTROLLED LIGHT
ROLL -UP GARAGE DOOR
Lu
44,
`CONCRETE
DRIVEWAY
''r`'^%
e
SLOPE 1 % MIN ,%
I
(q
FLOW LINE
",, , :'
w
`w
w
- ENSENADA J
F.F.:V-0" ABOVE THE CURB
PAD: 0'-6- ABOVE CURB MEASURED @
CENTER OF LOTS @ EISENHOWER DRIVE
70'-0"
77-730 Q�57;0-/.
V I WATER
• �' I SERVICE
;1% MIN.
LINE
8
0
c�
Y
Q
m
I•
I
I
I
I
BLOCK WALL NOT TO. EXCEED
HEIGHT FROM SET
'HOLE IN WAL BACK LINE TO PROPERTY LI
FOR DRAINAGE
/ N A'W HIGH R
BLO _
1 1
I SLOPE 1 % MIN
FLOW LINE
��\F PATIO SIZE _/ )
SE SHT. ##2
%
l � i
r
I
I
1
(5) QUEEN PALM
' 15 GAL. OR EQUAL
MIN.11/, TRUNK
VERIFY FACE OF CURB TO /
DRIVEWAY APPROACH REQUIRES A PROPERTY LINE DIMENSION GROUND COVER
SEPARATE PERMIT AND INSPECTION WITH CITY OF LA OHINTA .. _ "PALM SPRING GOLD" OR EQUAL
— VERIF
PROP
WITH
PUBO