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0211-011 (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 01 6129 C53 Hic, 8 101.1112( Date Signature of Contractor r OWNER -BUILDER DECLARATION ' I hereby affirm under penalty of perjurythat 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. (�Lhave 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. STA` HI COMY'Nr SATY Policy No. 0460006163-02 (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: ) Applicant— Warning: pplicant 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 1.80 days will subject permit to cancellation. I certify that l,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, �ffoor inspection, purposes. ( Signature (Owner/Agent) ^ f � ,,Alj` , LY Date �•!T :a I lUb- TOT , , AND PIAN s IMM IMS MR-PA.W.FM9 RECEIPT DATE / BY- D E FI LED $0.00 HERMIT PERMT# BUILDING DATE VALUATION LOT t 04 'M 31 TRACT IV JOB SITE n" , ADDRESS ��'IU��ftnl i:�1IM1 APN OWNER CONTRACTOR/DESIGNER/EN (NEER Drly-MaCres 4 yy ROPEI PZ - P, -�'.);UF0�.Q1'�.P�:"s.'}12, .JCS `Y0,P M#:.1 CO 1.I? #1:�. �!�;�`•+1�, r��3.�'.°� T,',�►Tt.lHse� �2e?�i:t R(�,. J ©(s .€�1i�i�N'Ct�.�� , (760)3:,8«9222 avo p0's-1 ; G " USE OF PERMIT C._MMAL.TMD1.Y3;'l f ' i 1 140 Lf $' 83,0CX'WA-LU&1 L? Y DLOCX A MALL. PFR. 04: G' DETAIL & APPROVED Pi..�€a�i. 6 r. I WALL 140.00 IYs' 5 k"Y.'IV1it t. 6:04 Ldp' F ANCA QUINyq - pT. 14'133MCOST OF C011,51TWCUOR IV '? 101-000-418-VOO MCI itumminn, I lUb- TOT , , AND PIAN s IMM IMS MR-PA.W.FM9 RECEIPT DATE / BY- D E FI LED $0.00 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 i F.A.U. Framing Compressor Insulation 1 Vents Fireplace P.L. ; Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wail Firewall ' Exterior Lath 1 Drywall - Int. Lath ? i i Final Final POOLS - SPAS BLOCKWALL APPROVALS steel Slit Backs_ ` Electric Bond Footings ti Main Drain B+md Beam Approval to Cover • Equipment Location Underground Electric Underground PI . Test Final �/ Gas Piping PLUMBING APPROVALS 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 Appliances Final 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) LI I Y Uf LA A U"� QCT 28470-2, I THE BUILDING PAD ELEVATION OUGH -GRADING PLAN AND A WORKS DEPARTMENT. FADING ACTIVITY RELATED TO I'HE PLAN, ONLY IF, A VALID S AND SAFETY DEPARTMENT ,FOR .AR 'LOT. INTA BUILDING AND SAFETY DEPARTMENT —LOT CONSTRUCTION ACTIVITY THE STREET. RIGHT OF WAY, 3 BY THE LA QUINTA PUBLIC ;TIRED PERMITS. BIBLE FOR ENSURING THE ? BY LANDSCAPING FEATURES 4ATERIAL FROM THE BUILDING PAD, 'E, SCARIFIED TOA MINIMUM O DENSITY PER A.&T;M: NUME:NTS OR BENCH MARKS NOTED ON TIME ACEMENT SHALL BE DONE BY 'A REGISTERED CENSEQ LAND SURVEYOR ONLY. Y OF DIRT, MUD, AND DEBRIS :TION OCCURING ON THE LOTS SATISFACTION OF -THE CONML MEASURE AS REQUIRED BY THE T WITHIN ONE HALF MILS OF HUMAN OCCUPANCY QUINTA LOT 31 30 PM :00 PM HOLIDAY. iWALES SHALL BE A MINIMUM OF 0.3' DEEP OR FILL SLOPES. MINIMUM . SLOPE OF SWALES PAC70 TD 95z - Rm Sw (wpw 'w Paco y0', I KO UAWWM Sat -. .. 5Ci("L 1JW 4i1fY'd} r ....fp".,.. µ- . ' PMMAT€D COtMTF RM UUBBL.ER BOX TO BE PLACED 14" WASHO ROCK ON 6r OF COMPACTED 1" ROCK 'vV'fiXTr"_77 t'AERX PD? SEE AL STD. SPED SHALL BE USED , RE W'ASH'ED ROCK AND m SUL 114' WASHED RON Oq CD SaL A AMMM 12' TNJCit 4 PLANS kPPROACH j e CURB LIP EXISTING C CURB A- 60 4 �+ #moJURY H, 4 - -- AM S TS' mr-cm i► S y My Or LAtA1iiRA 4 C�ti�" " Y Mir rur till) f� CSM 4F LA "7A CONSTRUCTION . NOTES , i CONSTRUCT YARD DRAIN, NYOPLAST 12" DRAIN BASIN OR EQUAL. 2 CONSTRUCT F PVC PIPE, SDR -35, T SLOPE A 1 pUNLESS OTHERWISE NOTED. CONSTRUCT 10' DEEP DRYWELL PER DETAIL ON THIS SHEET. CONSTRUCT BUBBLER BOX fir/ GRATE TOP. NYL.OPLAST 12" DRAIN BASIN OR EQUAL. CONSTRUCT BLOCK WALL PER SEPERAXTE PLAN AND PERMIT. SEE PLAN FOR wALI ELEVATIONS. CONSTRUCT DRIVEWAY APPROACH PER "DETAIL SHOWN HEREON, LEGEND LOW POINT . . . . . . . . . . LP TOP OF CURB . . TC FINISHED SURFACE . . . . . . . . . . FS HIGH POINT. . . . . . . . HP INVERT. . .. . . . . INV j TOP OF WALL. . . . . . . . . TW i TOP OF FOOTING . . . . TF FINISHED GRADE . . . . . . . . . . FG FLOWLINE . . . . . . . . . . . . . . FL PROPOSED ELEVATION . . . . • . . . , . . . . . 538.26FS a EXISTING ELEVATION . . . . . . . . ... (538.73TC) PLANTER AREA . . . . PA ,. PROPERTY LIFE ; _ PUBLIC UTILITY EASEMENT. . . . . . . . . .. BUILDING 'SETBACK LINE . . . . . U U W 7— CITY OF LA QUINTA BUILDING & SAFETY DEPT. t APPROVED FOR CONSTRUYPTIgN DATE � tit AVE. !P.4 50 CALLE TINPIGO AFSE-INSPECTION FEE OF $30 MILL PE CHARGED IF THE APPROVED _ AVE. 52 PLANS AND JOB CARD ARE NOT ON THE SITE FOR A SCHEDULED INSPECTION. .NO EXCEPTIONS! PROJECT LOCATION VICINITY MAP LA QUINTA, CA NOT TO SCALE �.m