0401-283 (RPL)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter 9 (comrrierictng wltri Seutiull 7000) ur Divisiun 3 of the Du3inc3o and
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date -7 to 7
f 1J,31/04
Date t a> Q ' ' * 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
Y..
WORKER'S COMPENSATION DECLARATION
i 1 hereby affirm under penalty of perjury one of the following declarations:
( ) „ j 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 ( ) 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 STATE VOIDPolicy No. 13A29"431
(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 Yshould become
subject to the workers' compensation provisions of Section 3700/of the Labor
Code, I shall forthwith comply with those provisions.
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 inspecti `n purposes. '
Signature (Owner/Agent) Date>
BUILDING PERMIT PERMIT#
DATE '/ -i �,VALUP��IF11V<.�,• "�•U LOT MI-•'�'�•�i _ TRAr.T
�.
JOB SITE
APN
ADDRESS X3SIM A F.S A VAL-U E,i 0
OWNER
CONTRACTOR / DESIGNER / ENGINEER
Yo JI= 589
51-105 AV.I? LVA V111A -9-10 1
LA Q?Y_t11.173"A. CA,' 9.2?SI-
LA QU,CNTA CA 92453
(161 564.4604 Caui 2261
USE OF PERMIT
R001 A141dOR S' PA
PGO.L SPA, AlLAPUSfiB IZRIL?RS SHA.Ll..BF IN ,PLACP AI' UPJL•PL,AQ;`tZPZ
INSPEC f fOX. ,RQU4PMEkl`l: ENCWSU E NOT MMUDED
POOLJ11MOR SAA kwo.00 Iv,
YISISJ3lF 1S..3.°'i+0*Tr \a'.1' c0BVhri..tiidM9pA.Y
4?pl.i�RNY�%li
fes,, �L'3�.,�UMIX L1 PAMARY
PIAN CHECK PEE .01-000-439-318
COMSTRIICTICYN RZ 101-000-418.000 $99xio
WCt'INNICAL RY. — POOL 101-000-421-000 WIN
It'fftY,M, 'R1CALVE"U° a POOL 101-000.420-000 $45.00
F`1:1 MOR40 FRE... POCIL 101 -Bit 0-419.000 $27.00
.81 MTOTAL CtYNZi"RUCorICr.;+1'AiJD PI.aW CI C``K
259,31
US� 1x YAELDFEW
$0,010
.Trr Fm DurALY
TOT
a
JAN 2 9 2004
CITY OF LA QUINT
tea.,.
BY�<
DA E FINA D
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
1 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 - IM. Lath
Final
Final
BLOCKWALL APPROVALS
steel
POOLS - SPAS
Set Backs
Electric Bond
C
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
L
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Witer Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
S�.)wer Pans
O.K. for Finish Plaster
S2wer Lateral
Sewer Connection
Pool Cover
Encapsulation
�
- / p
Grs Piping
Gas Test
Appliances
Final
i
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:
V-04 t,40•-0• _ . .
W" raw
00 a F li
AC COND04M WTME 0VAWLlb
Gobs
�.
SHEET INDEX
1
SITE PLAN
GN
CsENERAI. NOTES
2
FOUNDATION PLAN
3
FLOOR PLAN
4
ELEVATIONS
5
SECTIONS
(o
ROOF PLAN
"j
ROOF FRAMING PLAN
$:
TITLE -24 REQUIREMENTS
EL' ECTRICAL PLAN
9
10
M4CNANIGAL PLAN
v
1 �a•o.� ;
I.pm
: GENERAL INFORMATION
Erni r
•TWMAS BIaFFW
P.O. BOX 134 .
14LA WINTA CA 92253
PROJECT ADDRESS: 5 3 --�� �J�.�\
• I ! � iran�oan a.�s ,.
ZONE: R.C.
i 1 OCCUPANCY: SINGLE FAMILY
❑ 1` ' j TYPE Y NONRATED
I '1, AREA TA5UL AT I ONS
RESIDENCE 1,9i8 SQ.FT.
`U00Co PAT10 19 5►CCZ..F1'.
TOTAL STRICTURE 2,411 SCaT.
TOTAL SITE 5#000 SCAT.
iii '�i�•,. _ TOTAL. LOT COVERAGE 483%x'•
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