0303-004 (BLDG)!,. LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Clapter 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 e " Exp': Date
60(A 86 X3 �' 11l30r� t
,Date %" .1," Signature of Contractor 4
g r,
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
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 STATIg FUtil) Policy No. 046001160-2003
(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:- f. Applicant f , . _A-,
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 or`inspe tion purposes.
/f
Signature (Owner/Agent) A, Date '='l'.'f�
r t •i• �Sa .r
BUILDING PERMIT PERMIT#
DATEVALUATION $3���+0� LOT 5.t TRACT 29323
/�, i r,'.
JOB SITE/
ADDRESS 7!9�_ 7S6 peiIA1V,v Fr�.�1� g0V.„
APN
,-023
OWNER
CONTRACTOR / DESIGNER / ENGINEER
LAS C UINTA. D'c71;SM, 350
CORNMRS'TOINE., r)EVE UPERIS, lmc.
5 003 CAUX wS.nit� TV,& �l AE , SM. 13 1
5005 CAL 12APHAKL:, 81 is B I
PAIM S}7FLiIRNS Chi. 92264
RAI m RI PRINGS CA 92264
? 60)323 4.289 CB1#1 6867
USE OF PERMIT
0141NERMw BUILDING
LOT S3 0,FsP (3 Cr`OWVFP_310N TO S X13 OFYqC f- & I.UI' 36 aAR.AC1E
CONVERSION TO DESIGN C04TER PUZ i<HUP-02370
V•AI. U A T10 4 14,990.00 Ind
EMMATED COST' OF COKFIRU(71011
I,
14, 3.E
RY
Minor FM SUMMARY
FLAN CHECK FEE 101-000-4•39.318 !fit®S,9Ii
C:ONSPRUCTION D'fZ 101-000•41.8-000 $Ib3.60
MECHANICAL FU 101.000.421-000 M.00
gMLCTPICAL FEE 101 -COO -x•.20 -00th
lilt
FIt�'�
"3AR 2 1 2U 3
d GiIFAYorrr nzZaT..
SUR -TOTAL CONN M1
$343.15
` LFASIN P'R'-PAID RMS
fl.OJ
RECEIPT
DATE” �f j
�X�
DATE FINALED
INSPECTOR
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
O
Final
Final
POOLS - SPAS
BLOCKWALL
APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
R-{ • d 3 JT
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
- '7 . D �,�'
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) Z _
pl,
L.
14,
ks
SALES OFFICE
ELECTRICAL FLOOD PLAN
SCALE: 1/8" = 1'-0"
ELECTRICAL LEGEND
DUPLEX OUTLET
TELEPHONE/DATA
CABLE J -BOX —
CITY OF LA QUINTA
BUILDING & SAFETY DEPT,
APPROVED
FOR CONGTRUOTION
Df3rtce-
d
W
tD
SALES OFFICE
REFLECTED CEILING PLAN
SCALE:
1/810 =1'-0"
LIGHTING LEGEND
SINGLE POLE SWITCH
RECESSED CAN LIGHT
=
RECESSED EYEBALL CAN LIGHT
CEILING HEIGHT & MATERIAL
GYP. BD.
FAX COPY
1
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SALES OFFICE
rA"s\ ARCHITECTURAL FLOOR PLAN
AI/ SCALE: 1/4" —1'=0°'
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CIiY OF LA QUINt,
EQ. 11,-601 ING'&GAFEWDEP ft'
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