9906-204 (BLCK)LICENSED CONTRACTOR DECLARATION
I .hereby affirm under penalty of perjury that I am licensed under provisions of
"Cti:3pter 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
6151.J%0 A. 8 -t 00311.'10(/Date=�f1 Signature'of Contractorf
OWNER-BUILDER=DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) 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 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.
V. 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 Policy No. 111.'IWC�3 181914446"
(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
Pbde, I shall forthwith comply with those provisions;
Date: !�� r" �' Applicant `" "�
Warning: Failure to secure Workers!- C mpensation coverage is,unlawful and
Shall subject an employer to cn nal penalties and civil fines up to $100,000, in
Addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety,
for a permit subject to the. conditions and restrictions set forth, on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null.and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspecti purposes.
Signature (Owner/Agent) - a414oDate
BUILDING PERMIT PERMIT
��
DATE VALUATIONLOT TRACT
JOB SITE
ADDRESS S2-5,19 3E.:.���+$t',.RSO4N STRUC T APN
OWNER
+A�r2 / C �it
�..T l id �..iFOR. �d..LA. I C.
ONE ME PLACE
nIOUS.AND OAKS
USE OF PERMIT
C�RNRRAL
CONTRACTOR /` DESIGNER
j/ ENGINEER yr 107
T AP
:710 S. 1tta.FiRTSC7`Ni.V17>, tf203-t1
QA 941362 C ULVEit C,rrY C.A. 90232-a3=
180 LY, 61110H MOM VIALL PACO S`,'STl47
o.i' . 'WALL
190,00 iur
g ER pp�a K] F-��yp ±i6prwii�i�,MAm.9teo,.4s..�i..%a
C01,,4.S'.► ERLfMON'4'El4 101-000-41M 00 'STl.rJ4i
CUB,'MT«FL.1, CONSTftd.TGCTCJN AND PLAN CHECK
K
LESS PRE-P.MD PFS
':TOTALPC RMfF&US1)1lir+;ItiOW
RECEIPT DATE BY DATE FINALED INSPECTOR
-72.00
- INSPECTION RECORD
OPERATION DATE INSPECTOR
BUILDING APPROVALS
Set Backs
Forms & Footings
Slab Grade
Steel
Roof Deck
O.K. to Wrap
Framing
Insulation
Fireplace P.L.
Fireplace T.O.
Party Wall Insulation
Party Wall Firewall
Exterior Lath
Drvwall - Int. Lath
OPERATION DATE INSPECTOR
MECHANICAL APPROVALS
Underground Ducts
Ducts
Return Air
Combustion Air
Exhaust Fans
F.A.U.
Fans & Controls
COMMENTS:
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs A
Electric Bond
Footings 3 J
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground PI . Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Neater 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
COMMENTS:
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
ALL AMERICAN CANAL
(100.6)
(100.8)
EXISTING FENCELINE
23.5' BLOCK WALL TO BE CONSTRUCTED
WITH ORCO BLOCK" 87x 1 STACK BOND.
-,o r, cs rel, W/Cd P T?a
CONSTRUCT 6' HIGH
BLOCK WALL PER G. T.E.
N 89'31'14"E 50.03'
(99.5) 1 ' 100.0 100.1 (100.2)
106.0 T.W. 1
100.5 F. C.
100.0 T.F.
m on
> v
0
ci
-0
-��-,
0
Z
q
OCn
)
C m
^
1v
�m:�
C:
z�m�
(99.0)
John Hack
C o n s u l t i n g C i v i l/I
684
Telephone
(760) 321-5201
EXISTING
RIGHT OF WAY
N89'31'14"E
106.0 T. W.
100.5 F. G.
100.0 T.F.
PROPOSED GRA VEL PA_ D 1
0
1 PAD. 100. 5 106.0 .r W. 1 v
1 100.1) (99.8)..
99.8). 100.5 17'. G. (99.2) .
100.0 1:F.
106.0 T. W.
PROPOSED 16' 15'. 100.5 F.C.
GA TE PER G. T.E. - 1 100.0 T.F.
OI
1 1M
106.0 T.W
100.5 F. G. I ' .. :...IZ 100.5 F.G.
100.0 .T. F.1 1 100.0 TF
99.3) :.: (99.2) .: -(99.6) .
N89'31'14"E 50.03'
30.0'
30.02'
(100.4)
(100.4)
GRAPH16 SCALE
n
Associates 10 0 5 10 20 40
ers Surveyors 44
234 IN FI�,ET Fox
et (760) 321-5701 1 inch = 10 M I>�
(99.4) 52 - 519 _7 �j�aes0
I
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I
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EXISTING I
E.P.
I
I
I '
(100.38) I (100.46)
I �
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I
C.
I I -n
I_n
m
30.0' I
I ' �
O
I z
I I VI
I
SET C -NAIL
I �
(100.0) (100.1)
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APPROVED B COM "DEVELOPMENT 0 PT
BY
EXHIBIT
CASE NO.