0207-120 (PAT)U)
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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
Date' �'�!�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
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.
(,r) 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 TTATp. FLiND Policy No. $29-0 000=4
(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-ag a that -if I should become
subject to the workers' compensation provisions of.Section 3700 of the Labor
Code, Ishall forthwith comply with.fh6se�provISlons. tf. .
Date: % a !I f e' Applicanp v k'5-. %f;Z 6f � .✓ x lip `x b'...
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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 epresentatives•of this City to enter upon
the above-mentioned property,forinspectlon purposes,
/Signature (Owner/Agent) t Ar t—#X 4 r«- Date✓
BUILDING PERMIT PERMIT#
02.07-120
DATE 07A&AX, VALUATION LOT i ' '��z TRACT
JOB SITE ADDRESS 4!).- FJ, C.'3�.CM0N APN 155&.2 02Z
OWNER CONTRACTOR / DESIGNER / EN (NEER
$iMRA K R1WRY rA0B1;Xi PWJ..,NV.V B K E BUILDING AND DE'Vni, .01"MLEW IPI i
h 9-984- I .. •eC 3LO 41-910 UOAi21iti'vVIC .M2 A-10
Lla. Qi,: UI -A. CA 92233 PAI.d1+IDF=Zr CA 92211
C160)776-4940 CRTA' 2829
USE OF PERMIT
PAd"10
y`CJti! HIPATIO
V>rf100 ail
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3'3.aAN CHECK Flu 101 -000-439-318
CONSTRUCTIaN ",9 101 -000-4 18-000
ST.ROHs.;MOTION PEI. - USID 101.000.241.000
LINT 1-11AU)1
RECEIPT DATE BV,r DAT„fINALD/ J� INSPE
OFILARUI q
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:619AAI
$25.25
$0,00
INSPECTION RECORD
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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
0. 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
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam >,
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Mumbing 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
Lava Voltage Wiring
Fixtures .
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
'M
ROBERT A. P I T C H F 0 R D
DESIGN AND .DRAFTING
41-625 E(LE(II( S T E A-2
PAIN DESERT, CALIFORNIA
760 346 2856 92260
NOTE: .ALL 'OR EQUAL' SUBSTITUTIONS
SHALL UE SJBMITTED TO BLDG DEPT.
PRIOR ;0 `INSTALLATION
NOTE: ALL CONSTRUetION SHALL COMPLY WITH
THE 1998 CALIFORNIA BUILDING, PLUMBING
AND MECHANICAL CODES, AND THE 1998
CALIFORNIA ELECTRICAL CODES.
49-984 EL CIRCULO
BANTA ROSA COVE
LA ®UINTA, CALIFORNIA
CITY OF. LA QUINTA
BUILDING & SAFETY DEPT.
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ROBERi
A, P I T C H F 0 R D
DE5IGN AND DRAFTING
41.625 E(LE(TI( 5 1 E A-2
PALM 0E5ERT, ( A L I F 0 R N I A
760 346 2856 92260
EXISTING RESIDENCE
NEXT DOOR
ROOF PLAN_
SCALE: 1/4' = 1'-0'
CITY OF LA 0
BUILDIN:G & SAFE'
APPPOV
FOR GONSTRU(
DATE BY
EXISTING TILE
ROOF
'EXTENSION
A
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\ \ NEN BUILT—UP CLASS A ROOF
I A I PER 'MANVILLE' 4GIC OR
1 APPROVED EOUA_ —\
I 3 I 1 ( OVER 5/8' CDX' PLYWOOD ROOF
I I I I SHT'G W/ 10d @ 6" O.C. EN & BN
1 & 12' O.C. Fhb — P.I. = 40/20 —
I I I I OVER 2XI2 JOISTS @ 24' O.C.
EXITINGIANACAPA I I 1 W/ U—HNGRS
UNIT I I 1
I I I I I I
I (EI) 2XI I I I
JgI5T5 � 24" P, C. I I
A
ROBERT PIT(HF0'RD.
DESIGN AND DRAFTING
41-625 E(LE(TI( 5 T E r.-2
P A L 14 0 E 5 E R T (.A L I F 0 R hl, I A
760 346 2856 9260
SECTION
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SCALE: 1/4"
= V-00
FOR CONSTRUCTiGN
DATE Ry
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