0307-132 (SOTB)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
779'165 65 r E! MY - 5.{31 /04
Date 1- ( s� Signature of Contractorx"{11
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.
,(4) 1 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 8s ATE. Pt,ND Policy No.
(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
Dater 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, indemnity
& 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 inspection purposes. - y
'Signature (Owner/Agent) "' `- Date
BUILDING 'PERMIT PERM'S
-
DATE VALUATION ., LOT TRACT
JOB ADDRESS
APN
OWNER
CONTRACTOR / DESIGNER / EN (NEER
CQr,7 DE C.PZA C 92679
TPA1.M M19GS CA 92262
�'>►is�f7"��S�2i'�0 ':�F>X;i� 2151
USE OF PERMIT
Flrh;tiTt ITF7b:lalSi:►M4WZY
MAN CHECK FEE _00-439-31
COWSTRUCTION fr< 101-000-4;8-00) S!'i.vo
0144,"0419d00 11t;I
5it3Vl?q TER 10
ST;:O�10 dOTN F"If • ieSiD to 1 _000,
iVUB•=707.1`..'L1.,/VdRMrtR.te.YiS.`.1..iONAND .�9'.L.wMrii..�C7LIPICK,
$43.25
LstT,i
$0,00
Q
f443.25
JUL 14 2003
Clip. OF LA QUANTA
FINANCE Ijgwr.
1/3
RECEIPT
DATE
BY
DA FIN
IN TOR
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 & 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 BeamIT
Approval to Cover
Equipment Location
Underground Electric
00 4 44
Underground Plbg. 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)
4•_
UARTZITE SLAB_
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SHEER DESCENT
CASCA DE
PSL-
ps a bench
15'6 pool
tanning led a 5, '13'9
-6WI- planter
sella sleeve vac:
A • FIREPLACE `
planter
(see detain sheat)
129 deck! 119 gas cuff ANSI # 16.33
,-f planter p
SMOOTH BAND TRIM 0 137
FULL PERIMETER loggia area I .� ;i / planter
—planter �, bbq
G/Eill
ALL PLANTERS 35'
'} /L.V.WIRE ,
BOSS REMOTE
STAGGER STEP STONES.
KOVACSRESTDENCE
PLAN 1CRF/C
LOT 5 F F
- 12'6 ,,_........,
APPROVED BY CONSTRUCTION SU>ERINTENDANT u I„
DATE P _eXi5 i ng wall
APPROVED I3Y DESIGNER & SALES PERSON
SMOOTH BAND TRIM
=DATE FULL PERIMETER
patio deck
APPROVED BY CUSTOMER q U.,
GFT
DATE FOUNTAIN WOWNER
2,295 Last lamaAsk Road Vilm Springs, -CA 92262 a, License No. 7791 .5
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FIREPLACE
DESIGt�f4%- FOOTING DETAIL
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#4 REBAR VERTICAL @ 24" OC
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FInEPLACE
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REINFORCEMENT
2'6
STRUCTURE
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4 REBAR HORIZONTAL @ 12" OC
2'6
12" CONCRETE
R
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FOOTING
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REINFORCEMENT 2
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Sol,j
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- #4 STEEL MATERIAL, #4 STEEL AT CORNERS AND 24'1 ON
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CENTER VERTICALS
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GROUT SURROUNDING A 36" WIDE BY 30" HIGH FIREBOX
REINFORCEMENT
I
BUILT WITH -STANDARD FIREBRICK, ADJUSTABLE
6'0
FORMED DAMPER, 13" X 17' FLUE LINER, 9 GAUGE METAL '
SPARK ARRESTER AND SHALL NOT EXCEED b' IN.HEI6NT .
- HORIZONTAL REINFORCING SHALL BE 8t1 HIGH #4 STEEL AT
FIRST COURSE, MIO HEIGHT, (TOP OF. OPENING. OF FIREBOX)
AND 8" BELOW TOP OF MASONRY.
CONCRETE FOOTING EXTENDS
- GAS LINE AND LOG LIGHTER PER UBC AND ,CITY CODES
1' FROM FIREPLACE
GAS CUFF• ANSI # 16.33
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