0312-239 (BLCK)` 4
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 Busiriess and:"r�_
Professionals Code, and my License is in full force and effect.. `
License # Lic. Class r� Exp. Date
Date- Signature of Contractor_ __-:/
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that•.I'am exempt from the Contractor'§-
License Law for the following reason:F/
( ) 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).
( ) 1, 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(N)' I have and will maintain workers' compensation insurance, as required by
Setion 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:
Cartier STATEFUND. Policy No. 329-6671-200$
J (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 L_abor„.. .
Code, I, shall forthwith comply with those •prbvisionv,, � ;SKr •�,4�,,
Date: ) Applicant �'"'—w , `'`rte
i Warning: Failure to secure Workers' Compensation coverage Is'unlawful ander
shall subject an employer to criminal penalties and civil fines Lip_to $100.000 in
addition to the cost of compensation, damages as provided f�n Section 3706
of the Labor Code, interest ar ;.attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, &..shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 day }will subject permit to cancellation.
I certify that I have read this application and'state that the above information is
° correct. I agree to comply with all City,±and State laws relating to the building,.
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection
purposes
A_
Signature (Owner/Agent) ' - Dater
-- _..._.-''-_ �- o � . Wil._ _� .lr', .�"` ¢�•g' `�
BUILDING PERMIT-,'..;,., PERMIT#
DATE` VALUATION
b LOT TJOB
SITE
• ADDRESS �•�'�'w5+i e�VEMDA11FI� TIA
.�j'
^ ^�
APN
OWNER—
CONTRACTOR / DESIGNER / EN (NEER
'�fiiATk'1;i T'�U S+'A$aIi
i s EL VL 3'T L% 5 c.
54.1451WE1,T1DA"iT1U h
78-120 CALLF_ViYa 0W.-=:2.04
LAQ0114TA CA 92M
LAQtMitl'a CIA 92253
(J60)564�1866 mu 8S9
USE OF PERMIT
160 L.F. 6- SLOC'1::'8+�'.,AL4 96 LF. V T;LOCK WALL, SO L.F. 3'
BLOCK W.c1d.4.ALL CITY `3'I'.1!'.ND-ARD
y F.r. WAU, 160.00 LF
5 Yr. WALt,, 96.00 LIP
4 ;I?'.W.,kL T , 30100 LF
k°STITt!it'in'L+'D CCW;tF 01' CC)MIMMO,DR
PRRARTPER HUX. MMIZ
CONSTRUCTIONFEE i o i -m-1.0 pt►0 gStl�,@+�
D IEC 2 4 2903
5
CITY OF LA OUINTA
FIMANCE DE - .
8.OR-'1'CY.I AY„ COMMt.Tt" f0fi A.tM PTr V C1'UZM, :'
$90.00
LJ ;y3 *P.RB-PPM REBS
50100
TOTAT, , .i'I ' ax if` c., Lam 19 -ow
SWC. M
J
RECEIPT
DATE') J
BY
DA�.T FINALE
.
INSPECT
�C ;fT 6;e• 1
r
� .oL
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
- a b
Electric Bond
Footings
Main Drain
Bond Beam
/_B—Qd
Approval to Cover
Equipment Location
Underground Electric
Underground PIN. 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:
p-0,Utility
Final
Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Extarior Receptacles
G. .I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
PM
- _ . r - •.N . ' _ UNAUTHORIZED USE WARNING r -
"'' THESE DESIGNS ARE THE PROPERTY OF
LENCH DESIGN OROUP. REPRODUCTION
.. E,j'^ • _ ' " �. , - -� IN ANY FORM WITHOUT WRITTEN CONSENT +' -
+ IS EXPRESSLY PROHIBITED. L"AUTHORRED
_
` ` .. - • f. .. • . + +� USE DERIVATIVE
P AN ORIGINAL IS AND MODIFIED • ` .
DERIVATIVE PLANS AND IS APPLICABLE TO
+r INTENTIONAL AND UNINTENTIONAL /[..
7r 1 INFRINGEMENTS. • `.. , �' r .0 '
• w
„. .
• COMBO WALL t1'-6" RETAINING WALL t N ,PROPERTY LINE 100.0] +-
- W/ NEW 6' HIGH BROWN BLOCK
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A.P.N.: 774-223-018 I �I
xADDRESS:` 54-145 AVEN I DA VI LLA ,^, •.
LEGAL LOT #6 BLOCK #295 UNIT #27 ti r y�r N a el
r - . w1. ^ ,>q.-•-�.. —.. y • tVi r J.+o�r� '•_'k... a••..� S'�. .:...:'." .1,. • •'t ,,_ e' -. .r'r s i a k 'a ` ' r -- ,,ir _ ��. ,v , {i . t - '� ^ Rl
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HIGH. i' - ? .'.�-FLOW.LINE' ? O C
"a I BLOCK TANK , o.$* .; .: ,>r - 1 - „�.+sa• ' M
— — ----
".r. WALL �._.._._.=.T _ -
. r .•- , _ COMB •
- W/ NEW SAHIGH BROWN BLOCK ; r ALLIIN
ALL RETAINING
\'-PROPERTY LINE 100.0 1y WALL ON TOP W
CITY OF LA QUIP .F t DRAVIN
BUILDING & SAFETY DET" `
' { A.RADONI
_ -•, t CHECKED
' + • � `- ".; -- LAMS PREPARED BY: - S.L. .. ....
t n LENDS VENTURES, DATE
-
,. APPROVED dba
_ .
=J
FOR CONSTFZUCI l it•: . « ' �. 3. 10-22-03
SCALE
v ` LENCH DESIGN GROUP SCALE
•t . .
SHEET
...� // r .. r r •a , T - t- . _SHEETDA 1 C� Z �Q BY — — ` . t 1 . A.P. LENCH H 1
• PRESIDENT