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LICENSED CONTRACTOR DECLARATION
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
6161.28 MUM C: -Py 10/11/014
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).
O la * m exempt under Section , B&P.C. for this reason
DateSignature of Owner
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
(r ) 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
ion 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 ST.A�TI CL�kAI'ENSA I Policy No. 009006168-01
(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.
'Dates 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, Indemnify
& hold harmless the City of La Quints, 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.
Signature (Owner/Agent) Date
BU_ ILDING-PERMIT PERMIT# J
.2
DATE VALUATION LOT TRACT
1e�1dM—
JOB SITE
ADDRESS 5044 M,ATMOZ Gr
APN
OWNER
CONTRACTOR / DESIGNER / EN &NEER
I`i1(fs'fe:( )�VIrI f1>MF.I'i`
CYlI I�Y�.F21:ad t"C3t}L::. Sd��� i; t'17.�' 3 f�f R
P.O, J: QX 171
1A QUWrf% CA 92233
PALMDV%TA0t C.A. 92260
(7 t5j?t4Q-�3t1C+6 �II04 00353
USE OF PERMIT
11133 ANWOR :
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POONSPA,,WA.- 'ft N'k":r!L'i't.'it'Y TO BE UND+ERait;`e�`.Fl.IU'1'tr qr,, tAJT.
AL�,,itMIX)ARWH9110MLL, rads (N PLACE AT l°'1' kl PLASTER
INSTIECf1014, EQUII'ME7HT MJCt,t3V,llP.L+ Nog' INVIIIUDE
POOL UOR SRA, LIN
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MAR 1 2 LU02
1
1TY0F1-AQ p0g7A
EgrwAnx C:I? a or, rr'oN91IdT3cIL'ion
V.00
]f'hamI'r IS EE SiTMMt1<) Y
P ,Aa4 CHECK FEE 10) •000.439.31 R
CCINSTRIJi: TIf:'.+'N'F&7.Z 117111-030418-000 $W34.0
MC; ANICAL 177 •=. POOL 101 -000-421 ••000
EUC't?1CALFaP--::PCJOL lilt-ock-420-o6o s$4S.0
PLixMklWO FEE 101.000-419.006,
I'9�1� OF ji AQUIHT-A
'AY..VAT, Ph -Ma lfX1'9 DUE N0141i%
tires f.:.44a
RECEIPT
DATE
"BY
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 & Controls
Party Wall Insulation.
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS a 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
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
OX for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
q QL
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
odures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
651 E. Northridge Ave.
w
r PATLL
ENGIJ1f,EERING
GROUT, INC.
Glendora, CA 91741 • PH: (626) 335-4362
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FAX: (626) 9.63-4812
ENGINEERING CALCULATIONS
AND DETAILS FOR
WATERFEATURE SURCHARGE
DATE:
ON THE BOND BEAM
ESTANCIA #10
50145 HEATHERGLEN
LA QUINTA, Cj�
MARCH 7, 2002
CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
ENGINEER: DOUGLAS R. FERRELL
RCE # 32994, CALIFORNIA
651 E. NORTHRIDGE AVE.
GLENDORA, CA 91741
(626) 335-4362
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ENGINEERING
Client:
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GROUP9 INC.
Engineer:
651 E. Northridge, Ave, PH: (626) 335-4362
Date:
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Glendora, CA 9174.1 FAX (626) 963-4812
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PAC MELL
ENGINEERING
client:
GROUP, INC. JEngineer:: � �-
65:1 E. Northrid ge Ave. PH; (81.8) 335=4362
Glendord, CA 91740 FAX: (818) 963-48.12 Date: 3(-i (Oy Sheet of
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General Notes:
1. Concrete - 2000 p.s.i. Min. C, 28 days.
2. Reinf.'Steel Grade40. fs=20,000 p.s.L �.
3. 'Reinf. Steel Laps - Min. V-8'. ' ton. 032994
4. Concrete Masonry Units with type .fm=l500 p.s.i.
5.. Grout -1 part cemerif(plastic cement not permitted) 2'/s to 3 parts sand,, 2 parts pea gravel. Exp- 6102
6.Mortar type'W or 'S' - t part cement,'/. part hydrated lime or rime sand..T/+ - 3 times the Ci V 1V
sum of cement and lime.
7 AS! woriarsa�ip and materiaLS to conform with the UNIFORM BUILDING CODE OF
8_. Backfill -,sand or grave! sod.
AI
Project:
PATRELL
ENGINEERING Client:
GROUP, INC* Engineer:
651 E. Northridge Ave. PH: (626) 335-4362
Glendora, CA W41 FAX: (626) 963-4812 Date.: -27 Sheet— of
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GROUP r
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651 E. NorthridgeAve. -PH: (818) 335-4362 Sheet of
Glendora, CA ,740 FAX: (818) 963-4812 Date: -2,
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