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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
736920 8 �'' 03/31/2(
Date ��ff3 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.
(. )' 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 M1'g FUND Policy No. 1576+103_2002
(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' compensatiop�provisions of Section 3700 of the Labor
Code, I sh 'll forthwith comply with t6se"provisions.
Date: r/ / �/ Applicant i/
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 representatives of this City to enter upon
the above-mentioned property for inspection purposes.
1
Signature (Owner/Agent) . Date
BUILDING PERMIT PERMITk
DATE VALUATION LOT TRACT
(
JOB SITE
ADDRESS 54 2W AVENIDA RE1nRP"A,
APN
-
OWNER
CONTRACTOR /DESIGNER /EN1NEER
ROpk.F1O1.000
uQNTEMPOWY HOW -19
PO'S(X 8243
5.1370 AMI•LiA BER11:7RIAS
LAJOLLA CA 92039
LA, QUWA CA 92253
-(760)56 -1404 CEIR6255
USE OF PERMIT
POOL. ANDfOR. SPA
POOLiSPiL A1.h:F,.A43/iS.ARRIER-3 SHALL 62 IN. PL,A(;`S,AT PRI? -1) ASTIR .
iWSPECTION. EQUIP>�!(,r".NT ENCLOSUitENOT INL`i.,i7DED
POOL AND/OR SPA MOM LS
MWAT.Ia:Tt COST Or, C<?NSMUK:'1'i[O.N
PFIRAM, Fps: SUW. dARy
PLAN CHECK FEE 101-000-439-3183 S1451.30
C0119TRIXTION 1 101-000-41.8-000 $162.00
MECH.P NICA . FRE -- POOL 101-000-4-21-000 $24,00
ELECTWCAL FEE _- POOL 101-000.41.20-000 PWf5.A0
PLUM}3TNO PEE POOL 10'1.000.419-Q00 $27.00
APR 5 103
CITY OF Lit C U!',< A
FINANCE DEPT.
aM—TOTAL COMMUC110HAMI: PT AK C"klrn CK
$363.30
T ., 3' PRE -PAW FEES
$0.00
:d'MAL PMOT Fk 3 p.Yl'iTs; NOW
LW V
RECEIPT
DATE/ /
f �
BY
Dl L
INSPE CT
(y/i
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 8 Controls
Party Wall Insulation
Condensate Lines
Party Wail Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
steel
POOLS - SPAS
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
ShowerPans
O.K for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
7
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbttures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
N
;t
UNAUTHORIZED USE WARNING
THESE DESIGNS ARE THE PROPERTY OF
. euru nee�nu nw..�e '='RODUCTIOJ
N CONSENT
LL ITHORQED
D MODIFIED
-LICABLE TO
AL
(A.P.N.: 774-214-027
ADDRESS: 54-200 HERRERA
,LEGAL: LOT # 15 &16 BLOCK 282 UNIT 26
1 LA QUINTA
IIGH
)CK WALL
i PREPARED BY.
VENTURES, INC.
dba /
A.P. LENCH II
PRESIDENT
DRAW)
A.RADONI
CHECKED
S.L.
DATE
03-12-03
SCALE
1/8
SHEET
#1
J
3Y"
C, n
e BENCH DETAIL
SCALE: NONE
n
UNAUTNORIZED USE WARNING
THESE DESIGNS ARE THE PROPERTY OF
LENCN DESIGN GROUP. REPRODUCTION
W ANY FORM WITHOUT WRITTEN CONSENT
IS EXPRESSLY PROHIBITED. UNAUTHORIZED
USE EXTENDS TO ORIGINAL AND MODIFIED
< DERIVATIVE PLANS AND IS APPLICABLE TO
INTENTIONAL AND UNNTENTIC NAL
INFRINGEMENTS.
WATER LINE
12" RAISED
FINISH SALT
BOND BE
+*
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::. POOL
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SPA -POOL DETAIL
SCALE: NONE
a140rt
2'_3r'
LONGITUDINAL SECTION
SCALE: NONE
3Y"
C, n
e BENCH DETAIL
SCALE: NONE
n
UNAUTNORIZED USE WARNING
THESE DESIGNS ARE THE PROPERTY OF
LENCN DESIGN GROUP. REPRODUCTION
W ANY FORM WITHOUT WRITTEN CONSENT
IS EXPRESSLY PROHIBITED. UNAUTHORIZED
USE EXTENDS TO ORIGINAL AND MODIFIED
< DERIVATIVE PLANS AND IS APPLICABLE TO
INTENTIONAL AND UNNTENTIC NAL
INFRINGEMENTS.
SECTION
SCALE: NONE
A.P.N.: 774-214-027
ADDRESS: 54-200 HERRERA
LEGAL: LOT # 15 &16 BLOCK 282 UNIT 26
LA QUINTA
P S PREPARED BY:
LE EL VENT[TRES, INC.
dba
LE CH DESIGN GROM
A.P. LENCH
a
DRAWN
A. RADONI
CHECKED
S.L.
DATE
03-12-03
SCALE
1/8"=V-0"
SHEET
#2
3 BENCH
12" RAISED
1
BOND BE
+*
�ti4 1s° SPA
::. POOL
yi�rji 1 ,
'try:'' ;ti •ti��j; �+.�
.iT�•Atw 'c �M�1�4 00 T
•ty
.14"GSn `:S..IAT Nt(V �,i•:^ .`, r:y"{.\4��
SPA -POOL DETAIL
SCALE: NONE
SECTION
SCALE: NONE
A.P.N.: 774-214-027
ADDRESS: 54-200 HERRERA
LEGAL: LOT # 15 &16 BLOCK 282 UNIT 26
LA QUINTA
P S PREPARED BY:
LE EL VENT[TRES, INC.
dba
LE CH DESIGN GROM
A.P. LENCH
a
DRAWN
A. RADONI
CHECKED
S.L.
DATE
03-12-03
SCALE
1/8"=V-0"
SHEET
#2