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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 Sectiorr7000) of Division 3 of the Business and
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
7782,80 1 /21
,Date
,Signature of Co�tractt)Kr/,J
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 KXEM T Policy No
(This section need not be completed if the permit valuation is for $100.00 or less).
(N 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, -(shall forthwithrcomply with,tho a provisions, ,!�
Date`tl - �r Applicant ! Y% C f �7
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-mentionedpropefor insp�ec`•tion purposes. .
Signature (Owner/Agent), r'-f� --'" Dafe� r.✓�~;
BUILDING PERMIT PERMIT#
(XV -8-1,1
DATE VALUATION LOT TRACT
x,(100=
JOB SITE -
ADDRESS .,"vs A-wumA am�
APN
OWNER
CONTRACTOR /DESIGNER/ EN (NEER
CO�1✓ � YP .OFA,�t
LEGACY HO3>< S
2214 X. ]olJ;3Gk?WOOD
47.750 ADMiS ` .>.I k,'4228
SANTA ARTA CAA
LA QTJJXTA CA 92253
(760)564.7820 CBUA 411063
USE OF PERMIT
POOL A)t4WOR SPA
PCOL ONLY.lit,,A.RX!Ii13A F:1UEIL'3S1KALL h*,E ltl PLACE A"t
PRE-PLUTER. IB SPECTFON. E(WIPMEW ZKOLO, SURE 1400 INClfUND
POOL ANDIOR PRA 9,600,001-3
ESMAT COST OF C6)NSIRETC71TON
3,hii14). 0
XWO T FACE ;3'QAG1m4ny
PLAN CHECK FEF, �3 f l nt�?U 4��•3113 $64.33
C014STRUCTION 1<Ee, �:Ol-f?Ofj-•d1£�-Ot�4 $9 .00
ELSE PLICAL r, BE — POOL 101.000.420.000 �43.4p
MUM= PRE POOL.. 101-000-41,9-000
VUB-TOTAL COW. rRUC110N AM T' AN CFFs'.: X
$235,35
35
Lx PRP -PAW MI
$0.00
n
MZW1'FH%S DUE NOW
AUG 19 1003
CITY OF LA CBUIPdTA
FINANCE DEPT.
RECEIPT
DATE,
f
B f
r al
DATE FINALE
INSPECT
�3
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
BLOCKWALL APPROVALS
POOLS - SPAS
steel
Set Backs
Electric Bond .v
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test O
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 27
Gas Piping
Gas Test
Appliances
Final
40
...
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp., Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbftures
Main Service
Sub Panels
Exterior Receptacles
G'.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
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ATER RETURN
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UNAUTHORIZED UBE WARNING
THESE DESIGNS ARE THE PROPERTY OF
LENCN DES ON GRP -REPRODUCTION
IN ANY FORM WITHOUT WRITTEN CONSENT
IS EXPRESSLY PROHIBITED. UNAUTHORIZED
USE EXTENDS TO ORIGINAL AND MODIFIED
DERIVATIVE PLANS AND IS APPLICABLE TO
INTENTIONAL AND UNINTENTIONAL
INFRINGEMENTS.
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SET BACK
A.P.N.: 774-245-021
ADDRESS: 54-425 AVENIDA HERRERA
LEGAL: LOT #9, BLOCK #290, UNIT #26
.......
11
111AN5 PREPARED BY:
MEL VE\'TURE>
dba
A.P. LFINY11 11
CHECKED
S.L.
DATE
7-21-03
SCALE
SHEET
#1
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IN. TO PROPANE TANK
PROPANE TANK a
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FLOW LINE I-
PERTY LINE 100.00
UNAUTHORIZED UBE WARNING
THESE DESIGNS ARE THE PROPERTY OF
LENCN DES ON GRP -REPRODUCTION
IN ANY FORM WITHOUT WRITTEN CONSENT
IS EXPRESSLY PROHIBITED. UNAUTHORIZED
USE EXTENDS TO ORIGINAL AND MODIFIED
DERIVATIVE PLANS AND IS APPLICABLE TO
INTENTIONAL AND UNINTENTIONAL
INFRINGEMENTS.
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SET BACK
A.P.N.: 774-245-021
ADDRESS: 54-425 AVENIDA HERRERA
LEGAL: LOT #9, BLOCK #290, UNIT #26
.......
11
111AN5 PREPARED BY:
MEL VE\'TURE>
dba
A.P. LFINY11 11
CHECKED
S.L.
DATE
7-21-03
SCALE
SHEET
#1
SECTION
SCALE: NONE
3'
i
BENCH DETAIL
SCALE: NONE
UNAUTNORIZED USE WARNING
THESE DESIGNS ARE THE PROPERTY OF
LENCN DESIGN GROUP. REPRODUCTION
IN ANY FORM WITHOUT WRITTEN CONSENT
S EXPRESSLY PROHIBITED. UNAUTHORIZED
USE EXTENDS TO ORIGINAL AND MODIFIED
DERIVATIVE PLANS AND IS APPLICABLE TO
INTENTIONAL AND UNINTENTIONAL
INFRINGEMENTS.
A.P.N.: 774-245-021
ADDRESS: 54-425 AVENIDA HERRERA
LEGAL: LOT #9, BLOCK #290, UNIT #26
PLANS
A.P. LENCH
DRANK
TAYLORE
CHECKED
S.L.
DATE
7-21-03
SCALE
1/8"=V-0"
SHEET
#2
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FINISH SALT
WATFRI INF
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OIL
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LONGITUDINAL SECTION
I
SCALE: NONE
SECTION
SCALE: NONE
3'
i
BENCH DETAIL
SCALE: NONE
UNAUTNORIZED USE WARNING
THESE DESIGNS ARE THE PROPERTY OF
LENCN DESIGN GROUP. REPRODUCTION
IN ANY FORM WITHOUT WRITTEN CONSENT
S EXPRESSLY PROHIBITED. UNAUTHORIZED
USE EXTENDS TO ORIGINAL AND MODIFIED
DERIVATIVE PLANS AND IS APPLICABLE TO
INTENTIONAL AND UNINTENTIONAL
INFRINGEMENTS.
A.P.N.: 774-245-021
ADDRESS: 54-425 AVENIDA HERRERA
LEGAL: LOT #9, BLOCK #290, UNIT #26
PLANS
A.P. LENCH
DRANK
TAYLORE
CHECKED
S.L.
DATE
7-21-03
SCALE
1/8"=V-0"
SHEET
#2
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