9909-197 (SIGN)ON W
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LICENSED CONTRACTOR DECLARATION
I heret�klff'rm under penalty of perjury that I am. licensed under provisions of
Ch.,,iar 9 (commencing with Section 7000) of Division 3 of the Business and
p-ofdssionals Code, and my License is in full force -and effect.
License # Lic. Class Exp. Date
i'24483 C-115 C6 J D-42
Al
ate Signature of Contractor
OWNER-BuILDER DECLARAP&
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
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, forthe
pe12#)vrnce of the work for which this permit is issued.
4 n have and will maintain workers' compensation insurance, as required. by
on 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.
rl. XY A t_%XIE Z `V r Policy No.
MR1.1 �, S,
vswrt,%., a ,, IT. 1�
(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: prc!Yisiong n of Section,3700 of the Labor
Code, I "ll fo hwith comply with thopi provipons
p, L Applicant F,
Warning: Failure to secure Workers'LITIpg4alion coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, 16
addition to the cost of compensation, damages as provided for in Section 3706
of thlb-Labor Code, interest and attomey's fees.
IMPORTANT Application is hereby made to the Director of Buildingand Safety
for a permit subject to the conditions and restrictions set forth, .66 his,1
application.
1. Each person upon whose behalf this application is madeA 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
truction, and hereby authorize representatives of this City to enter upon
;_e"Sbove-mentioned property forinspection purlibses.
�p
nature (Owner/AgAnt) e-' pate
7
PERMIT #
BUILDING PERMIT
DATE 09!XJJ1!Y9 VALUATION S17-3.00 LOT TRACT
APN
JOB SI TE
ADDRESS
OWNER CONTRACTOR/ DESIGNER/ ENGINEER
K 1 1 ,� r.., 5 r s,: a m-, . mc.
11,40 Vv_iA BLVD Z 60', t c) i C, KiJ K E L, vvs�,Y
LAQUINI'VAL CA 92253 PALM SP'RJN08 (.',A 9�1'6jr
USE OF PERMIT
GRNL-AAL
A -Wk iti K 640iN LNIFM- i E N -11i V 1 i t 4 P 1� fi', k 9- 4-4 -11 5�3 AN", F A R�*,) '1� 4.
SJ9)
tOwIn a 4A It' W.10) '0 Mi
111*41131.7.6*21
CONNTFW-�'FION
t
'M 30N
il)ilryl'y C Sl? [X'rJ.0N ANO Pl_A N' VHKK 15 IN
t0l'A-1, PIAMST MOEN IMP', NPW S1 5.00
DATE I BY r V .,! I DATE FINALED I - JINSPECTOR
OPERATION
DATE
I INSPECTOR
OPERATION
I DATE
I INSPECTOR
BUILDNG APPROVALS
MECHAMCAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
ExhaustFans
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
SLOCKWALL APPROVALS
POOLS_ -SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMMMIS APP'R'OVALS
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
Final
UU14 Notice (Gas)
ELECTMIGAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
ur Lti u Iuv 11-1
• ' • BUILDING AND SAFETY DEPARTMENT
GARDEN WALL STANDARD
6' C.4.U. '
rm- 1350psi, Fy- .40000psi
/4 O 24' Vert O CL
/4 O 32' Hofiz
I 1
6 1/4'
ALTERNATE
3CLEAR BENDS ,
/4 HORIZ. AS SHOWN T c
rm. 13
50ps(, Fye 40000psi
#4 O 24' Vert O CL
/4 O 32' Horiz
r
GARDEN_ WALL
Scale: 3/8'
6, C.M.U.
rm. •1350psi. Fy. 40000ps1 3" CLEAR
/4 O 24' Vert O CL /4 HORIZ. AS SHOWN T
/4 O 32' Moriz
"o
1 ti
Ift v
OPTIONAL
10-11/16" 30'I.AP
�41 GARDEN' WALL
Scale: 3/8' . 1'—O'
ALTERNATE
3" CLEAR BENDS
..
/4 HORIZ. AS SHOWN T I
6' C.M.U.
2 —.0` emk 1350pfi, Fy. 4000Opsi
#4 O 24' Vert O CL
/4 O 32' Halt
Ac
GARDEN WALL
Stole: 3/8' . 1'-0' OPTIONAL
r 6' C.M.U. 30%AP
v
f'me 1350psi, Fy. 40000psi
p4 O 24' Vert O CL
L /4 O 32' Horiz 3' CLEAR T
/4 HORIZ.. AS SHOWN
I �I _
Io in
OPTIONAL
10-11/16 o 30'LAP GARDEN WALL
' Sane: 3/e' - ►'-o'
ALTERNATE
3' CLEAR � N
14 HORIZ. AS SHOWN T ,I
—3'
GARDEN WALL
seole: 3/8" V-0"
4CIT, OF LA QUINTA
BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
DATE
9� By
T
t-- 2.0 i
Best ;Figns
ANO PLANS INDICATED OR
ALL IDEAS, THIS
REPO NTED BY THIS DRAWING ARE OWNED 8Y ANO PROPERTY OF:
LI AGNS. INC. AND WERE CREATED EVOLVED AND DEVELOPED
- � PG
project t1Qme:��� �
qty: I
1 1
I N C O R P O RA
ON AND IN CONNECTION WITH THE SPECIFIED PROJECT.
MM
scale: '
PALM SPRINGS r PALM DESERT
NONE_OF SUCH,IDEAS, DESIGNS, ARRANGEMENTS OR PLANS SHALL
BE USED BY OR DISCLOSED TO ANY PERSON, FIRM OR
800 -50 -SIGNS
ORPORATION FOR ANY PURPOSE WHATS
WRITTEN PERMISSION OF SWSIGNi INCOEVER WITHOUT THE
item:
date: �,� 0I al at