0308-073 (PAT)H
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LICENSED CONTRACTOR DECLARATION t"
I hereby affirm under penalty of perjury that I am licensed under proTsions 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
771699 ::15 /,% 04/30/l(
Date �'! �,fS gnature of Contractor /-"
J OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am -exempt from the Co'ntractor's
License Law for the following reason: ` • 1.
( •) 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 Funder 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 L1SER X 1+ U TUALF, Policy No. WA20217Q04`n3012'Ti
(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, a9d?agree that if I should become
subject to the workers' compensation provisionsbf Section 3700 of the Labor
Code, I shall forthwifh,comply with tFiose'providionsr
Date: f., At 1/1 -Applicant t
r • Warning: /Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application:
1. Each person upon,whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant'to
any permit issued .as a result of this applicator agrees to, & shall, indemnity
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any, permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City„and State laws relating to the building
construction, and hereby authorizeyrepresentt tives of this City'to enter upon
the above-mentioned property
/foorfinspecttio�np rposes.' !
Signature (Owner/Agent) 4`r�' /� Date/ /•
1 �. t'..:.�r4 filer .a>S' • _
BUILDING PERMIT r PERMIT#
DATE VALUATION LOT '-073 TRACT
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JOB SITE^
ADDRESS a._22.5LEj+C,�..I+rMS WAY
APN
OWNER
CONTRACTOR/DESIGNER/EN (NEER
Mill, EVROTHERS INC
TOLL BROi M81 UqC
73-121 FRFJ) WARIWG M 00'
13-'121 RRMI) WAMTG A100
PALM pE,MEiL7” CA 92260
PADS DE, WO.` CA 92260
(760)614-9699 C81,4 383.3,2
USE OF PERMIT
PATIO
PATIO TRELLIS FOR '!'N.:D�il . ,SAIES TRAIL IEE
PORCIPP. rIO 203,00 8.0
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x4,766,40
P:14iX9C M SM. MARY
PLAN CHECK FE T n�-ac)a,439.31$ $35.1t1
CO STRVC-%ION PF}?• 101-000-418-000 $54.00
37 RO'NObNOTION FEE - COMM 100.000.2.41-000 $1.53
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SEP -17:2003
,
CITY OF LA QUINTA
FINANCE DEPT
UR-TOTALcognRITIC110M fiND PLAN C'HF=
$89.68
LMS PRE -]'AM FUS
$0.00
SOT AL FEMM* FEES DUE NOW
"9168
RECEIPT
DATE
BY f,
DATE FINALED
INSPECTOR
7
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
Steel
POOLS - SPAS
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final I I
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
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service -
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
UU14 Notice (Perm)
COMMENTS:
r •
08-29-2003 09:07 FROM-MDS CONSULTING 7607714073 T-842 P.002 F-669
l 26,00' 61.39) 461,50 �rorol
TC TC EXIST, 6" WE DGE CURB
..;
8900.Lj
. K'' ;.
34
c'': EXIST. HC PARKING STALL WITH
I462.50
FL-c8'"2 463.01 x BLUE PAINTED INT'L LEGEND
462.8
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SIC
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cAt
LLJ
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r.r....;a.• .t _4:L l'-=:•�',;xJ- �,, 5;" EXIST. HC PARKING SIGN
DIST. VAN PARKING
ACCESSIBLE
NG
�
`t�� t3 x STs- BLUE PAINTED
' � I .:� 3�'y :...` � � �r � -
-,>3{,___ DIAGONAL STRIPING.
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Lo
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/
. •.t, �. b'''' �t1 gL V i�.'4
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(P=463.5)
to _ - .d'':,._; _ .',?'j S!.•bE, �+c"`
-,a.,�i, . ].tic. w �}i.�•.',J ta, h-:..
/, - ``�:. :cb.�tS . t•s.:.r^; *:.,,.:�'A�^.. �"" EXIST. �' HIGH
WOOD FENCE
21. ONG EXIST. LOT UNE
x 10.00'
�'� -try..•: . "!.:.:.r�:a:�'AFaic �k
:?:....I UTURE
463.2 t. TRUCT
ION
FL
463.3
x 463.28 463. V o 463.50
FS F�
I I -,� _ FS f �
cn I ao
00 001z'SALES ' TRAILER OFFXtx CONSTRUCT 10' x 10' .
0 x CK) FF=463.60 PAD--461.1 PAVED WALK TO SALES OFFICE:
N I CN 81-255 LEGENDS WAY j T A.C. OVER NATURAL.
SLOPE _- 1.00%
CD I �z BM EXCAVATED PAD ELEVATION FOR 6' x
SALES OFFlCE IS 3(r BELOW F.F. ELEV. f ,�
I SHOWN ON PLAN.
in MW
x K �! Md 9
25. CITY F Q Arm
.,� PAD=463.3 BUILDIN FETY DEPT.
0.87. A P� V E D _
QCT BpU�DARy OA.. t. - .::.,: RUCTION Y
SCALE; 10=20'
DATE �-% -p 8�►�.0