0210-248 (BLCK)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. D,gte/
:?975] B
Date/� Signature of Contractor
OWNER -BUILDER
I hereby affirm under penalty of perjury that I 6 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 ST.&Tg pL11gD Policy No. 1661,591.01
(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 agree7thattJf I should become
subject to the workers' compensation grASr safff ct on 3700 of the Labor
Code, I shall forthwi h comply with t ses,� ns
Datej Applicant �
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to crimina 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 applicatonsagrees 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�tate laves relating to the building
construction, and hereby authorize rues nt&atives bf this City to enter upon
dA Y If I
the above-mentioned property for,ins ectlo , ,urgoses.
Signature (Owner/Agent)%� f —''r Date A dl�
RUI,LDING PERMIT PERMIT#
MIAS
DATE VALUATION LOT TRACT
JOB SITE
ADDRESS 47-5-10 VIA FLORANCE?
APN
OWNER ;'
CONTRACTOR ENN61NE/ER��p
p�7x yp�p / 7�g�� y��y
CAIW �W.A7 5, ,& 4.'OSVId'"�'YF`1 X
�y/yDESIGNER
6,il9E�iAD tY & �+�.✓!.'�ll,.b�.�ia��� .f.
1:09rol CA 9272
:t`US.H.N CA, 92M)
0714)308.4440 MIA, 4485
USE OF PERMIT
C��fr"1�.At, 33`CT5113��
s
S LY. 4' WAM,, -73 4F 33°
LI,,, Ory+
�t..�.t+y6''p0ARTT)�KH 7�iH./
�Ly`��i��.DEN
(�
!I 91' �YXR 40 WALL. AIA, z.dXlCO SYSTEM
EM
6 its', VIAM, 3AID V
4 FT, V,;:sALL 43.00 LF
PK'.%2 fi " ]FR9 SUMMARY
4Ot 3TRUC`i`IONVEM 101.000-418.000 $13.10
�+ f
y.
- D e
t
OCT 3 , i1'1!/
CRY OF
Lk QUJNjA
FlNANi E ompt.
41
W GSC
TOTAL r.LIM! f,1�.10 a S L��� NOW�?�+4�J
1 RECEIPT
DATE
BY
DATE NALED
d�
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 8 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
Footings ri
Main Drain
Bond Beam
Approval to Cover
S
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING AP OVALS
Gas Test
Electric Final
,Haste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
'jhower 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
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
i
• 1 V• Illi' 11 1• Il1A YVU YVV ♦1VV .
�I PLAN -JOA
j LIONG AREA = ,3, 0.34.0 S F:
GARAGE, AREA = 630.0 S.F,
1 gFF: 60.40 0
CO�}.�CRE1F
ORYK'AY PAD: 59.90. 20.61'
g
110.7% 70'
20167'
- 00
Q�
BLOCK WALL
N 69 39 52' E 111.50'
' I '
1 (2) A/C CONDENSER UNITS ON TOP
OF 3- (MIN.) CONCRETE PAD
I
L 0 T- 1120
SCALE-- 1" =20'
I
LAND 1910 S. ARCHIBALD AVE., STE. N
ONTARIO, CA 91761
DEVaOPMENT(909) 930-14-66
✓OB A��R�-SSS
DESIGN FAX (909) 930-1468
CORPORA TION PLANNING • CIVIL • SURVEYING
47-510 KA FLORENCE DATE: SCALE: SHEET: JOB N.:)L.
OF WATER COTS.
LAKE LA OUIN TA, LA OUIN TA, CA 9225) 12/26/00 1 1---20' 1 106 Lor 121
V1
N 693 52~
PHONAL
L07 ,121
Pool
of
�I PLAN -JOA
j LIONG AREA = ,3, 0.34.0 S F:
GARAGE, AREA = 630.0 S.F,
1 gFF: 60.40 0
CO�}.�CRE1F
ORYK'AY PAD: 59.90. 20.61'
g
110.7% 70'
20167'
- 00
Q�
BLOCK WALL
N 69 39 52' E 111.50'
' I '
1 (2) A/C CONDENSER UNITS ON TOP
OF 3- (MIN.) CONCRETE PAD
I
L 0 T- 1120
SCALE-- 1" =20'
I
LAND 1910 S. ARCHIBALD AVE., STE. N
ONTARIO, CA 91761
DEVaOPMENT(909) 930-14-66
✓OB A��R�-SSS
DESIGN FAX (909) 930-1468
CORPORA TION PLANNING • CIVIL • SURVEYING
47-510 KA FLORENCE DATE: SCALE: SHEET: JOB N.:)L.
OF WATER COTS.
LAKE LA OUIN TA, LA OUIN TA, CA 9225) 12/26/00 1 1---20' 1 106 Lor 121