0209-001 (BLCK)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that l 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
Date` �j ✓t-' Signature of Contractor -14 -
OWNER -BUILDER DECLARATION
1 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:
( ) (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 9EMPT Policy No, SEE SUBU.18'i
(This section need not be completed if the permit valuation is for $100.00 or less):
certify that in the performance of the work.for which this permit is issued,
I Ws ll 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, I shalliforthwith comply with those provisions.
Date: Applicant
X p
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 anis 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.
Signature (Owner/Agent). ,& Date �` "• �' '
BUILDING PERMIT PERMIT#
�209-`01
DATE VALUATION LOT TRACT
JOB SITE_ . (,')
ADDRESS [;,'"!—WO ��E&Q
APN
OWNER
CONTRACTOR / DESIGNER / EN (NEER
�1'£',�;CtTi;`+�,.�..,F-;A )
�s'��'C9�r''itr✓a::t^11+�:�t%i�^�Ca:��
7tr6,51 THAX�r.VRAIANa`�
LA QUIRTA CA 92253
PA, -L-,&4 =U1TFXa CA, ! w260
{i Q)179, *90 CSr, H CA 48
USE OF PERMIT
GE,`ff W.,k3i1'lZ7Nfir
RIEW 4 ,tt SCREI+N V:i3lt.L FOR KW,ATER M:,TURE.AND Pf: 0L lC,Q0IPMi?"N .
et'. T1pZI V00.1,110 LS
XSr1Tgf'.f4,n'•!3 CO, Fr OF £:.`O:t*iKRCfC31Ci0
PLAN CHECK FEE 101.000x43.9Y318 MUD
CONSTY-13<"I'ION MZZ 101400-418-000-
STRO110MOTION XtE 101-€00.7,41.000
�ISC;�I,.L.A.'Ail�'�lS142�•iaQr1-�k23-��?G �bii.Uti
.
A40 PLA.'te9 CVW{Iti
(� i.���a PREP YLZ
$0.D0
SEP 12
$179,1D
CiF CEDEDQUINT? A
REf,EIPT
DATE
IBY `/ /
DAT FINA _ /
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 & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
Set Backs
Electric Bondpti
Footings
Main Drain
Q"
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
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
��p 2---
COMMENTS:
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
Utility Notice (Perm)
Bin ii?:: City of La Quinta
Bwlding S Safety Division
P.O. Box 1504, 78-495 Calle Tampico
Permit #La Quinta, CA 92253 - (760) 777-70: 2
Building Permit Application and Tracking Sheet
Project Address: 7 l Owrtcr's Name: �F
A. P. Number. �p��j -- ��0 ^ d Address: 0 !% /Tao
Legal Description: City. ST. Zip:
ontractor: ^� P Telephone:
-Address: 7�L' i-/ //�,o„ .gest /�l Project Description
(City. ST. Zip:
#
Submittal
�o
Telephone:
TRACKING PERMIT FEES
Plan Sets
State Lic. #
`City Lic. x:
Item
Arch.. Engr.. Designer:
Structural Calcs.
Address:
Reviewed. ready for corrections
L Plan C=heck Deposit
City. ST, Zip:
Truss Calcs.
Telephone:
State Lic. #:
Name of Contact Person:
D
�1
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.: #StoricsFN Units -
Telephone # of Contact Person: ��% 2 T 4-7
Estimated Value of Proiect: ar
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rcc'd
TRACKING PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed. ready for corrections
L Plan C=heck Deposit
Truss Calcs.
Called Contact Person
/ v2 Plan Check Balance
Title 24, Cales.
Plans picked up
O 2 Constuction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2" Review. ready for corrections/issue
Electrical
-
Subcontactor List
Called Contact Person
Plumbing
i
Grant Deed
Plans picked up
SMA
H.O.A. Approval
Plans resubmitted
Z Grading
IN HOUSE:-
» RevieN, ready for correction issue
3 Devebper Impact Fee
Planning Approval
Called Contact Person
A.I.P?.
Pub. Wks. Appr
Date of permit issue
School Fees
Total. Permit Fees
Lake La Quinta
73-320 El Paseo
Palm Desert, CA. 92261
y 760-568-0349 Phone
760-346-4349 Fax
7/10/02
Wende West
47350 Via Koron
LaQuinta, CA. 92253
Dear Wende,
This Letter is to inform you the Architectural Committee has reviewed and approved
your architectural / landscape request form on 7/10/02.
Sincerely,
Craig MacDonald
Architectural Chairman
�TON6
Lake LaQuinta Association
ARCHITECTURAL/ LANDSCAPE REQUEST FORM
Lot
;late Submitted: � �� _ Date Received:__—
Ga°per's Name(s): �_1��T-__-.-_-- _--- (Herdt:aiier "Ap)>lica tt")
Property Address:3 sd�! ..J'! ��% -_ __-••-- —_---- --
Local Phone:.J_f' �250_ T � Other Phone: __ — ----
Mailing Address; .—II&In)'= ------ _------- -- -----
(If different from property addreaa)
18 applicable: r
Architect/ Contractor Nam Q
Telephone:
The following described modifications are proposed and approval is requested in accordance with the
Procedures outlined in the Association's Architectural/Landscape Guide -tines ('nereina:t:r "Guldehnes')
Description of projectlici-einafter "lmproven;ent ):-��-.--
(Pleesc provide n couiplelc utltrntivc ilc sci.piiuti of tht prupuNed utUdiliLMliU11 at:d iuW'.utic d17;A Titus em aIJjJ1ul1iat0
This Architectural/ Landscape Request Form shall be accompanied by:
i. Ail copies of plans and specifications, as e:_urnerated in the Application Procedu•e,
Ar•t.iolr. 111, wit.11iri 0it: i�rllltl!-1111('~.
2 Complete Architectural improvement Agreement, where required.
3. Neighbor's Comments.Section, w-hcre applicable, (Neighbors should also sign the. fans.
THE APPLICANT UNDERSTANDS AND P.GREi S To THE K)LLOWING:
I. 'rhe modifications will be made in strict coinpliartce with the approved plans and s?ecifications
sl-ibnnitted with t1ni3 application. S!iould any changcs be required at any time during the ,.)reject, those
changee must be approved in advance.: b}, the Architectural Review Committee and luted on thia
application.
2. Owner shall hotel the Association ha::nless from a)1 !iability related to my damage: to existi-ng
i-rsitlt'71Ct-S, ilrthrcwrrnt-.'nts tlitrt-oli, ;Im ::crf11111 T) propt.7.y.
3. Appl_ican-, shall advise Association cllrce prorriptly upon: completion of the work.
4. Applicant shall comply with the Architectural / Landscaping Guidelines and Design Standards for
l,nkt•- La Quinia Ass(xJHI.lolf, and rurnitili colics of l.littsr. provitiiolls I.o Llw txnil.r�utor(s) rii�agrcl
by Owner -for the improvement. Applicant further understands that it is Owners responsibility to
ensure that his/her contractor(s) also complies with these provisions.
5. Applicant shall secure proper building permits, if required by the local governmental entity.
Applicant understands that the City of La Quirita may not approve any plans which Rave not
yet been approved by the ASSOciaUol-i's Architectural Committee.
OWNER SIGNATURE (S)
Neighbor Comments: (fhe comnierts of any ow,iers of any home adjacent to the property lines of the applicant's
Improvement shall be rcyuired for awnings, built-in barborucs and water fcatur cs, coucrctc lendscagc borders (curbing) L-nces,
weMa, imst cooling systems, patio extensions, pools / -Spa's, room additions / enclosures, alar panels. certain tee151 palms and such
other improvements the Architectural Review Committee deenis appropriate)
I/We, the undersigned, have reviewed and signed the pians and specifications for the above requested
improvement and 1/we either: (1) do not object to this improvement; or (2) object with the following
comments:
N h i ure /Printed Name Lot # _
Comments
(For Association use only)
COMMITTEE REVIEW
❑ APPROVED as submitted. Project to be completed by:
❑ APPROVED subject to the following conditions:
DENIED for the following reasons:
❑ HELD OVER pending receipt of the 1 w' g inf r7n tion from Aplic
Committee Member Signatures
ti
APPLICANT NOTIFIED OF APPROVAL/DISAPPROVAL, Date: _
/-� 2 CITY OF LA QUINTA SUB-CONTR TO LIST �/
ADDRESS l J�D C '� ✓ PERMIT NUMBER � (�i' OWNER � BUILDER` Z �''
���� �F ��t zz ?
Form shall be posted on the job with the Building Inspection Card at all times in a conspicuous place. Only per ons appearing on this list or their a ployees are authorized to work
is job. Any changes to this list must be approved by the Building Division prior to commencement of work. Failure to comply will result in a stoppage of work and/or the voidance
ilding permit. For each applicable trade, all information requested below must be completed by applicant. "On File" is not an acceptable response.
.de i r. r c ns >` Workers.Com ensaUon'insurance . Cit .Business. License
/ Classif cation Contractor State.Cont a for s L ce e . Y
Company Name Classification License Number Exp. Date ICarrier Name
(e.g. A, B, C-8) W I (xx/xx/xx) I (e.g. State Fund, CalComp)
Policy Number Exp. Date License Number Exp. Date
(Format Varies) (xx/xx/xx) (xxxx) I (xx/xx/xx)
(C-531:
SIPOVAC CONSTRUCTION INC.
"AN -AWPP":",TELY SIZED DEBRIS CONTAINER
' .-. pili; D ON THE JOB SITE DURING ALL
:..,;SES OF CONSTRUCTION AND MUST BE
��ITIED AS NECESSARY FAILURE TO DO SO fm `55
' fm 1350 psi Py 40000pe1
IzwIs1=D:
pT 10, 2002
�',fiAY CAUSE THE CITY TO HAVE THE CONTAINER �+4 0 24' vent. O c
DUMPED AT THE EXPENSE OF THE OWNER/ 4 0 32" Ho
per Gltyy of La Qulnta
ACCEPTED BY:
CONTRACTOR." 4' garden wall epee.
new wall for water
feature HOLE5 12° DEEP SAW DRILLED
EPDXY #4 a 24" VERT O el
Water retention see eng. dot. 04 O
New wall
patio - patio
grade grade �<3QYOF STSnSIo,
,,-"16' RUCTION HOURS existing ij � ENNIS S. WIS
ktober 1st - April 30 emv retaing NO.0-04125
tin wall 4 footing x E P.
,1;-uda•y - Friday: 7:00 a.m. to 5:3 g ��
retaining 3
a��rday: 8:00 a.m. to 5:00 .m. Pool equip. '�. c
None wall 4 Footing p
'
_:s (aay: behind wall a
w- 2rnnient Code Holidays: one "= Cf t c
t 1st - September 30th
Jay - Friday: 6:00 a.m. to 7:00 A RE-
NSPECTI ON FE E
:..,-Gay: 8:00 a.m. to 5:00 p.m, rillll B
CHARGED IF THE AP
.: None
1
• ^rs:ti"T nent Code Holidays: None PLANS
AND JOB CARD ARE
ITE FOR A SCHE
f HE
DETAIL
L
north � i e w INSPE
ION.
�, �
1 - o„
NO EXCEPTIONS!
WEST RESIDENCE
DS
SGING.
PROPOSED WALL OF LA QUINTA P01�ARAWN G CONSTRUCTION
7BUILDING
AND WATER FEATURE & SAFETY DEPT. 12651 THEODORA LN.
47550 VIA KORON PALM DESERT GA. Q2260
LA QUINTA, CALIFORNIA 760-567-2547
FOR CONSTRUCTION
'12
--�
31 01•-
01POVAC CONSTRUCTION INC.
6" amu
fm I!Mpal f� 40000psi
24 Vert. o CL
REVISED:
#4 ®92" Horiz
AUOU5T 10, 2002
perLa OvInta
,r'W
.d, spea.
ACCEPTED BY:
nev4 wall for water
120 VEEP 5/160 DRILLED HOLES feature
EPDXY 04 a 240 VERT a al
Q Water retention see eng. dot,
New V4011
Patio patio
I -
grade grade
existingg
amu
rl
V4011 4 footing existing
amu retaining
o'n
I ut wall 4 Footing
ut
=In=
existing
steps
2 DETAIL
South vicvw
1/411 = 11 - oil
CITY OF LA QUINTA
WEST RE5Z)ENCEDRAWN
BUILDING & SAFETY DEPT
8Y SOB 51POVAC
PROPOSED WALL
APPROVD
E
51POVAC CONSTRUCTION INC.
AND WATER FEATURE
72651 THEODORA LN.
47550 VIA KORON
FOR CONSTRUCTION
PALM DESERT CA. C12260
LA QUI NTA, CALIFORNIA
760-567-2547
DATE BY
0
SIPOVAC CONSTRUCTION IN, C.
V 6" CMU 4' GARDEN WALL PER CITY SPEC'S
METAL TIES PER GBG 1403 QRO�ESS�p
0
REV 15ED:
AUGUST 10, 200:2
.
tr DENNISu". YlISH d�
3.4 METAL LATH OR STUCCO � N0.c-04125'0
ACCEPTED BY:
MESH
EXP. $
IVIL
1 FLAT SCRATCH GOAT OR .`
BROWN COAT��
3/6" MORTAR Mosonry and stone units (5 Inches (127, mm)
maximum in thickness.[ Masonry and stone veneer not
e;<ceeding 5 Inches 021 mm) In thickness may be anchored
F— GORONADO STONE OR BRICK directly to structural masonry, concrete or studs In one of
the following manners:
1. Wall ties shall be corrosion resistant, and if made of
sheet metal, shall have a minimum thickness of 0.030 Inchi
(0:76 mm) (No. 22 galvanized sheet gage) by 3/4 Inch (14.1
mm) or, if of wire, sholl have a minimum diameter of 0.148
Inch (3.16 mm) (No. 9 B.W. gage). Wall tbs shall be spaced
so as to support not more than 2 square feet (0.19 m2) of
"
wall area but shall not be more than 24 inches (610 mm) on
center horizontally. 'In Seismic Zonas 3 and 4, wall ties
shall have a lip or hook on the extencbd leg that will
engage or enclose.,a horizontal Joint reinforcement wire
having a diameter of 0.148 Inch (3.16 mm) (No. q B.W. gado)
:• - . '
or equivalent.
The point reinforcement shall be continuous with butt
Splices between tie:: permitted
1,14
GBG 1403.6.4.2
STONE DE'TA 1,L
A13.1
1/4DETAIL- oII
CITY OF LA QUINTA
WEST RE51DENCE
D"WN 15Y 801551FOVAC
BUDDING &SAFETY DEPT.
FROF05ED WALL
51POVAC CONSTRUCTION INC.
STONE ATTACHMENT Pr=T4,IL
APPROVED 72651 THEODORA LN.
47550 VIA KORON
FOR CONSTRUCTION PALM DESERT CA. c12260
LA OUINTA, CALIFORNIA
760-567-234.7
DATE BY — �—A
SIPOVAC CONSTRUCTION INC.
REVISED:
6" cmu
AUGUST 10, 2002
fm 1350 pS1 f 4001
#4 ®24 Vert. is CL
ACCEPTED BY:
8t _ #4 ® 32" Horiz
new wall for water
per Gty of La Quints
feature
4 garden wall Spec.
12" DEEP 5/16" DRILLED HOLES
EPDXY 04 a 24" VERT a ci
Q
patio
grade
patio
/grade
L/ &-"*' STEPS TO BOAT DOCK
POOL EQUIP.
BEHIND GATE
EXI5TINS SCREEN WALL
ON EAST SIDE OF HOME
QQpFE Slo
existing
amu re lning
�a
existing
am reialNng
-
�{ DENNIS S. WISH i
wall
wall
o.C-041250 m
Ex P.
3-AtP
current pool
equipment
t rc�FC �a
under ground
,�
WEST VIEW
EW
A1�.1 1/411 = 1, o11.
CITY OF LA QUINTA
WEST RE51DENCE
BUILDING & SAFETY DEPT.
DRAWN BY BOB
51P0\/AC
PROPOSED WALL
APPROVED
51 PO\/AC CONSTRUCT I ON INC.
AND WATER FEATURE
-72651
72651 THEODORA LN.
47550 \/IA KORON
FOR CONSTRUCTION
DE5ER7 CA. C12260
LA G2UINTA, CALIFORNIA
760-567-2541
DATE BY
SIPOVAC CONSTRUCTION INC.
Q�OFESS/p
O � �,lr
REVISED:
AUGUST 10, 2002
DENNIS S. WISH
NO. C-041250
ACCEPTED BY:
XP.
VII `
q
�F
ADM AREAS
E NEW WALLS
STEPS TO POOL EQUIP OVE PATIO GRADE
BOAT DOCK
O
.............................................................. U-
T -
r WATER
CITY OF
Q U I NTA
see e,,,g. dotTOME TU I LDI N G& S
FAE/TY DEPT.
A P r"pR
�/ C
FOR CONSTRUCTION
STONE VENEER
DATE ___
BY --
DETAIL1/411 FLAN VIEW
= it
WEST RE51 DENOE DRAWN BY BOB 51 POVAO
PROP05ED WALL 51 POVAO OON5TRUCT I ON INC.
AND WATER FEATURE 72651 THEODORA LN.
47550 VIA KORON PALM DESERT OA. Q2260
LA QUI NTA, CALIFORNIA 760-567-2547
• 1
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ataar'
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473-50. VIA KORON
LA QUINTA CA
92253
71-011
ELEV. VIEW
0
S[POVAC
CONST. I.N.C.
567-2347
r1rin
1
A-1
47-350 VIA
KORON LA
QU ENTA CA 92253
•
PROPOSED WATER
FEATURE
siPovac
GQNST. INC.
567-2347