0206-219 (PAT)LICENSED CONTRACTOR DECLARATION _ "`•�`
I hereby affirm-urider p2nalty 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. Date
f619D64 3 FIX A 00012C
Date f d -,VA) Signature of Contractor �J''•" r�J�r/
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 3TAT9 FUND Policy No.
(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 provisions of Section 3700''of the Labor
Code, I sVll'forttlwith comply with those pr�sions..�.,.�-�
Date: "'i'.2 LIU Applicant-
Warning:
pplicant 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.
BUILDING PERMIT PERMIT#
02,06-119DATE VALUATION LOT TRACT
JOB SITE APN
ADDRESS 50-415M. .772.4 -007
OWNER CONTRACTOR/DESIGNER/EN (NEER
'E 1401 1w, ICU i Z,tv V. i ,l°, iwc.
PODOX 810 142 5 :k? UL35zJMY1"L�' WANE
1AQ1:1'kwx.r'�. CA 92253 AY, 85034
`602j?57.1 656 MIX: 4990
USE OF PERMIT
121 $? C4A"LP80 WITH SWIC: & S3Q PER lAPPId.C;e'f<.:±.! PL/LXuS.
POl1.E.1MA I'IO
121,00 3F
q+,q� �+�y �v yV i, r�� �yESITI.i�, (IM) cosr OF CONS'.f. .I MON
PWI CHECK FEE 10 1 -NO-429 9-X1 8
W?dSi':RVCPION FRE 101.000-418-000 $39.00
PLUMBING "R19 101-000-419-000 $21,00
;1`rRGN%0';,AO'1'4'IUN Yg , MID 101-000-241000 $.50
��%1fAld'#t^Al,'F`I?� � 101�0(tii�Q21*Oti!) 't19,5(b
JUN 2 8 200Z
U �
.—WY OF LAQUINTA
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-mentioned property for irtspectionpur •pse/s-
X / RECEIPT
Signature (Owner/Agent) ..� " " Date �1..
•Y
.i
DATE // BY DATE FINALED INSPECTOR
r/ �3 Z
1111610101,M)
)
' 105.3
$(X00
$105.3%
I
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 r
BLOCKWALL 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
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
Utility Notice (Perm)
COMMENTS:
2"
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11
CITY OF LA QUINTA
-915» BUILDING & SAFETY DEPT.
16 APPROVED
R7'-116' FOR CONSTRUCTION
DATE �IOa- BY
e�,a 37,-1116„
10' I
11'
9'-116» 7'_07 » ��-116»
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Gazebo ceiling to be 9.5' stucco lid. Counters to be at 32" high unless noted otherwise.
Columns to be 24"X24" with stone veneer to match house.
BBQ (ETL-3020914) with insulated Jacket. Roo?c Am= elTGr/
Stainless steel sink with 4014010r vent
installed. Clean out at south side of
Gazebo.
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headers between columna to support
hand cut roof. /4 top and bottom
were used in the footings under the
cotumns. We hove sheared the
column with 1/2" plywood. Tile roof
with 18" overhong. Stucco
throughout similar to our current
patio overhang with stone on
columns,
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hand cut roof. /4 top and bottom
were used in the footings under the
cotumns. We hove sheared the
column with 1/2" plywood. Tile roof
with 18" overhong. Stucco
throughout similar to our current
patio overhang with stone on
columns,
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Columns to be 2'x2•x9.5'with 4x8
headers between columns to support
hand cut roof. #4 top and bottom
were used in the footings under the
columns. We hove sheared the
column with 1/2" plywood. Tile roof
with 18" overhang. Stucco
throughout similar to our current
patio overhang with stone on
columns.
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