005-335 (AR)U)
F-
04 CV W
W
O =) C,3
r-du7
I W
I
o Z
� OO
I— co
J '
LLJa
Z
CO
Lr)
N
ON
U_ °)
W Z
r•� O
W
X W —
mVU
O
LO H
Z
coD
r, C)
Q
J
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. Date
44 A 1.8 B 0&3 a.
Date Signature of Contractor �� ~
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. .
( ) I, as owner of the property, am exclusively contracting, with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code). 0-
( ) 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. ;•l-
( ) 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 STATE FUND Policy No. 229.93-400921.1
(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
pgubject to the workers' compensation provisions of Section 3700 of t 4 Labor
Code, I sh II forthwith comply with those provisions., / W
Date: Applicant
i � r
Warning: Failure to secure Workers' Compensatiojn coverage is,,u lawful 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. N
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 and state that the above information is -
correct. I agree to comply with all City, and State laws relating to the building
cpnstruction, and hereby authorize representatives of this City to enter upon
)fie above-mentioned property for inspection purposes.
Signature (Owner/Agent)"_-\ - Date S •�� �77�
51)1-t110 BUILDING PERMIT PERMIT"
DATE VALUATION LOT "' TRACT
JOB SITE
APN
ADDRESS 49�-5.17 GUr ARO
646-210407
OWNER
CONTRACTOR / DESIGNER / EN (NEER
3IA HAPiMHOW
T.A. IF,1`MMY COME Co.
49.517 GIMAIRRO
48731 BA141.1MR0 MW=1
LA,. t7UJ9rA CA 92253
L,A. qJ—ftTf A CA 9225:
(760)564-+4660 CBV1 469
USE OF PERMIT
REMENUAL AlaMION y
135 SY ROOM ADDITION ONI Y - PER APPRML01) PLANS --
/
PATIO CONVIIPNiON 135.00 5F
FST A.I') COST O.' C0.N'SJW7VCiT()l.►1'
51535.00
PROGTli`U NUMARY
PLAN C11PCK FUS 101.000.439.318 $5.2,65
CONSTRUCTION FZX 101-000-418-000 $81.00
ELECTMAL 1YEE 101.000.420.000 $15.00
STRC NCI MOTION IetIE - RZSID 101.000-241-000 $.5�
SU -13 -TOTAL CONST RUCUOR AND PLM CHECK
$14.9._20
?
LUSS PRE—PAID PTM
$0.00
T E.sTA_.L PVR 1; _ S 1DUE NOW
$149-20
F
a
RECEIPT
DATE
BY//
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck 'zZyy
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Dz?
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Walt Firewall
Exterior Lath
Drvwail - Int_ Lath
2s? oa
lQ.
Final
rinai — z7f—,4
POOLS - SPAS
BLOCKWAL A PROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
I
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
_I
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temo. Use of Power
Final
Utility Notice (Perm)
:iF aad
,.
zi
�oucid
R fI:i'
i$
:J
�Q
..........
......
Jt
xx
... -:
=..
3R t
3?.: r
- ]
J3a a Ala:
Y: p q......... . ....................
:..�. �:..............
.: .............
Fes.,.:... ..:........:...........
�<> a:
..::......... ae=ra ' iswzw
1:•.,:
..........:.:.....
Qo
::................
. . ........
.........:..:::
t�
..:.:::... . ra ;
--
......::..
<.......... .......
p�:
aas�aa= ik a
E�
aew +�•
S �d
311
eJ1 i w n
Q S
:pafaid jo onWA RIVErnsa
0 ' }�
:uosiad i,eJuoD;o = auog alai
:Sl!II :Satlo3 C :13 bS
n S # f7t. j
C. f •'7'1
:uosjad loe]uoD jo atueN
oulau
lmd7g r�rjd .PPS' rI :(auo 013113) OCW 133fold
71 aidams
- —�`
C :auo da a
g I1
c• IIo
i1 IIO[J�nns
7. .7dlC
.L tR dnaa�Vr'�jr .
Z t�7 V
• '.ill
1 �4 vs :dtZ 1 S J
+
lllj
:ssaIppv
l {+Zv►ra r—� (, kA :latrdisaQ ..�au3 ..tla�d
:# 'ai`Z'�riu�
2 -ai-1 "leis
0'. :auogdalal
:dtZ
Vi IVV:uonduasaQloafold
7�`�
�f —• i �L �r :ssaiPPb'
.....
:sIIot;dala j
J - L ��'� V'
...
:drz -i-s"( )
:uotiduasaQ leaa�l
1 r1_ 1 C 1•� :ssavpv
:iagtunK •d '`d
_
? 1'Z 1 :atueH s lattmp
")7;A-1) }� ►
:ssaippv wfoJd
r
hays Sui�Peal pue uoiIvilddy Mwaad 2uiplin8
ESZZ6 VD 'mulnb ei
#mad
031dwel alleD S6I-SL
�koS l X09 'O'd
uolslnri(I tia;eS B SulPlin9
eluinZ) el
Jo
/a!D
ul>
�Iugun000d - Adoo ;diaoaWpuuoilddy - AdoD luuollddV/•IdaQ SuippEl-luujSiio passogmg
•slanlu,b llu l03 ddoa;ala;slp o; mlo; uol;sagddu Kaaga null iW to f4unoa;o Adoa u gaunV :ao;aalloj
'Ja!pea s! Janeyo!ym 'l!egaq (,$)(s,)youys!0 egy uo wegl loa!!oo
oy p-gogyne /ggua o!!gnd jegyoue of jo (s)youfs!0 agy of p!ed a,e Aegy go!gm uo jo pensss si loefoid s!gy jol pw,ad uope!!elsu! jo 6u!p!!nq agy go!gm uo alep ag! wail uru of u!6eq !µm anoge
pegguep! yuewAud jagyo jo seal egy yselaid hew noF go!gm u! poued !ena,dde step-06 agy yegy nog( Illgou oy anus Illm s!gl (966 L 'S1V1S '645 dVHO) L80E lll$kgwDssy jo yuensmd 30110N
VV/N °N )IaauD
00'0$ Iduzaxg
ufzog -I uuv XjuW
31aaga aq; no amuu
1117 a.ln;uu2lg
dq pa;dmaxa/ pa;aalloa aag
;uapua;ulaadnS
uoslTm sTJOU Al in
auogdalaZ paa uuoL - �/N plu saaj
panssi ag nnou ,(uul Ioafold posodoid sill ul a2too3 aiunbs sill ioj Aouudn33O3o saluoggja3 lo/puu s;!uuad
2uippq;uq; puu anoqu palsll ,Cuadoid aql 00'0 $ 10 S£I X 00'0
jo Iunoum aqI ui 080£S apoj;uamuiaeo0 of luunsmd pasodull saaj ,Clg!ouj loogos Imp sagglao slgZ
,Ldiaxa
ssa►I .io ;aag bs OOS uouippV jupuapisag
mosua.l Ouimollo3 oqI of onp aural slgl lu saaj loogos 2?uixud uio.g Idulaxa sl JOUMo pauluu-anoqu oqI pammialap uaaq suq
II •sauiogapgoui luaulaouldoi io samlongs Ajossaoou pagoulap laaj aaunbs 00g japan suoulppu luiluaplsai `s,funvllunn/soiled
p01OA03 `sj1odju3/sa&jia2 uo saaj loalloo Iou saop loius[Q loogos paglurl spuuS liosaQ aql `aunt tumid aql IV
I s;lun;o -ON
S£I a2u;oogaaunbS
said Apnis
# 2107
SU-S000#;Iwaad
£SZZ6 dlz
u}uLno u'l nol;alpsllnr
L£0-OLZ-9t,9 # udV
s;uammoa
uoijjppV j puapTsag ;uamdolanaQ3o ad,fs
# 3asa,L
njuma n7 Alj
o n?fm0 ;aaa;S L I 9-6V *ON
aaNvi'Idwoa d0 a,LVDIAIIH93
9198-ILL-09L
£SZZ6 V3 `94UM j u'I
pnog smind aun(I 0S6-Lt,
pi.i;s►Q IoogaS pagiun spuuS pasaQ
uojWuTdreg unramuX aawe0
6Lt,OZ '°u
00/9Z/S a;uQ
paj,eagdnQ og }oumo luaumoo(I
:aat;oM