0101-196 (SFD)LICENSED CONTRACTOR DECLARATION
Ifhereby 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
7,1 •18,,/8 0 4— ff lf?3 Yf2P.
+ '+' 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).
( ) 1, 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:
Carder Policy No.
Ooumq EAGLA 1XV, I~il}1►•C-A400-02
(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 shall forthwith comply with those provisions.
Date: l• rr1. Applicant``"i*#>1
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 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 inspection. purposes. f / • -
Signature (Owner/Agent) > , s�;" Date '
y^{/� BUILDING PERMIT PERMIT#
Dqf VALUATION LOT ���� TRACT
VVV XT -,. ` A*.% 17.1
JOB SITE
APN
ADDRESS n
OWNER
CONTRACTOR/DESIGNER/EN INFER
C":kW1:UPOIC MC1WEt.L C01a!f,€rralTM8
Cr'M1XURY LL C()Y1bML'�,a'4"
1535001 VDI arIMMY, ME *`1200
1535 30, 0b° ,r:FYR'_K1Af,; T& 01100
SAX B ."f:.W A -M.40 CA 92408
UNURNATUNO CA 92403
2120
USE OF PERMIT
W9011y, FAM11, 7 f 31 CT
SM, -WAW 3 ALTAR WT.147 - PE)MUT DOES N='T INCLUDE,
k.'. tf°�. Y41i4,€J'r C? d7istf .?C,o-` P RC)Af,`i 'i %PL'.&W CHECK VES
REDUCTION FOR MLY f1PLY, ISSUANC +, OF 2&AME K,,A N TYPF.
TRACT CONSi`,R:t?C°`PPON V26:00 ills
i?ObtC.Fdilaf TIO 166.00 sp
>;1`AR.«`ot'i3WC"•,Fi;T PORT {OP, ti.152,40
Ei�%�7fAU:I ED 0091 OF t:'C3P'YUMMOX
1.5101522M
CFS,NO"!'RITC170N FEE, 103-000-418-000 MUD
PIAN CHECK 1f3X f�v1i-�3��-`tIa $169.54
MEC1'tANICAL, :FRE 101-000-421 -OW 833 SO
:ELTI'C"°1'lUCA1, l✓C, E a til. • 000-420.000 $13A Z9
i'1,idIV4l3ING 71tF 101t,000-419-000 SlAio
STIRONO MOTION V''81e, • dtMM 101-000-24-1-000 $15.05
O WI-000
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3,302.8e
..LE50 PRE -PAID FEES
AN 1 8;,20,01
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RECEIPT
DATE
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR,
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings C,p� Q�
_
Underground Ducts
Ducts
Slab Grade T
_( _
� Z�p� _
Return Air
Steel
Roof DeckExhaust
Combustion Air
Fans
O.K. to Wrap
�����
F.A.U.
Framing
�/`�
Compressor
Insulation/I/6�e/
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 Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Waste Lines
_
$�Z�CSj ,�.�
Electric Final
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connectiong�
_
fj�b�
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
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
Temp. Use of Power
Final
Utility Notice (Perm)
e Certificatof Insulation
Your Home has been insulated with CertainTeed Fiberglass.Insulation products, which are designed
for today's safety standards and tomorrow's energy requirements.
Fiberglass is inorganic and therefore permanently noncombustible, so it does not have to be treated
with fire -retardant chemicals that will likely lose their effectiveness over time. It has not been treated
with chemicals that can corrode wiring or metal. Fiberglass will not absorb moisture nor will it
settle over time as may other insulation materials.
This also certifies that CertainTeed Fiber Glass Insulation has been professionally installed in this home
to provide the following thermal performance..
Job Name: Tournament Coll.- Canterbur Tract: 24317-1 Plan #: 3AR-ALT Phase: 4
Lot No.:. 17 Job Address: 54-255 Riviera- La Quinta, CA
Ceiling Area: R-30 Blown Insulation Garage Ceiling: Non Access:
With Living Above & Sloping Areas
Exterior Walls: R-13 Unfaced Batts
Overhangs: Access Attic:
With Living Above
Interior Walls: R-11 Unfaced Batts Between Floor:
Subcontractor.. OJ Insulation Co., Inc.
42620Mo Nedo, Temecula, Ca 92590
Signed
Tom Berry, General M ger- Temecula Branch
R- means resistance to heat flow. The higher the R- value, the greater the insulating power.
Ask your builder for the fact sheet on R- values. Keep this certificate with your other
valued papers. If you ever sell this home, this certificate -should be passed on to the buyer.
WCertificate of Occupancy �n
City of La': Qu'inta
Building and Safety Department �°FMo,,..E°`'�
This Certificate issued pursuant to the requirements of Section 109 of. the Uniform Building Code,
certifying that, at the time of issuance, this structure was in compliance with the various ordinances
of the City regulating building construction or use. For the following:
BUILDINGADDRESS: .54.-255 RIVIERA
Use Classification: . SINGLE FAMILY DWELLING
Occupancy Group: R-3 Type of Construction: , VN
Owner of Building: CENTURY CROWELL COMM
Building Official
Bldg. Permit No.: 0101-196
Land Use Zone: RL
Address: 1535 S. D STREET, STE 200
City: SAN BERNARDINO, CA., 92408
By: BILL GORDON
Date: 2/5/02
POST IN A CONSPICUOUS PLACE