0101-201 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions oA
Ghapter 9 (commencing with Section 7000) of Division 3 of the Business an
Pipfessionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
714.108 B 10431 Puyi
Date j°� ",g Signature of ContractorVP
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 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 shall forthwith comply with those provisions. r
Date: Applicant '-.- , h
Warning Failure (o secure Workers' Compensation coverage is unlawful and
"shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at"-.
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify-
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if.
work is not commenced within 180 days from date of issuance of such,
permit, or cessation of work for 180 days will subject permit to cancellation. a
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
L.Signature (Owner/Agent)-_-,,"V y.• I ���� Date 4 !)1,' +}
BUILDING PERMIT PERMIT#
D rE VALUATION LOTTRACT
24317.1
JOB SITE
APN
ADDRESS
4-31 5111V "k.A f -r
'769-50.1--W4
OWNER
CONTRACTOR / DESIGNER / EN (NEER
I URY CROWHill. C-10 IALWL:tl
r0 :`��%f` .TR. C antowax, C'oivmLJYd-S a' s
1555 S01 17), STMIMI , M 000
1535 so. -Y,:)- mlmu, sane 0200
SAM BEI N'AR 1,14\10 CA 92408
SM BER 3AI&M10 CA 924.08
(909) 3 31 007 CS1.1# 2170
USE OF PERMIT
GLE D."r'iWLYM�'L"'.L4NG
aP'D,P.I.,AN 4AR T.,t'3T.14 - PERMIT I102.1 NOT YNCLUM
1,1,OC K"RAIAIP(,�OiJi'3'[ilVr"WA l' APPRCiACT-l' M/o P1 AN CH..3rPM, PER
UD 1C' ION 5.11 Ibfl1J'1.TIPIX 1,,13SUA210E OF SAAR PL.,• N `4 5°Pz;t
TRACT CONSTRUCTION Z11R,00 sp
SY
fPZif}�€.C�.1�ig6$pP�.�fl.'fpl�Mr�n/�y�ry� ,�y �y �1198.(M
V.�AIfL'fAt'7ufk�d,'.0,11.1: ORI (Ck j 9,gs q
PERMIT ME riM AR's
CONSTRUCTION FEE 101.000.4? o-000
PLAN CH C::4.; FE i'• 101_000-4� 318 sigo.24
WJ.-C1iKNICAL FEE 101-000-421.000 $33,30
X111WI rICALL P7,E 101.000-420-000 $142.14
P'USIVYFSING 6199 103-0010-4.19.000 S1!63150
STRer NG MOT1ON FRE, a R.E.SID 101-000-241.000 $16.54
ORJ4DINO til; 401-000-422-000 Qkoo
F1'9,EV-11 0PIM IMPACT FEE
5'
811 B-TOTALOMI'12C3M1019 AND PLAN" CHECT9
$:3,188.4.1
1
. JAN, 10 2001
_
✓ l T B UF L Y t U 1 A
RECEIPT
DATE ! . •BYq
� 1
DATE FINALED
INSPECTOR
,c i
iA)1
INSPECTION RECORD
OPERATION
DATE
I.INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
f
Ducts
-��
IONA,/a
Slab Grade
lD�
Return Air
Steel
Roof Deck
l��QI
Combustion Air
Exhaust Fans
O.K. to Wrap
Framing
�_
6
F.A.U.
Compressor
Insulation
��l! .�, ��
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
_
steep
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
_
�/� m
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
_
8����
Pool Cover
Encapsulation
Gas Piping
Gas Test
7�f/z8/��
Appliances
f
'Final
COMMENTS:
6,(V
Final
i^D�
Utility Notice (Gas)
C��/� /�!��
v
/���/ 01VELECTRICAL
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)
Certifica.te`.of Tnsulation
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 losetheir 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 #: 4AR Phase: 4
Lot No.: 14 Job Address: 54-315 Riviera- La Quinta, CA
Ceiling Area: R-38 Blown Insulation Garage Ceiling: Non Access: _
With Living Above & Sloping Areas
Exterior Walls: R-13 Unfaced Batts Overhangs: Access Attic:
With Living Above
Literior Walls: R-11 Unfaced Batts Between Floor:
Subcontractor.. .OJ Insulation Co., Inc.
42620 Ri%Nedo, Temecula, Ca 92590
Signed
Tom Berry, General Ma 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.
REGISTERED INSPECTOR'S WEEKLY REPORT
JON TANDY
37630 Medjool Ave.
Palm Desert, CA 92211
Office (760) 772-7192
Fax (760) 772-7193
Pager (760) 776-3338
TYPE OF
INSPECTION
PERFORMED
❑ REINFORCED CONCRETE UCT. STEEL ASSEMBLY O JI��
O POST TENSIONED CONCRETE O ASPHALT HER _, •^
❑ REINFORCED MASONRY ❑ FIRE PROOFING
JOB Off: y► r •
7 t U ale -LA, aux"-3-A
REPORT SEOUENCE NO.
TYPE F STRUCTUgE O -
PERN]J�Np. o t ^ ^
DFji�
O�
DAV OF WEEK
MATNAL DESCRIPTION
R 3�
ARCHITECT
INNS1PECT0
c
HRS.CHARGED
1
ENGINEER
ASSISTANTS
HRS. CHARGED
INSPECTION GENERAL ,e SUB
DATE CONTRACTOR j1i� 1J1� �'10 � -CONTRACTOR— " •- N r. -
1.11�(+4
u,� tw o.—\ -s Cp wvxN(Scr"
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COPY SENT TO CLIENT ❑
CONTINUE ON NEXT PAGE ❑PAGE
OF
CERTIFICATION OF COMPLIANCE
'HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MY
KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE
NOTED. I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED
PLANS. SPECIFICATIONS. AND APPLICABLE SECTIONS OF THE
GOVERNING BUILDING LAWS.
\� �Ica'jmu
-
e -
NATO E OF REGISTERED IN
ECTOR
30
o 1d-�7J
ATE OF
EPORT REGISTER
NUM13FR
Certificate of Occupancy
City of La Quinta
Building and Safety'Department
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:
BUILDING ADDRESS:
Use Classification: SINGLE FAMILY DWELLING
54-315 RIVERA
Occupancy Group: R-3 Type of Construction: VN
Owner of Building: CENTURY CROWELL COMM
Building Official
Bldg. Permit No.: 0101-201
Land Use Zone: RL
Address: 1535 S. D STREET, STE 200
City: SAN BERNARDINO, CA., 92408
By: BILL GORDON
Date: 2/4/02
POST IN A CONSPICUOUS PLACE