0101-193 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
—Chapter 9 (commencing with Sectiori )W00) 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 Signature of Contraor'"`�ti•1 1 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).
( ) 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 Owlter
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 b7 Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
(Q11 have and will maintain workers' compensation insurance, as required by
Section
n 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).
( ) 1 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: + `` I Applicant _ �--i.'�
;/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. *I c
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.
Signature (Owner/Agent)" `;�NN t.4`/% Da,.e
BUILDING PERMIT PERMIT#
VALUATION LOT TRACT
.74317-1
JOB SITE
APN
ADDRESS
OWNER ,
CONTRACTOR / DESIGNER IEN (NEER
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1.555 so, 'lily Frld•n8ITJ 9.t E. A•=
SAW D' .��:P,',Wroo "' OA 92409
OA111DE;%NARD1 90 Gly. 92409
(909)381--6007 MiA 2120
USE OF PERMIT
R
IN.M�i���1 ��.�A�G.L1iJIZ in'{='tl.it�.MJy'bY
S't"V-P:t.A14 3 ALT OR i.,tbTA3 A PERMIT 00 a ' NOT ]INCLUDE
BUDOXNAL14N)OUDIUVEWAY dfiiRA:9.7+Y'tN CHECK ;W,
12&[: UCT1014 1''.3'E MUt TIPi.E MwrtUA14C:E 011 SAME PLA14 TYP'.r.,.
`:'k�,.0 T' c:OWSTiiElt;TaON sF
PORCRV TIO EF
XhIMIA . J.? COST +C. F CC"S.NSM1 0111O.~d
C"sYAi.7`iM.' CT1014 )t`09 401 00.41113.000
ialAH CH1tCC 1tT? 1i}3-(3�t�3-rF3�•31 �fG+3.4�f
;Nlls� 3•ih,'T•1YC.A,do'��;E 3i97nOt�i7���'&•�04� ��;g.�t�
'tL'wfr'(".7't�itt".�3.E..?a,?�' �C}3-f3f)a-d'�C;•-L�C�D $133.:di
•
PL11NT6 MIG FXV, 101.000 -419 -NO
STL;,i3NO i1t OTIG(N fyE- KFMJJ 103-000-241-000
OR,k> DINO Fre 101.000.1423-000 3��,t141
1'WELiOPY.1tIMPACT YZE �i,g07.430
?l'-'iliil1A,C101T137:3O_i't':'i:iON MI) PL -AX CHECK
$x,:302.88
TX 3. a 1)1LEI;1?AU) AU)
$0.00
Tow, nin rms DUE iTOW
JAN 18 2001
SIT Y ut� Ar� UuOn
e. A
RECEIPT
DATE
BY.,
DATE FINALED
INSPECTOR
a
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs/_
Forms & Footings (����
_
�L (
Underground Ducts
Ducts
Slab Grade i
_
��
Return Air
Steel
_ _ _
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
I/
/� Ql 6N
F.A.U.
Framing m�i %� �/i�6!/L W
tier
��/ 6r
Compressor
Insulation -
/ 6��
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
6/�
Final
/f0_�
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
_
Electric Final
Waste Lines�j
f -?
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
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
/ ��y
Utility Notice (Perm)
Certificate of Insulation
Your Home has been insulated with CertainTeed Fiberglass Insulation products, which are designed
for today's safety standards and tomorrow's energy requirements.
Fiberglais 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. Fibergla ss will not absorb moisture nor will it
settle over time as may other insulation materials.
This also certifies that CertainT6ed Fiber Glass Insulation has been professionally installed in this home
to provide the followingthermal performance..
Job Name: Tournament Coll.- Canterbur Tract- 243174 Plan #: 3BR-ALT Phase: 4
Lot No.: 13 Job Address: 54-335 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 Betiveen Floor:
Subcontractor.. OJ Insulation Co., Inc.
42620 R[cl Nedo, Temecula, Ca 92590
Signed
Tom Berry, General Maager-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 othe r
valued papers. If you ever sell this home, this certificate should be passed on to the buyer.
Building and Safety Department
F
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: 54-335 RIVIERA
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0101-193
Occupancy Gr6up: R-3 Type of Construction: VN Land Use Zone: RL
Owner of Building: CENTURY CROWELL COMM
Building Official
Address: 1535 S. D STREET STE 200
City: SAN BERNARDINO, CA., 92408
By: BILL GORDON
Date: 1/28/02
POST IN A CONSPICUOUS PLACE
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