0106-350 (SFD)LICENSED CONTRACTOR DECLARATION
I hai-eby 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
L`7rtilN.o}' bJ �.ifi�lA�i
Date °yf � `� � Signature of Contractor`< ' 1 ✓ + � �=, fzr
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 providedfor 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 Gn IN MO"E 1NSIPolicy No. yYC -347p l -0o
(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
iCode, I shall forthwith comply with those provisions.
Date: 1! . A. - Applicant..._ .ri 77- > )
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.
Signature (Owner/Agent) ' ,� ?Z > ± + " ' t h : s Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT TRACT
slason70 23 7A -I W -1
JOB SITE
APN
ADDRESS
44—eM MOMICLEX0 AVE
60"32 -ism
OWNER
CONTRACTOR/DESIGNER/ENGINEER
CSITA.1RY i;ROVVII�?t;., . �l�r!4 1 i
f �!!,"s'TT 1� L3d,fJ� 1< .. Ol ti1T.WftjZ
I s"o so. -V e%'�`l"�:, .,T"3'. f._ ftoo
15.-4,5 so. "Xx5T1 rt .,'I't eT.�.'& Raw
SAW TALMNA,R W0 CA
aW BERRAItiti:C7.0JO CA 92408
(909)381-6007 007 id 2120
USE OF PERMIT
RINC-11.2- FAWMY 1i WELT�i�ti 0
SPO - LOT 23 MAN 2.0, - PERMIT DORS NOT INCLU D,% BLOCK WAid4
POOL OR D IRWEW'.€i.TA PROS CH. 75% PJAIN CHECK F99 RED6:f TION
aAPPl.dY0 FOR. MULTIPE PLAN T'Y'PV; SUBMITTM.
M. ;
'i'3DACT WNSTRUCTION IpaDo SP
PORCsbr'I" T110 49,00 SP
0ltiAa,t'AMIC ARPORT 420.00 O
FF 'I r r3Sifil. 0,01WdARY
CON STRUOTION" 101.,00€:-41.8.000 5664.0
PLAN CvHPAX ;PEK' 101-004-1.119-318 $.f SF.d6
WC1iMICAL MY, 101-000.421.=000 $160.40
?'.Litr'TR.tCAL FRF, 101-000-420-000 $119.9+0
PLUMaTHO FRE 1P1-000.419.00 $130.09
MWONO in910' 1014 F"a, - RESID 101-000-21.41-f:00 $10.66
MA1040 l{ : 109 nt9(ZO^E'.2 •OCTU $ ,f1fl
DEVEWPER I,AVAC;T ME,$x;902a90
7:rJlol AND k'��t
i y � ; �vj1 ,��1 F • t G�n:�y/�� 7w�e�,+�+ ^�+.yy C1�gp
V t� L y ��G�1 rd,A ..7.aS'F.l�`�.►A J4��C:•.�,AY &J!l��n �S9 v7 ,
�.r� },� y
ria'.✓1�G:
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
TINSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings
Slab Grade
Steel
Roof Deck
O.K. to Wrap
Framing
—_ _
_8
_
_ _ _
9//,� _ _
"moi!% _d _ _
Underground Ducts
Ducts
Retum Air
Combustion Air
Exhaust Fans
F.A.U.
Compressor
Insulation �j- p —
/
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
. c) Z�
Final
2-02
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
_7
Waste Lines
Water Piping r
Gas Test
Electric
Electric Final
Heater Final
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
-Sewer Connection
.. // . CqX
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
,
-
Final o_
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 _ z
Utility Notice (Perm)
INSULATION CERTIFICATE
This is tocertify that insulation has been installed in conformance with the current energy
regulation, California Administrative Code, Title 24, State of California, in the building located at:
44-814 Monticello Avenue, Lot 23, Monticello -Heritage, La Quinta, California
CEILINGS:
TYPE: BLOW MANUFACTURER: Certainteed Thickness: R-38
WALLS:
TYPE: BATTS MANUFACTURER: Certainteed Thickness: R-13
GENERAL CONTRACTOR: CENTURY CROWELL COMM UNITITES LICENSE #
BY: TITLE:
PARAGON SCHMID BUILDING PRODUCTS, A MASCO COMPANY LICENSE # 632072
B TITLE: ADMINISTRATIVE ASSISTANT DATE: 12/12/2002