0011-250 (SFD)r 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.
L!, nse # Lic. Class Exp. Date
k3 y _ • .1031/x?
�Uate� '��/' Signature of Contractor�"��'
0
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.,&e 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.
GOLDEN' EAGLE W11
(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
ode, I shall forthwith comply with those provisions.
ate: e� �� .. ��� `Applicant" 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 madb'& 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 Cii 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) kms- r - ' Date r
BUILDING PERMIT PERMIT#
p
DATE ` ` 1 � VALUATION LOT 0011. 41W TRACT
JOB SITE
ADDRESS
APN
OWNER
CONTRACTOR / DESIGNER / ENGINEER
CINTURY CROWP„U, CC)M00=0
CIFIT URY CROWELL C010AUXVrMS
1533 gip: V moi'. VM #800
1535 so. TO, S`7 `�, F111. 0200
SAN)IEWARDINO CA, 924.08
S'.l�.1•dM,1,TARDINC) (:A 924
(909).381-600.7 CBLO 2120
USE OF PERMIT
M40LE, 1?AM1LVDWMLWG
LOT 3, PLAN 1ARR; SIM a PEAM,1T D0fPS VDT YNCLtJVX RU C10VALLS,
P001, OR Uf`ttVRWAY KPPR.f.A.00
CUSTOM CONSTRUCTION 2,815100 SF
POR-Cli/PaGITIO _ 157.6 DV
OARA.CiMA.12PORT (SP,
. - flT 9.:dYR+79..i eis.7J Civ�A7r M1 F!�..i:71'7►i!�%�73
231 ezdz.+w
CON.TR.UC"EIC5N FSE 101,;000-116rOW $.B,jolm
PLAN CHECK 1W 101-000.439-318 ViS9.99
MECHANICAL AL FU . 101 ^OQOQ4%1 SOt1q 596,51
II' TRst.',AL rX9 101-0 0G 4itl- 00 $142.31
P1.,U4�i13i4�C1 f�l+;l�` S01n0t30ti�,1,9°i,10� $1�R,54
STP,0NO MOT .ION .FFF: • 'ft�2 ID 102-000-241-000 521121
OIAD.1NQ F 1 U1i .�?fit?° 23•t9 iia 3�O.tlit
L1&?",i F%&1P8fZ IMPACT FEE a 1,9ID F 00
ART IN PUBLIC PLACES - RblfT 701-000-255-000"_,M
$.
+ n
r.PI
SQDb-TOTAL COXb'I'KICYION MTD PLAN CI-xfr.—
$4,429.11,
TOTAL 1"ERKr.rFL%8 DUE NOW
U,429.11
DEC 12 2000
..
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RECEIPT.—
4
DATE
6Y }'
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
-
Forms & Footings
U.9 471.
Ducts
Slab Grade
—zzzal
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap -
F.A.U.
Framing_
�d j��
Compressor
Insulation
_ _' 0 ��
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
• Party Wall Firewall
Exterior Lath
_
Drywall - Int. Lath
Final
ll/ CJ/
Final_�
l fj —
POOLS - SPAS
BLOCKWA
L 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
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
%
Z�
i Pool Cover
Sewer Connection
/
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
a a�
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fb(tures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Ficial
Utility Notice (Perm)
i
— — Your Home aen s—lts Ted WJtI�( t ed FibcOOw-lersulatbn-prodn�rv►Ib'ic are-dest�ee�
for todWs, safety studards and tomotravfs energy re4ttirements.
Fiberglis Is it oic snd there6ore pantmnettily swnc0tnbmstible, av it does not lave to. be treated, ,
with fire -retardant chearics�4 t�at;hnif fikeJy7ose toedGMtIvmms ever *=-It-has mWbee&t m*e4 -=--
o with cbcmicaty that eofl ooarodc WiriSg or MO. Fitietg%a will trot absorb moisture oox.vrill it
Q, settle over tip av may older i e3=i mate3 ----- - —
m
� 'l1�is also mertifees that_ CertainTeed Fiber Glass dr►sultuion has beer9.pro(cmio»elly itrstalted on this home
-- _ --top--Ida the 1501101409 durmd P"fO taaoe
m
T _.lob D'lante: McOderi� Tre %eta 8? 19.. Plan ik 3AR _ Phase: 2
Let No.: 3 Job Address: 70-330 CetaitntMr I '.
z .
Q ....
w
ing4: R--315 Biown frtisulattotn _ �rageC�etiiog :�.:��...
Ceil Pl°8 ees: „
With [Sviog SbpWg Moe
W-------------------...�a4�lar Walls: R-13 lJntsOed Batts - Arcess Arlie:
---
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w With Ydviag Move
Between Flay: —
O lnWur Walls: R-11 Unfacad Batts
Subron&act� c.. 0J Insarla&n .Co., nc.
U
`• _ 4" Rio Pled-, TeuJW618, Ca 43590
Tem Bemy, Gmers,A9 cep- Tense "le Brrrwk
R- means mislartco to heat flow. The higher the R -value. the greater the insulating power.
Ask your builder for the reset sheet on R. vdues. Keep this cWifteate with your other
valued papers. 1f You ever sell this home, this certificate dtould be passed an to the buyer. .
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i/24/01 MT 13: it FAX 760 7727193 JON TANDY
Z 002
• N�It® trate.. .
376$0 Uedjool Ave.
Palm Deeert, CA Mll
Office (760) 772-7192
Fgx (7+60) 772-7153
pager (780) 77"M
REGNMEO BR'S WEEKLY REPORT
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