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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.
License # Lic. Class Exp. Date
71418U I3 _ ^� " 10/3112(
Date' �� Signature of Contractor^��y;iF.t.f::f
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 001.439N EAGLE IDIS. Policy No. NWC4440U-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
C99de, I shall forthwith comply with those, provisions.,
�15ate: c' f �` Applicant;
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 ove mentioned property for inspection purposes. f
,i �
Signature (Owner/Agent) %: 1 [�1r.9 Dater i_/-;:_,4 . /.% 4
/ BUILDING PERMIT PERMITk
I(l
DATE VALUATION LOT OM -057 TRACT
9202.468.1.0 29 28719
JOB SITE
APN
ADDRESS 79.69SS C1E�O
769-490-042
OWNER ICONTRACTOR/DESIGNER/ENGINEER
CENTCT Y CRt»VIa L CC}h41uSC1NrM
CENnTRY CROWE,L COMMUNITIES
1535 30. "D' UfRW- Y. M 0200
1535 30 'D• 371UZZ, -M E. 0200
SAN R&,NARDINO CA 92408
SAN F31?22.NARDIWO CA 92408
(909)381-6007 CZ141 2120
USE OF PERMIT
SWGI 1✓' FAMILY DWELLLNG
SFrD-LOT 28 PLA24 18 PERMIT 0010" NOT INCLUDS BLOCK: W.ALiS OR
FOOL 75% PLAN CHECK PEE REDUCTION FOR MULTIPLE ISSUANCE UP
SAME FLAN TYPE.
CUSTOM CONSTRUCTION 2.413.00 SF
PORCHtPATIO 200.00 SF
WAGE/CARPORT (S4) 11,3$8.00
I
RST7,t10ATO) COST C'i7[t' C0.NS'i'RVC-0N,rsq.10
CONSTRUCTION FEE 101-000.418-000 $1,000.00
PLAN CHUCK: FER 101-000-439-318 $10.2.30
MEC1iANICALFEE 101-000-421-000 $84,50
r.7
ELECTRICAL "Z 101-000-420-000
PLUMBII-0 FEE 101.000.419.000
-
STRONG MOTION SEE _ RESID 1411-000.24.1 _000 K $80.25
ORADI O PER 101.000.423.000 $20.00
DEVELOPER IMPACT FEE $1,007.00
ART IN PUBLIC PLACES 8011701-000.255.000 $20.00
r" 1-1 �
itl,>* TCyfA'L CONSMU•C1I014 AND P A14 CHECit
$3,546.32
Lx M P119 -PAM FM
$0.00
F TOTAL FST IIS DUI; NOW
S3,546-432
' r
RECEIPT
DATE
13Y/
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR OPERATION
DATE
INSPECTOR
BUILDING APPROVALS MECHANICAL APPROVALS
Set Backs A Underground Ducts
Forms & Footings Ducts
Slab Grade Zg Return Air
Steel Combustion Air
Roof Deck Exhaust Fans
O.K. to Wrap F.A.U.
Framing -Compressor
`Grills
Insulation _�/dam Vents
_
Fire lace P.L. //
P
Fireplace T.O. Fans & Controls
Party Wall Insulation Condensate Lines
Party Wall Firewall
Exterior Lath � Zee)
Drywall - Int. Lath �pv
x
Final
Final
POOL - PAS
BLOCKWAPROVALS steel
:I
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 to Zo .-0-0 45,g,6L— Heater Final
Water Piping Plumbing Final
Plumbing Top Out Equipment Enclosure
Shower Pans O.K. for Finish Plaster
Sewer Lateral /�/„ Pool Cover
® �j-l-
Sewer Connection 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 O
3
K,
Final 7
Utility Notice (Perm)
I
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Certificate of Insulation
----_—_-- Year Home Iles been insulated with Cedaiftlwd Fiberglass Insolation proWs, vrk" we designed --
fbr todays safixy standards and temomoWs energy regatremuft
Fiberglass is inorganio ad therefore permanently none mbustible, so it does not have to botreated
---------.------------------- retardant_cl,emiralathatwSil_likelytc�aetbeire>�dive rer�� itkaunotbeen
_ece�ed--•-----.--------.—._.— _.
with chemicals that cm taocrede wiring ores W. Fiborelass wd1 not absorb moisture nor will it
----------------.--------------------settle-ovmtimaas-rosy-athminselation_matmiats. --- -- -----
'Ibis elks ocrtifies that CertainTFeed Febw dlws 1nstihaian has beim pmfessioinally mstalted i,ethis home
to provide lice follavr:tg Thermal perfa m mee-
Jvi Nsnne 11aSdaYios 'bract: 2571 Pba:1B�P�
i — --- --
-Cetcirto Street -
Calling Area: R-39 Odkcad Batts Garage Ceifiur — Nm Aeeew
AM Livlag Above ..._. __ .. _........... & SMpiag Areas. ... . ..... ... ..... ... ..
BaDeriisr Wags: R-13 [ht#aood lla3ta Atmos Atm
ltataertar Wafts : R-11 Unfaced Batts Between Floor:
Safer.. OJ Insarla dOW Cie, IAW-
z ltb N 'I'emecda. Ca
o Sigised
Tom Berry, General Maxager- Cela BMW*
m
v
R- means resistance to heat flow.. The higher the R- value, the greater the insulating power.
Ask your Witder for the filet sheet on R- values, Keel this atstifleate wjtb Year other
m vakw papcm If you ever sell this home, this ca6fkmft should be passed an to the buyer.
a
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,SPECIAL INSPECTION SERVICE__,
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
O REINFORCED CONCRETE STEEL ASSEMBLY O S' d
O POST TENSIONED CONCRETE O ASPHALTTHER
O REINFORCED MASONRY O FIRE PROOFING we -w
JOB LOCATKIN _d:T o `
REPORT SEQUENCE NO.
TYPE OF S UCTURE
f t II� /�`I�S a
rEiARCHITECT
PERMIT NO
GATE t '
DAV Of WEEK
MATERIAL DESCRWTION
�3 a
111SPECTOR
NRS. CHARGED
E-4701$ —4r --.w% h -
ENGINEER
ASSISTANTS
HRS. CHARGED
INSPGcTI1ON GENERAL
�Mxo FsTIZAAo rhAfMiA mIli t -we•Z
'tombs u -e 'T.eS7'i tJ oeTjsSit
COPY, SENT TO CLIENT O
CONTINUED ON NEXT PAGE O
PAGE OF
CERTIFICATION OF COMPLIANCE
I HEREBY CERTIFY THAT 1 HAVE INSPECTED TO THE BEST OF MV
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.
GNA RE OF REGISTERED INS CTOR
`Ly a 6p-i��
TE F REPORT REGISTER NUMBER