0005-060 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
F- Chapter 9 (commencing with Section 7000) of Division 3 of the Business and -
c14 W Professionals Code, and my License is in full force and effect.
O 5C) Licen9 a # Lic. Class Exp. Date
r- CY U.) �.
r / 714188 13 ; --� 10/3112(
Z r- }d ate zi _ Signature of Contractor
J U OWNER -BUILDER DECLARATION
LU W I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ IZ License Law for the following reason:
Z_ ( ) 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
U
N Date Signature of Owner
p CSI
Q)
U Q WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty df• perjury one of the following declarations:
HIr
p () 1 have and will maintain a certificate of consent to self -insure for workers'
K W �= compensation, as provided for by Section 3700 of the Labor Code, for the
D � Q performance of the work for which this permit is issued.
n Q C) ( ) I have and will maintain workers' compensation insurance, as required by
U Q Section 3700 of the Labor Code, for the performance of the work for which this
L Z permit is issued. My workers' compensation insurance carrier & policy no. are:
<; It Z Carrier 0OUDEN 1 AAOLE 1215, Policy No.
1C .544068-02
J (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,
V 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
1 subject to the workers' compensation provisions of Section 3700 of the Labor
•`•77 Ate
de, I shall forthwith comply with those provisions,
: v-"�. I _ Applicant
b Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,060, 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
• corre2t. 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
/Ihabove-mentioned property for inspection purposes.ature (Owner/Agent) �, ;),' , % l l Date
PERMIT J/
01140 BUILDING PERMIT
00C15 -W
DATE VALUATION LOT TRACT
S2MA ;.#,0 25 28719'
JOB SITE
ADDRESS 74-72s cr iI.Oxl, wo
APN
76949" A2
OWNER
CONTRACTOR / DESIGNER / ENGINEER
CENTURY CRO .L COMIdLT ITES
Ck:MURY CROWi%ELL COIAMU.N3.
1535 30. ID40TRUr,111IR 4200
1535 30,"V 3ITr'M, S'J'I?, #'.Z00
SAN B +a 1JiARDINO CA 92408
SAN DF"ARULKO CA 92408
1;5109}381-6007 CBVf 2120
USE OF PERMIT
EDTOLE FANGL.Y Mal -MG
Mq)•LOT 25 PL IC PERMIT DOES NOT INCLUDE HWCK WALLS OR POOL.
75% PLAN CHECK PPE REDUCTION MR MULTIPLE 10fl IANCE OF SAME
PI -6,14 TYPE
CUSTOMCONSTRUCTIO14 z4mo03F
POARyC�1��ry/,P.ATIO 200.00 S3�
,.._.
p�T
OARACI�J:.�,RPORT (,.,) 11,868.00
1 snNATC D COST 01� C0N51'.C.RUCn0N
202,460.10
PEIU&r FMi SURD RY
CONSTRUC:T1aff PEE 101-000.118.000 81,000,00
PLAN CHW...K IEF, 101-000-439-318 $203.30
MECHANICAL FEB 101-000.4.21--000 SK50
ELECTRICAL FEE 101-000•.420-000 $129,Y1
`TI
PLUMBING IxU 101 -000 -4 -19 -OW $162.50t�.--
STR NQ MOTION FEB RiSID 101.000-241-000 $20.23
ORAADING FRE 101-000.423-000 $20.00
DEV'ELOPtR IMPACT IfF.9_ $1,907.00
ART W PUBLIC PLACES - RF,11r 701.000.255-000 $20.00
k"n
ffM-7WAL OONSTRIICMOId AND PIAN CI'IWX
$3,546.32
LESS PRE -PAID k.F9
$0.00
TOTAL I.'U- fff MS DUE
RECEIPT
DATE BYi
DATE FINALED
INSPECTOR
of
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
!_ f /
Underground Ducts
Forms & Footings
/ �J
Ducts
Slab Grade
Return Air
Steel
�-•�
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
Framing
/� _/5'
Compressor
Insulation
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
_
_/(o
POO _ SPAS
BLOCKW�Z!-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
Pool Cover
Sewer Connection
��_ oU
Encapsulation
Gas Piping
Gas Test
Appliances
Final
t
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Vottage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
J
Final
—
Utility Notice (Perm)
a
= Certificate of Insulation
. _— —. Your iiom�h�.heen�nsnlated_with�CectainT�l:ibe�b'pssInsuiation-proderts��icikare-des'sgned
Nr todws safety standards find tthmorrmWs energy requirements.
Fiberglass is inorganic and thcrefare permanently nancombunil de, so it +toes not have to be Inured
----------------with-fir®-retardant-chemic�ts-tfasEeviSlilEehr-dosednir-etFe�vene�-overtirree.—Rhes•rlotbEenlrefited----....------------ —
with chemicals that can corrode wiring or metal. I Fiberglass will not absorb moisture nor will it - — -- — -
r,--. --. _-------- ---- ---—9ettleevertimeasmayother�laEiom-materials----------
m
Cr . Subconfr8imt.. ®JInsufaiiien Car., Inc
cn z4t
o, r4wq Ca 92"0
0
TOM Berl+, Gem -rat Meer- Tallide BMWI,
0
R neons resist ince to heat flow. The higher tha R value, the grew the insulating power.
Ask your barer for the fad sheet on R- values. Keep this eertifieate with your other
0 valued papers. If yon ever sell this home, this certificate should be passed on to the Bayer.
0
N
N
This also =ffm that CertsinTeed Fiber, flus bmiation ices been pro�sionally inslelled in ifs home
to psmride Obe following the®al perlitwmmance..
ILO ---------�
Job Name: MenderiQm_ Tract: 2Sn9 - Plung. IC
Phase: 1
M
Ceiling Areae R-3 & Unfaoed Bags Game cefll qp
Nor► Access: _
- -
Wilb Irtving.Ahow
df Sl0*g flare"
U
Exlerlor Well$ R-13 llnfioed Haus
-----._ ::. Oyerheugdi�- =----
A ma AtHr
=-- ---
`w
:_-_—:-- _-- -.-:—_—:__-..- - -- -- -= -
Wi th Uv ng Above
-- _
~
z
Interior Walls: R-1 l Unlik"A Batts
Between Hoar. —
0
Cr . Subconfr8imt.. ®JInsufaiiien Car., Inc
cn z4t
o, r4wq Ca 92"0
0
TOM Berl+, Gem -rat Meer- Tallide BMWI,
0
R neons resist ince to heat flow. The higher tha R value, the grew the insulating power.
Ask your barer for the fad sheet on R- values. Keep this eertifieate with your other
0 valued papers. If yon ever sell this home, this certificate should be passed on to the Bayer.
0
N
N
NOTICE OF BARE FLOOR CLOSING
TRACT I Cl
IAT Z
DATE
V
TO WHOM IT MAY CONCERN:
PLEASE BE ADVISED THAT AS BUYERS OF THE ABOVE REFERENCED LOT AND TRACT,
WE HAVE ELECTED TO ACCEPT THIS',"PROPERTY'WITHOUT•FLOORING AND WILL RECEIVE
A CREDIT FROM THE BUILDER FOR PROVIDING OUR OWN FLOORING.
DATE �B�UYE��� DATE
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
b REINFORCED CONCRETE CT. STEEL ASSEMBLY O S H f7 IP
O POST TENSIONED CONCRETE O ASPHALT �QTHER�
O REINFORCED MASONRY O FIRE PROOFING 1
J08 LOCATWN 1 5
t4 O r A ko `v\.�
W ca `_ ` /3
REPORT SEQUENCE NO.
TYPE F S CT Io \ 1 � 0+1 -4-S
is .7 e
PERMIT NO
OV
' �i
/rJ_ vV
OAY OF WEEK
MATERIAL DESCRIPTION
f � -3 G Pi -tea
RCHITECT
INSPECTOR
ok
HRS. CHARGED
` 701.3
E-—<, f*
ENGINEER
ASSISTANTS
HRS.CHARGED
DA CONTRACTOR Ce-NTU a a 1 kQS oDNTRINSPECTION GEMEM
�ACTDR Ci} 4 %le7S S'�`t-.
(a
v iN (rP A -So. (A -ie F
S - a- '6- %01-:5
i U -e- '%.s i i J
COPY SENT TO CLIENT O
CONTINUED ON NEAT PAGE p
PAGE OF
CERTIFICATION OF COMPLIANCE
I HEREBY CERTIFY THAT 1 HAVE INSPECTED TO THE BEST OF MV
KNOWLEDGE ALLOF THE ABOVE REPORTED WORK UNLESS OTHERWISE
NOTED. 1 HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED
PLANS. SPECIFICATIONS. AND APPLICABLE SECTIONS OF THE
GOVERNING BUILDING LAWS.
�G"AE OF REGISTERED INS CTOR
TE OF REPORT REGISTER NUMBER