0005-061 (SFD)LICENSED CONTRACTOR DECLARATION
U) I hereby affirm under penalty of perjury that I am licensed under provisions of
H Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
WProfessionals Code, and my License is in full force and effect.
Z) ch► .License i Lic. Class Exp. Date
C) LA
LV 7,141$R L� / 1013I!a(
Z Date �I>rJ�ll Signature of Contractorr-
O t
(fl
r— OWNER -BUILDER DECLARATION
co
HW r— I hereby affirm under penalty of perjury that I am exempt from the Contractor's
to License Law for the following reason:
Z_ ( ) I, as owner of the property, or my employees with wages as their sole
compensation, will do the work, and the structure is not intended or offered for
sale (Sec. 7044, Business & Professionals Code).
( ) I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
co () I am exempt under Section , B&P.C. for this reason
LO
N Date Signature of Owner
O0)
a Q WORKER'S COMPENSATION DECLARATION
p 2 Z I hereby affirm under penalty of perjury one of the following declarations:
Lo H O () 1 have and will maintain a certificate of consent to self -insure for workers'
X w LL compensation, as provided for by Section 3700 of the Labor Code, for the
Om � Q performance of the work for which this permit is issued.
Q rJ ( ) I have and will maintain workers' compensation insurance, as required by
O Q Section 3700 of the Labor Code, for the performance of the work for which this
rn F— permit is issued. My workers' compensation insurance carrier & policy no. are:
,It Z CarrierPolicy No.
65 C$(1LI3Eid EAGLE INS: Policy
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,
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
ubject to the workers' compensation provisions of Section 3700 of the Labor
/Code, I shall forthwith comply with those provisions- /.. r
t Date: 4"7 Y ,0 4-_-; 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
/e above-mentioned property for inspection purposes. �r
Signature (Owner/Agent). Date r `'
BUILDING PERMIT PERMIT#
DATE VALUATION LOT OM45-067, TRACT
S216.9W.W 24 28719
JOB SITE
ADDRESS 79-7M *;Z WMO
APN
769-490-042
OWNER
CONTRACTOR / DESIGNER / EN (NEER
CkMURY CROWFI-:, CON ML1AR IW
CIi,..NTURY C''ROWM, C0MWi-23+T M3
1535 00. To STIiM, um ##200
133.5 30.41Y UMMf' M. ##200
SAAI'B1♦RATiARDINO CA 9MOS
SAMEJER1ti1'ARDING CA 92409
(909)3131.6007 M9 21201
USE OF PERMIT
WGLE FA&MYDWELL. IN
SMLOT 24 PL 2A PF:It 1IT i)OYS NOT INCLUDE IJLCxCK WALL 8 OR POOL
75% PIAN CHWX FRE ILEDUCTIO14 FOR .MULT IPIIL ISSUANCE OF SAME
PLM4 TYPE.
CUSTOM CONSTRUCTION %597.00 5F
PORC"ATIO 212.00 SI''
0ARAGEICARPORT (0) 11.355.00
ESID"RN D COSI.' O.F CONSURUCITON
216,98%90
CONSTRUCTION FEE 101-000-418-000 $1.049.00
PLAN CHUCK IVZZ 101-000-4.39-316 $21126
MEC14ANICAL FEB 101.000.421.000 391.00
ELECTRICAL FFY, 101-000-420-000
PL IMBING FEE 101 tOflO.419wi300 5160.50
h? -- C"
STR.ONQ MOTION FEE n REBID 101-000-241-000 $31.'70
t s w � 7 f Tf
GRAD1140 PER, 101-000-423-000 $10.00
:t;
D � IBLOPER IMPACT FRE $1,90:x.00
'. i'":i
ART IN PUBLIC PIACb - RESTE 701-000.255.000 $442,46
RIB -'T'O'TAL COATS MU" ON AUD PLAN CHEC`IC.
$3,648.42
YMSt�l.RPAW ril=
$0100
TOTAL PER -MM Mb DUF NOW
V,W,42
r�
RECEIPT
DATE
DATE FINALED
INSPECTOR
INSPECTION RECORD
r OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
o9
Exhaust Fans
O.K. to Wrap
=,� ��
F.A.U.
Framing
_��_� 6�
Compressor
Insulation
Vents '
Fireplace
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate lines
Party Wall Firewall
Exterior Lath , O�
Drywall - Int. Lath
Final
Final
BLOCKWA
ifn
L OPROVALS
_
POO S SPAS
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
Sewer Connection
- _
�°�
Pool Cover
Encapsulation
Gas Piping
Gas Test
/ Z
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICXL
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
Utility Notice (Perm)
4PPROVALS
_
hal
COMMENTS:
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.
Fiberglass 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. Fiberglass will not absorb moisture nor will it
settle over time as may other insulation materials.
This also certifies that CertainTeed Fiber Glass Insulation has been professionally installed in this home
to provide the following thermal performance..
Job Name: Mandarina Tract: 28719 Plan #: 2A Phase: I
Lot No.: 24 Job Address: 79-735 Cetrino Street, La Quinta, Ca
Ceiling Area: R-38 Unfaced Batts
Exterior Walls: R-13 Unfaced Batts
Garage Ceiling:
With Living Above
Overhangs:
With Living Above
Interior Walls: R-11 Unfaced Batts
Subcontractor.. OJInsulation Co., Inc.
2620 Rio Ne, Temecula, Ca 92590
Signed
.Tom Berry, General Manager-
ula Branch
Non Access: _
& Sloping Areas
Access Attic:
Between Floor:
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 other
valued papers. If you ever sell this home, this certificate should be passed on to the buyer.
NOTICE OF "BARE FLOOR" CLOSING
LOT 24 TRACT 28719
January 30, 2001
To whom it may concern,
Pleased be advised that as the buyers of the above noted..
property, we have elected to accept this house without
flooring and receive a credit for providing our own flooring.
Signed: January 301h, 2001
Rolondo Gotti:
Gloria Gotti: