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0005-062 (SFD)U) I— N W W ' W o Z Zo OO H CID J W W I— a Z co LO N Oa) UQ tl — Z Lo aCr 0 LL X W — mVU O Il rn H It Z Cb 5 O Q J 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 M w Lic. Class Exp. Date )/Date _ 71 A l SS B -,, /1, 1 C?W /2C 1 Date p �� �''��� Signature of Contractor ,�r �4���-���'� 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 () I am exempt under Section , B&P.C.Jor 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,DL'10 EAGLE DIS Policy No. NWC 44406f3.02 (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 'ode, I shall forthwith comply with those provisions. / ,- Oate:�Applicant .7`Yf ti -i 1 / `-4,< 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 he above-mentioned property for inspection purposes. Signature (Owner/Agent) 1117A i �T - �- Date BUILDING PERMIT PERMITk DATE VALUATION LOT -062 TRACT $202j468.10 23 2€3718 JOB SITE ADDRESS W-745 4= i.LJS. N0 APN 769-490-042 OWNER CONTRACTOR / DESIGNER / EN (NEER CWWRY CROWM-L COMNii3N11ilr l CENTURY CRO Wks. L CC1OMMM77ES1 1535 SO, "D° 5'iREFr, USE #200 1535 so, D. b'�72ELr, am, #-2Q0 SAN BE NARDINO CA 92408 SAN BE RNARDINO CA 92409 (909)381-6007 CB14 2120 USE OF PERMIT SINGLE F'AW Y DIWikIM C0 , SFD,,LOT 23 PL IA PER -MIT DOES NOT INCLUDE BLOCK WALLS OR POOL 75% PLAN CHECK FEY, REbUCTION .F'OR MUIT1 LF_ ISSUANCE OF SAW ' PLNN TYP1p, ' CUSTOM CQNSTRUCTION 2,419.00 SF POR.CH/PATIO !,00.00 Sr WRAGE/C.A.RPORT (Si) 11,368.00 1rS' n"TED CONT OF +C0X9=. r_7n.01I 202,4610 PIUZMU FW, 3;IITillMAIZY CONSTRUCTION FEE 101-000.418.000 �1oDDD.O►3 r "= > �:; ,* . PLAN CHECK'. FU, 101-000-439-31I5 MECHANICAL, FEE 1011100()421.000 $84.50 ELECTRICAL FILE 101-000-120-000 $ 129.1°;' PLUMBING FEE 101-000,419-000 $162,50 r b71;OWO MOTION FEE • PMID 101-000-241-000 ORADINO FEZ 101.000-4.23.000 DLIVMDPER IMPACT .flit $1,907.00 ART IN PUBLIC; PLACES - RRSIE 701.OW-235.000 $20.90 SUB-TWAL CONXIMT-TCiION AND PLAN C1IRCK $3,546.32 I.RW PRE -PAID FIM WOO r TOTAL PEFMT MS DUES NOW t' RECEIPT DATE BY DATE FINALED INSPECTOR INSPECTION RECORD k, OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Z 3cks —� /_ !? Underground Ducts Forms & Footings Ducts Slab Grade —/ ,gv l Return Air Steel Combustion Air Roof Deck s adv Exhaust Fans O.K to Wrap _ ,� F.A.U. Framing /— _ _ Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall 01 Exterior Lath Drywall - Int. Lath �Jl� _ 7 _ _ Final Final /d/ I K POO $ - SPAS BLOCKWA7-L f IPPROVALS 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 —/ —O'1! %f Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection Encapsulation Gas Piping �z Gas Test Appliances Final COMMENTS: Final Utility Notice (Gas) ELECTRIC 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) IN C- P-) r-) m fl u m a RI lD RI RI Certificate of Insulation Your Rome has-been insulated with CertainTeed Fiberglass Insulation product% which are designed _ for today's safety standards and tomornov/s oeergy requiretn¢Me. Fiberglass is inorganic and therefore permanently nonomnbuslible; so it does not have to he tmated ------.---.uritti.ffreRretardsnt-chem3cetat3teR.�uuilUikelytose_tileirei%oti!ieoeas-ovesrtime_Rbas.not been tmated-------..---.----._._. -...—..-------- with chemicals that can turrode wiring or metal. Pil erghm will not absorb moisture nor wilt it - -- _ .- --- --- ---- ---- -----scdttc-oveF-tirneas�n�a+�athe�insufatiao-matcriale.�-- 'Phis also cer iifim that CewtainTmd Flier Glass this home . to provide the following thermal parfo rinarsce.. Jolt Nmsm Mandwm a — — - 11raet: 2W19 Plm it IA Phase: -- 1 ----- — --- ---------------- -.—L-0 ac:— 23-- eWA-dttrear79-74TCektua Street,-rgQtdnl Cs�- -- -- - — ---- — -- Ceiling Ar": R-39 Unfaaed Haas GaraSe Celliog: —_— - Pion Aeeem: ..With t ogAlsove ..... ... .... & Stapiog.Areas _ .. ...... ......... .. ... ....... . Exterior Walls: R-13 Uofsoed Batts Liverb Aetess Attie: - a — With Living Ahave Interior Waits: R t I Uahced Bam Betwem Floor. Subcontra0m. ©Jlnsuratlron Co., Ike- Signed seals, Ca 925".91�UCd Tom Berry, General Manager- Te"aSrck 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. 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 D REINFORCED CONCRETE UCT_ STEEL ASSEMBLY O C7 jo O POST TENSIONED CONCRETE O ASPHALT �QTHER �i`� ❑ REINFORCED MASONRY O FIRE PROOFING IPOTHER JOB LOCATION � � t t� LA � , ` t� Ire i� REPORT SEQUENCE NO: TYPE Of ST0.UCTU� � � PERMIT NO. TE IUD OAr OF WEEK MATERIALDESCRIPTIONARCHITECT INSPECTOR HRS. CHARGED E-t7o1S --c. pi A� ENGINEER ASSISTANTS NRS. CHARGED SUB DATE CONTRACTOR CONTRACTOR -�-�-- S- A -x Y, Y8 Certs '94 e w- cow- t� � r� �s e�T mtle we --z COPY SENT TO CLIENT 0 CONTINUED ON NEM PAGE O PAGE OF CERTIFICATION OF COMPLIANCE I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MN 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. G TUBE OF REGISTERED INS CTOR C 307. CZ JP r-) 6617 ,2 TE REPORT REGISTER NUMBER