0005-063 (SFD)U)
H
CV U)
W
o:3CV)
r- Q lt)
' W
C)Zt_
c(0�o
W L)
I— a
LLjZ
M
LO
CV
ON
U °'
CL
g
It Z
T Cr
Q O
W
0 J J
mVU
O
dMFa-
`* Z_
Co 5
N O
Q
J
F1
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
,1.
71,41,88, 1/2(
ate YA?� f'%l? Signature of Contractor--�'•�'
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 ,
( ) 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.
( ) 1 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 C OLDID4 9AME INS. Policy No. NWC-54406"2
(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
sV6ject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions.
Date: r'`n i. i G. Applicant """Z�t
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 above-mentioned property for inspection purposes.
VsIgnature (Owner/Agent)"/'// Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT (1(}05-W3 TRACT
$216wvt3.S0 22 28719
JOB SITE
APN
ADDRESS 79-75S M.U.MO
7M4WO42
OWNER
CONTRACTOR / DESIGNER / EN 1NEER
CENT[712.Y'CROWF. ,L CO'.MieAzi;`1i13ES
C iIMY CROWELL COADALADTt'tF..,S
1535 30, "D' U M+''a STX #200
1534 SCS. TP Ste °, M, 4.2,00
SAW DERWATzDi? O CA. 92408
SM R1I WARMNO CA 92440
(909)381.61007 CB1,A 2120
USE OF PERMIT
811401.x' FA14LY I)1YJEL.�.'LI40
SPD- 10r 22 PL 2C PERMIT DOES' NOT INCLUDE SLOCK'WALLS OR
POOL -14% PLAN CHECK DEC, REDUCTION FOR MULTIPLE ISSUANC'.E. OF
SAME I Ual TYPE,
CUSTOM CONSTRUCTION 2,50.00 SF
PbRCFJPAT10 212.00 SF
0ARAOVC.ARPORT (SP) 11,363,00
VF11L4X= C09r 131.1' CONS:li2i M10.9
PERMIT FEE SU1104tllEtif;
CONSTRUCTION IEE 101.000-118.000 54049.00
� J : �I
PLON CHECK; FEE 101-000-439-318 $212.26
'
MECHANICAL, FEF, 101-000-421.000 $91.00
ELECTRICAL PER _ 1Q1'-00"20-0 0 $136,30
'
PLU1►4I11N41.FE_k 191,000=419.000 SIK50
STRONG MOTION FEES '� 12:F..SM 101-000-241-000
GRADING FEE 101-000423.000 $20,00
DEVELOPeft IMPACT FEL $1.907.00
ART IN PUBLIC PLACES • S2L91L 7011-000.254-0100 $42,46
�� ...:..t
SUB -TOTAL COM. 'RUCTION AND a'I.A1e1 Ck1P.CK
$3,648.42
TSS PRE -PAID b'1
$1100
TOTAL PERMT FEES DUE NOW
�3,0+AL3,42
RECEIPT
DATE
Y i
1}
DATE FINALED
INSPECTOR
Y
INSPECTION RECORD
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 Dec4irti;
—ls
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
p —/ —
Compressor
Insulation
=�
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
AA
Drywall - Int. Lath
_ _
Final - —_
Y-
Final
O
POOLPAS
BLOCKWA
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
/f =vd
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
Gas Test��
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAZ OPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors Q
Temp. Use of Power
Final Z 7.9 aLJ
Utility Notice (Perm)
9.
m
rq
m
0
Z
C'Aerif�cate of Insulation
Your Homo has been insulated wilh CerlainTeed Fiberglass Insulalion pWadw s, which are designed
for today's safely standards and tomorrow's energy requirements.
Fiberglass is iiorgimie and theref+oro permaneady noncx>ttsbustible. so it does not have to be treatad
with-ficekretandattt.c�nieals-ti�atwill..y-lo�sathoir_eflfectIve�ness-o�v�er_tima-was-notbeen-rre,�ed -----
�.lwith chemicals that cm corrode ®uiT* or metal. Fiberglass will not absorb mWsture nor wall it
---
m
o- This also tee3rtifies that CertaurTead Fiber (fuss -Insulation has been professionally installed in this hwet
r- to provide the following thermal per%nnnce..
C9
W — Job Nine. Mandarinn -- mast: .2019 Plan d: ZC 1phase: 1
� �-
a . ..... ...... ..
I[�C1�:22 Jam �ddi9�'T��ltriui3ireet; )v�4►zi�ay Cs - - ---- - ---
Cej'B g Ansa: R-39 Unfaced Batts _ Garage Cefflar. lion Aseem:
:.... WithYl"ag.Abgve_ .. _ .. . .._ ....drSlapfagAreas....
Exterior Waft: R 13 Unfaced Bath
Onerbsogr Attic:-.
U,
With Lhft Above
W
~
Z
Befteen lfloor:
IntMor WaRm R-11 Unfhced Bator
0
Sabconhw gar 0J1iasa1a&M [.e, Il
z
Ilio Mo. Temecu.12, Ca 92590
o
Signed
Toni BeM, Ceaaeral JAwageo3sawcala Braarck
m
R- means resistaw to heat flow. The higher the R- value, the greater the insulating power.
Asir your builder for the fact sheet an R- values. Keep this certificate wills your other
veined papers. Ifyou ever sell thin home, this certificate should be passed on to the buyer.
0
N
[V -
INSPECT -ION SERVI'CE'j
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
NSPECTION
[I,-ERFORMED
O REINFORCED CONCRETE UCT. STEEL ASSEMBLY a -S,40%
❑ POST TENSIONED CONCRETE O ASPHALT THER we -L4
❑ REINFORCED MASONRY O FIRE PROOFING We�4;�
JOBLOCATION j�
L-1 7
REPORT SEQUENCE NO.
T� � � �
PERMIT NO-
OAS Oi WEEKMATERIALDEESCRIPTION
R-3 G � a
HITECT
ffASSMISTANTS
NRS.CHARGED
E_r7Ot,3 S tt LJ
ENGINEER
HRS. CHARGED
INSDAT ECiION MMV=M CQ NTLI d2 d Wn QS . a MMCTOR W k- •-te-S
69,6 --so
�Lm N
f)QCIS i v e " Cis t'i t� �e-- Sit .-S
—4"
COPY SENT TO CLIENT O
CONTINUED ON NEXT 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 TURF OF REGISTERED INS CTOR
ATE bF REPORT REGISTER NUMBER