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0005-064 (SFD)LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of V6— Chapter 9 (commencing with Section 7000) of Division 3 of the Business and N W Professionals Code, and my License is in full force and effect. Cch _ License # Lic. Class Exp. Date t` Qom. r W - 714189 B o Z r- Date°Signature of Contractor �`S �'•` �� f.� m 0 W J U C) OWNER -BUILDER DECLARATION W WW r` I hereby affirm under penalty of perjury that I am exempt from the Contractor's License Law for the following reason: Z_ ( ) 1, 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). C0 () I am exempt under Section , B&P.C. for this reason LO N ON Date Signature of Owner CD ,i Q WORKER'S COMPENSATION DECLARATION p 2 CrI 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 - compensation, as provided for by Section 3700 of the Labor Code, for the O � Q performance of the work for which this permit is issued. m Q L) ( ) I have and will maintain workers' compensation insurance, as required by O U Q Section 3700 of the Labor Code, for the performance of the work for which this li rn t` permit is issued. My workers' compensation insurance carrier & policy no. are: 'IT Z Carrier Policy No. r co 00f. 713N pA()LE 1`t4S, NWC444068-02 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, 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 3subject to the workers' compensation provisions of Section 3700 of the Labor JCode, I shall forthwith comply'with_those provisions. / �+ Date:-' ✓/':' I Applicant '? i rf3 ✓./ a'i'l ll . r x° f 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 tl7o above-mentioned property�for inspection purposes. A Signature (Owner/Agent)< '� 1R d CSL% Date' BUILDING PERMIT PERMIT# DATE VALUATION . LOT WOIS 0fA TRACT $231, .f* 21 28719 JOB SITE ADDRESS 79-76s CW/awo APN '169-490-041 OWNER CONTRACTOR/DESIGNER / EN (NEER Cl`)TURY CROWELL CO)aAUXITES CENTURY CROWE, LL CON M'UMIES 1.535 SO. �" ST.PiM , ATTE. #200 1535 80."D* 3TR s. r,:_� 4200 SAN BERNARDDIO CA 9.2408 SAN' BERNARDINO CA 92A08 (909)381-6007 CBIJI -2120 USE OF PERMIT MW LE TAMMY DVAK- .Ll O :;ND -LOT 21 PL 3C PERMIT VO S NOT TNCLUDE BLOCK WALLS OR FOOL 75% PLAN CHECK CRE IR DUCTION FOR MULTIPLR ISSUANCE OF SAMLt PLAN TIM& CUSTOM CONSTRUCTION 21815.00 SF PORCH/PATIO 157.00 SP IUARAOEIC.ARPORT (SF) 0,976.40 XSTJ34ATfX COOSr OF C0.I4tJCr10H 2:51,3°G. .00 PERM W FEF SUMMARY CONSTRUCTION PEE 101.000.418-000 51,101." PLA14 CHECK FRE 101-000439-318 $232.47 L! MECHANICAL� E 101.000.421-000 �4�.5© i • y ELECTRICAL FLEE 101-000.420-OiDO $147.21 } . PLUMBINO FEE 101.000419-000 3118.50 STRONQ MOTION FEE . RESID 101-000-241-000 $2:3.14 ORADINO FRE. 101.000-423.000 12O." DLYELOPER IMPACT FEE �1,5cU1.00 t 3 � ti. ART IN PUBLIC PLACES - RF,91E701-000.255.000 MA 38 SUB -"MAL CONMRUCTION AND PLAN CHECK $3,761.70 7 E53 PR -PATro EFM $0.00 '1' rAr F�-'t* AffI'MS_ DVE $3,761,70 RECEIPT DATE Y DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs _ Underground Ducts Forms & Footings �/ Ducts Slab Grade ► — ' —GO Return Air Steel �, Combustion Air Roof Deck py Exhaust Fans O.K to Wrap o dpp F.A.U. Framing /-�!� jLB--—rr�� 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 3 _ Final _d� POO -S - SPAS r F, BLOCKWA A. PROVALS �L 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 Encapsulation Gas Piping Gas Test Appliances Final COMMENTS: Final Utility Notice (Gas) ELECTRICA APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors _ 3 �r Temp. Use of Power Final V2 O1 Utility Notice (Perm) 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 INSPECTION PERFORMED O REINFORCED CONCRETEUCT STEEL ASSEMBLY ❑ S l7 Q POST TENSIONED CONCRETE O ASPHALT PTHER �e�JO ❑ REINFORCED MASONRY ❑ FIRE PROOFING (( JOB LOCATION j'71/7 (- LJj l „/ can`� O S r LA � ` v\ REPORT SEOUENCE NO. TW F STRUCTU�II� ,1 ^1 I ■^H.4S e M Ts P `/ PERMIT NO. pA0 01/ op L/7� DAY Of WEEK MATERIAL DESCRIPTION -3 -spa ARCHITECT NRS. CNARGED E-- r7 O t s Lo ENGINEER ASSISTANTS HRSCHARGED INSPECTIONAGENOW ooNrRAWOR C2NTU �2 doves MaMw W i+v-re-S S tom+ --, P k I %(fes tir,J� e.�s �t1A N ��7��c'7 I(hA o2. i tial jNi►}I�i � tJ�Z `�-eGIS i u� T•e.s � i N � � ��4- Sites 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. kAGIPATURE OF REGISTERED INS CTOR DA OF REPORT REGISTER NUMBER N Ql - N B • e9 B Cerfifficate of Insulation Your Home hes bmm imulaW wM Cmat&kTeed Fiberglass ImmIstion pr0&d% whi b an designed A ktodays safely staoet:trds and tomarrow/e: emeagy s�egttireaments. Fibergtass is istmWie and &emere pe mane ntly nonombasfibie. so it does not have to he hefted o with fine-rea rdamt chemicals that will likely lose their efl'eolivea m over time. It has not bum treated ~ with chemicals dais; can cue wing or radel- Fiberglass will not abserb moisture nee' will it z settle aver time as may estber insidation snatuials_ F This also Owt&" that Ce:rtaissTmd Fiber glass tomdatiim has been profemiamally installed in this home D i to provide the following thenal pmfzmamw., a Job Name: Mmdmins Tract: 28719 Pilau M. 3C D bmw 1 m ----- — — ------ --- --Z -- .JWA4dii s—m 7"W'USttl� ►ll�Qalet�� M rC D Celling Avw- R-38 Unfitced Batts Genge Ceirmg; Won Aecm: ao 31..I:hdng �>Er &-Mme Aftas barter`Wisnu R-13 Untimed Helie �verlt®nmsti a� Attie: Wilh Daring Above m %tertorwalls:lR-11 UR&CMBatts: Sal em9raetor OJInsaAmdvn C'k, Isar IlUo NW% Temsesde, Ce 92M N Zorn Berry, Gene ml Mi Branch R- mews res€mam to fteat &w. The bf#lt r the R- value, Ria greater the inmdating PWRW. Ask your builder for the fad sherd on R. vedtes. Keep this aaaMeatse wlOt your outer z valued papaare:. if you ever sell thio lioana, tris eettifccetto should 6e passed on to (he buyer. �