0005-065 (SFD)U)
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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
R.;ofessioL')als Code, and my License is in full force and effect.
_ ;license # Lic. Class Exp. Date
�1 714188 .6 ` f} f10P31/2(
'1ZDate .r i� F�"Signature of Contractors
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 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.
( ) 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:
Carver 0OLbm El�k.GIs INS. Policy No. 14WC-544062-02
(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
suptect to the workers' compensation provisions of Section 3700 of the Labor
Pode, I shall forthwith comply with those provisions
Date: % * Applicant—
Warning:
pplicant r
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 abgue-mentioned property for inspection purposes.
�Slgnature (Owner/Agent) f / 1. V X1114 c i- r Date -.1 f�` le -15G
BUILDING PERMIT PERMIT#
'668
DATE VALUATION LOT TRACT
S216,9W" 20 28719
JOB SITE
`775
APN
A
ADDRESS
79-1-r-10-- c rrl a
76""042
OWNER
CON ACTOR / DESIGNER / ENGINEER
CEb1'MY CROS cobAl iiAi3rEm
CE1`3TZCRY CROS. CO i ""T1�Ii S
1535 00, TO, ErrRrIXT, STEP #E200
1535 ISO, 'D' UI'R-W, WF. #200
BAN W1t,Ai'Ai DBY0 CA 921088
SA13 +' Al2DWO CA 92408
(909).,81.6007 C13LfI 2120
USE OF PERMIT '
B. NG12 ITAMLY DV-1Ja11NG ,
SFJ) -LOT 70 PL 2BR PERMIT DOES NOT INCLUDE BLOCK WAa I S OR
POOL %, 04 PLAN CHECK FEL? K19DUCTION FOR MULTIPLE ISSUANCE OR
SAME PLAN TYPE
CUSTOM CONSTRUCTION ZSQ7.00 SF
PORCH/PATIO 212.00 SF
CIAIiAWCARPORT (SY) I1,35s,00
b
11:5'11AWIM COW 011' C.'OF►YrMiCnOR
21.�.9�3.9tI
1.'ERYW NW, 90W"R i
COWSTRUCTION FEE 101-000.418-000 $1,049,00
PLAN CHECK FEE 101-000-429-318 $212.26
MECRANICAL FRE 4 101-000-421.000 $91.00
�
ELIXTRICAL FXF % 101.000-420-000 $135.50
PLUMBNO PEE 101.000.419-000 $168.58
STRONG MUfION FEE . RES1D 101-000-241-000 $21.70
GRAUIN0 FEE 101 -(*0.428.000 $20.00
r, t
OVELOPM IMPACT FEE $),907.00
ART IN PUBLIC PLACES - RESIL 701-000-255.000 $4.2.46
MM -TOTAL, CO14aTR1TC 101i AND PT" CHECK
$:3,648.42
L&W PPY, PAID P71193
$0.00
' rAL PE -I .f FEES DI.T.:.0FOV1;?'
Se�1,6�dS,42
RECEIPT
DATE
B! / \
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
7-,Z-70— —c-5
Return Air
Steel
Combustion Air
Roof Deck
40--
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Z —ba
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
6C'tJ�
Final
BLOCKWA PROVALS
Final
Steel
POO $ - SPAS
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
—pry
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRIC
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voftage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
PL APPROVALS
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COMMENTS:
I
09/18/2000 14:26 17149789926 VCA
r
VANDORPE CHOU ASSOCIATES, INC.
CONSULTING ENGINEERS
296 N. Rampart Street, Sulte A
Orange, CA 8288
Tel: (714) 978.9780 Fax (714) 978.9926
Attn. ,lack Fisher
Century Crowell Communities
1535 South D Street, Ste, 200
San Bernardino, CA. 92408
Subject: Mandarina (La Quinta, Co.)
Pian 2B, Lot 20 (Tract 29719)
rear .lack,
PAGE 02
Since 1979: '
Facility Planners
Code Consultants
Structural Engineers "
Fire Protection Engineers
September 18. 2000
We have received and reviewed the sketch sent to us regarding the HD5A at rear of dining for
plan 1. A 5/8" x 12" aj chor bolt may be installed in lieu of SSTB anchor bolt as shown on the
attached Figure No. 1.
[f• you have any questions, please contsA Steve Trieu of our office.
Very truly yours,
VANDORPC CHOU ASSOCIATES:
Robert Chou, S.E.
ST
Att: Figure 1.
0johf ilk:020MAC'CC 1682\Riald08 (Plan 28 Lot 2014D5A).wpd
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01
09/18/2000 14:26 17149789926
® VCA ENGINEERS
295-A Rampart Street'VCA .
Orange, CaiMbrrda 92888
714 978-9780
VCA PAGE 03
Joe
SWEET NO. OF
mcuIATED BT DATE '
OWEGXSO Sr — _ — _ — DATE _
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Certificate of Insulation
Your llama has been insulated with Curtain%ed Fiberglass Insulation produws, which are designed
- for today's safely standards and tomomoNfs ®nerd oircrnaireq ts. — ---
Fiberglass is inorgarrie and therefore permanently neramnbustible, so h does not have to he treated
—__-- — _ - -- _ _------__---. wlthSM_rets€t}arrt t�trutieets stmt v li y lose their etted'eyraress over tirnc_ It has not been treekd —. -- - —
with chemiMs that can corrode wking or ureter. irfaergless wig not absorb moisture nor wifl it - - -- ---- - --
� _ _-- _-- ___-- settle_orieLtltng.es_a�sriheti�etlatian materials, -- -- —.—------------.__--
m
I its also certifies that CcdainTeed Fiber Glass insulation has been professionally installed in Qt» shame . -
to provider the following thermal perti rmunoe._
m
`r° — Job NM= li�aderti 3�roc )gnus 2011 !— —
T QuI ntea ---- -
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CeRiog Arep tt 3g Unfam di Batts Garage CaNiag: Non Ameaa:
...... . . . _ ..... ...... .. .. ......... ... _ With 1�i�tg Abeo'c ...
g 1iateerior WaII R-13 UY[�d omits
Orerhaw- Aoams AtQie:
W
►- Between Fkmr:
in7eaior Wall: R 1 p Uafaaed Hotta
o
K Z9 l m f a, Teateeals, Ca 92M
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C9
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N
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N
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Tam BeM, ttiEitt m1 MWwg 6mGu1& BAtTn&
R- means resistanee to heat flow. The higher the R- value, the greater the insulating power.
Ask you builder for tate fact shat on R- values, keep this certificate with your other
valued papers If you ever sell this home, this certificate sho®td be gassed on to the buyer.
04
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 CONCRETE UCT. STEEL ASSEMBLY D S t4o p
O POST TENSIONED CONCRETE O ASPHALTtiQTMER
O REINFORCED MASONRY O FIRE PROOFING 11 We -w ii
JOB LOCATION'
c t b �. � ko ` �;
C_ , �s
i
REPORT SEQUENCE NO.
TYPE _S1=0 F ST�UCTUCD-v� a ® PN�s
rA
PERMIT NO.
DATE �� /
1/CINSQECTORIJ
DAY OF WEEK
``'�� //''
MATERIALESCDESCRIPTION PV-
PC -J G li �L�
itCM1TECf
l
MRS. CHARGED
j p
E- r/ 018 .S v% ft LJ
ENGINEER
ASSISTANTS
NRS. CHARGED
suo
INSPECTION Gomm e-a"�S
(> a --So
G1Z•4i� � ��� S' 1 t� S �� � 01- -P�—
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, mo FS•voAo VhAoe'r,iA mole lwez-
'14rLC-LS r u -e 'TeS (i 0 L. a,P-- - s ii
8 7 a
COPY SENT TO CLIENT 0
CONTINUED ON NEM PAGE O
PAGE OF
CERTIFICATION OF COMPLIANCE
I HEREBY CERTIFY THAT 1 HAVE INSPECTED TO THE BEST OF Md
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.
IG TORE OF REGISTERED INS CTOR
ATE bF REPORT REGISTER NUMBER