0005-067 (SFD)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
Profewionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
7141..S B. 7. 10/31/2C
Date ` ° 7 a� 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 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:
Carrier0OLDE.N KAOLE INS. Policy No. NW -A-4069-02 .
(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
wor ers' compensation laws of California, and agree that if I should become
s4 ject to the workers' compensation provisions of Section 3700 of the Labor
O ode, I shall forthwith comply with those provisions`
Date: Applicant—
Warning:
pplicant 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 its
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.
I
Signature (Owner/Agent) Date i
A -y //1' BUILDING PERMIT PERMIT#
DATE VALUATION LOT OOM-067 TRACT
5.2143,583.90 18 2.8719
JOB SITE
ADDRESS 79-&%YAYA
APN
7469-490-042
t9-50-042
OWNER
CONTRACTOR // DESIGNER // EN 1NEER
CENTURYrJWLJ- COM-MMMM
CEN TIOR 4i4YML VN2AV1`y�M4J
1535 s 'D. sm +:ii STE. Itf}D
1535 so, Te ZIRM. I M. 4.200
SAN LJ+MWA12i31NO CA 9408
SAM BERNAffi D190 CA 97AW
(909).-481-6007 MW 2120
USE OF PERMIT
�iNt1I.� T�AA�:Y lr?1�...�1ldG
SIPO- OTMIS PL 2MZ PERMIT DOES'NOT I'NCLUDY BLOCK WALLS OR
POOL 15% PI.,11N 011FICR' 1799 RRDUCTION FOR. MULTI [PLL ISRUA:NCL OF
GAME" PLAN TYPE,
CUBTOM C'014MUCTION 21397.0D SIS
PORCF9l Nflo 213,00 SIF
GARAMUCARPORT (SF) 11,858,00
JIMMATED COM.' OF C:O1 5731;TTC,`7".ION
216,9W.90
' P3=L1'1Rz'd/Lft &1'11`8 SWfiMdR�
CONSTRUCTION ME 101.000-418.000 $1,D49,0D
LJ 't #
PLAN CHECK ME 101-000-435-318 $212.26
MECHANICAL ILEI? 101.000-•421-000 $9110
f -
w~
ZLEC'TPJCALFEE 101-000-42.0-000 $136,50
;
PLUMOD40FEE 101.000-419.000 t)68.5ta
�-•
5TRONQ MOTION IEEE - MID 101-000-241-000 $31.70
ORADING FRE I M-000.423 X000 V0.06
DEVZi DPF,R IMPACT YZE $1,90700
ART 114 PUBLIC PI.JACM - RESIC 701.000.255-000 542,46
ED
't e3V.13-TOTA,1>+ 0973.i?. V6MO1Y ANPLAtT l✓M. K
$3y64C7A
1=1. PRE -PAW MS
$0.00
I TOTAL PE '6FEN YOX NOW
c •
RECEIPT
DATE
BY k'
DATE NA D
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
1. INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
4�0
Underground Ducts
Forms & Footings
Iv
Ducts
Slab GradeC(,—
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
G,�py y
F.A.U.
Framing
�� _
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
Final
!z A
'PO
- $ , A$
BLOCKWAI,iL 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
Heater Final
Water.Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
�Tr��l9'� ��—
Pool Cover
.Sewer Connection
Encapsulation
Gas Piping
7
Gas Test
Appliances
Final
COMMENTS:
Final
nJ
Utility Notice (Gas)
rr _
ELECTRICL
PPROVALS
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 P •-r
r
Final
Utility Notice (Perm)
CENTURY HOMES
Century Crowell Communities
k
TRACT
LOT 0
BUYER �1S��
6LiId-p- K
Century Homes hereby agrees that, in consideration of the buyers of ohne above
referenced lot and tract supplying their own floorcoverings, a credit of $ LfS-D O — will
be given in escrow towards Buyer's allowable closing costs.
All payments to suppliers and installers of said flooring shall be the full responsibility of
the buyers.
Buyer(s) understands that the Seller will not warrant either materials or installation of
flooring purchased from any outside subcontractors nor will the Seller be responsible for any
damage sustained during such installation.
Buyer(s) further agree(s) to deposit any funds necessary into escrow in the event a
flooring withhold is required by the Lender.
BUYER
DATE
DATE
SELLER DATE
\dept\mktg\addendum\byrflrcrepSB5� South "D" Street, Suite 200 • San Bernardino, CA 92408
(909) 381-6007 • FAX (909) 381-0041 =
Certifficate of Insulation
_. Your Nome has bean insulated with C Wain jped Fiberglass Insulation products, which are designed
for sodayPs safety standards and temorroafs energy requirements.
Fiberglass is irtorgpnic and therefore pgrmanestly nonoomhrstible. so it sloes not have to betreated
-.--------._--.—.----.----with_firetr�etor±tlart_di that_will_li�jr eil►e etllbetittes sovertilos.--it
not been ----_ ----
N with chemicals that can corrode wiring or ime al. Fiberglas will not absorb moistam nor will it
� ...- _-.-- _ .- ----sattfe_nyer_timaas may_olheLina�rlatian.�sratri�sE�
m
- 'ibis also certifies that CcrtainTead Fiber Glass.lnsulation haa.been pref+essiorally installed in this tame
r to provsde the following thermal perfomanes_
m _
t° -- -- — — — Job Name: BUndariae 'fEirsets 28719 Rm tk 2AR Phases 1
z
CE
w Ce>>iug Ares. R-3 It Unfaoed Batts Garage tt.Riibrg; Non Access:
Q._
_ _ . -. _ With.Living Above._ ........ .... . . _-- & 11Soplag Arras
Exterior Welts- R-13 U�ced Batts Overhamp:Aeeeas Altim
—
�-
w
F-- Demean Floor.
z Interim Walls: R-1 I Unfaced Batts —
o -
CE Subs JH1HI1t elor.. Oj immadeII C&, ltw-
z 061t: 11edu, Temeenh, Ce 92 90
o Sr�sz� -
Tom Deny, Gmera M - TemeEt'Uk Brea Wk
m
v .
R- means resistance to heat now. The higher the R- value, the greater the aisuhting power_
Ask your builder for the fact shcet on R- valuea. Keep this certificate with your other
6, vakred papm. if you ever sell this haeme, this cmiificata should be passed on to the buyer.
CJ
lD
N
N
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 CONCRETETRUSTEEL ASSEMBLY
O POST TENSIONED CONCRETE ��:SPHCAIT
O REINFORCED MASONRY O FIRE PROOFING
O
OTHER +
JOB LOCATION
-/n 1 T 6 rb fSA �C , [ A f`�p O l O�
�J�
pEppRT SEQUENCE NO.
QF $TRUCTr�� � =
P rl` NOL
DAT DAY OF WEEK
MATERIAL DESCRIPTION
ARCHITECT
INS i HRS.CHARGED
�% CC
ENGINEER
ASSISTANTS HRS. CHARGED
DATE
CONTRACTOR vd2
ome-5 CONTRACTOR N . TEs SjE12��
O se�Rt Udle.�Lvi «► &As-Lv-
S&aA-,e-S = S7 -u-1050- —TO
L
S• y- y, 3)f aL5
to eua�
-
��C.i.�t1r-� l�V�- ���►��1-S Si�'�S
go C)
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 MY
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
RE 1 F REGISTERED.-A.�
OO(!�� 1