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0005-050 (SFD)tq H LU O ch L/ W oZr` r o I— (0 J LU LU t` f- a U) Z ch LO N ON U °) CL Q It Z Lo aCr 0 XW0 _J � m U U O CL: 0, "t Z oo 5 �0 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. �n Licerl' e # Lic. Class Exp. Date 7141" P � .f- 10/31/21 Signature of Contractor e, OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's License Law for the following reason: ( ) 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). ( ) 1, 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. 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 maintaiea 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 (IOL©EN EA0J.,E a INa Policy No. N'yyC-544063.0 (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 subj ''t to the workers' compensation provisions of Section 3700 of the Labor C,de, 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 is correct. I agree to comply with all City, and State laws relating to the building co >;truction, and hereby authorize representatives of this City to enter upon P.Si,6above-mentioned property for inspection purposes. Signature (Owner/Agent) 7f +�,'��L`' Date BUILDING PERMIT PERMIT# DATE VALUATION LOT "050 TRACT �'.�,.3113W O 56 28719 JOB SITE APN ADDRESS 79-6... DAY . 7694 70- 022 OWNER CONTRACTOR/DESIGNER/EN (NEER CEN`TU'RY CROW.IE:I.,l., C0 s MUNMES CENTURY 01910 NEIL C101V%T0Nr=. 1535 30. -D- #200 . 3535 so. -7.)- srT.Rk aE , = W200 GAl UMNAPD1N0 C.A. 92408 MN MTRWARDWO CA 924E08 (909)381.6001 CBLf# 2120 USE OF PERMIT '5127531 r 1iANSIEY`1t' DWIFL .]NG, SH'R- LOT S6 PLAN 3Ak PE.RR41T DORS'NOT INCLUDE BLOCK WAL Z OR Pool, " h' CUSTMCOMSTRUCTION 2,815.00 sn PORCWPATIO 157.00 SV C &Tik.OFICARPOR2.T (8Y) 9,976,40 R&I'MA• 141 MST OF COM:0170;' ON CONSTRUCTION RE 101.000.418.000 S1,10i.so PLA:N Ci FXK FEE 101-000-439-318 3689.E � MECHANICAL FEE 101-000-4.21-000 $93,30 LLeCTR1CALFEE 101.000-420-000 $142.31 t ;. PLUMBINO FFIR 101.000.419.000 $168.40 STRONG MOTION IM - MID 101-000-241-000 333.14 GR AID1110 ME 101 -NO -423 -WO $20.00 � : • DiL"�IFLOP1~fL IMPACT FLOE $1,907.00 ART IN PURVIC PLACLS - RES11 703 -0150-255-007 $W.38 ME DEPOSIT 101-000-439-318 4rlso,09 SUB -TMAL CC>N'MUC,1ION ARD .kT:LAN CFEC K $4,419.11 1=3 );+RxK.PAM I- ES -$750.00 TOTAL PF RMST :k EEE ME NOW 4 a RECEIPT DATE BY' DAE FINAL - ED INSPECTOR (7V INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade �,,,,� 3a –crb Return Air Steel Combustion Air Roof Deck Exhaust Fans O.K. to Wrap F.A.U. Framing Compressor Insulation _ �. –� Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath Final 6�— Final Kfad BLOCKWALL AP ROVALS Steel _ POOL' - SPAS Set Backs Electric Bond r Footings Main Drain ' Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final Gas Piping PLUMBING APPROVALS Gas Test, Electric Final - Waste Lines Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Sewer Connection Pool Cover Encapsulation Gas Piping Gas Test (® Appliances Final Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. f_ Smoke Detectors617 Temp. Use of Power Final Utility Notice (Perm) COMMENTS: M a _ N M 0 z Certificate of Insulation Your Home bas been insulated wish Certain'X'ea:d FhlheWass hisubation producIN which are designed for todays satbty standards and tomorraWs energy requirements_ Fiberglass is inorganic and therefore permanently noseombustible, so it does not have to be treated -_-.... _ _-- -_-- -- - - - ---------- --- withffre4etandantt$oemicalsAat_vr311_I ftly.lose lheir_effactiveness ov. tim.. It. 111 is 11 Ult -111 M�tw.. _ .. _. -------- - -- . -- - --- ---- with eharnicals that can corrode wiring or metal. Fiberslass will not abs moisium nor will it ---.-- --..------------.------- settleow-time.as-may.other. insubdion.materlals.___..----.---------•--..._.. _..---- --- - . ---- ----- : This also certifhea-that .CertainTcad.Fi&s Glass.Insulatien has been professionally insWled in this home to provide the folk wing thermd pv*rmarwL. -- dab Mame- rdandmko Tract: 2M Plan 4.3AH Phase:---- -LiirPlas: 5t3��on�aar�s: ��s-�rr�rreez,-a;a-�rmoa�aa • E _ — z Ceiling Avon: R-39 Unfaced Batts Garage Ce)hug: Yon Access: g-- Witd living Above & Sloping Areas Bnteriior Walls; R-13 Unlaced Batts Ohnndrsagc Access Attic;' Wan Lmug Aeove W Between lYoor: z Into dw Walls; R-1 l Unfiwtd Batts -- — 0 CE Samu&adar- OjInsulagen Co., 1w- Nledo, Tehneeate, Ca 9259D o Signed Torte Berry, General Tenwelada Brtntrrk �' R- Weans resistance to beat tia►v. The higher the R- valuq On grater the insulating pourer_ A* your ballder for the fact sheet on R values. Keep this certificate with your other valuta papers. lfyou ever sell this haat, this carrtificate should be passed ars to the buyer. m N tD N Rl • r ,,W 0 Ow = &i - 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 CI REINFORCED CONCRETE STRUCT. STEEL ASSEMBLY O POST TENSIONED CONCRETE tCI ASPHALT O REINFORCED MASONRY O FIRE PROOFING O stio P POTHER `. I (( w ei-��1'ICQY JOB LOCATION., �,J �-�-� J Qv i O i E T REPORT SEOIIENCE NO. TYpE QE 7RUCTURE —T. �f PERMIT NO. p�7E DI►r OF WEEK MATERIAL DESCRIPTION PC 36 _ �ARCHITECT W*k-Ly NRS. CHARGED ALJ ENGINEER ASSISTANTS I NRS. CHARGED DA A ONACTa� SR Home --S s N S Z_ oTu�R 0j9,Se'1lR1b- lei-iatijC, &46aF jeWAU—S .�-S • t,-4, y- 3 Gat. s 5*61P WeA,0-1149 Gam - ��iStta� i�•v� ��A�-S Si�.S 4 90 0 t --),© COPY SENT TO CLIENT O CONTINUED ON NEAT PAGE O PAGE OF CERTIFICATION OF COMPLIANCE I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MV KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE NOTED. 1 NAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED PLANS. SPECIFICATIONS. AND APPLICABLE SECTIONS OF THE c� (ate _ GNA JRE OF REGISTERED INXPECTOR