0011-262 (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
Professionals Code, and my License is in full force and effect.
Li nse #1 d �} Lic. Class Exp. Date
ey�
!Date imignature of Contractor rl °
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:
Carrier Policy No.
0OL DEN MAGLE Iii da • . 2J 4 C- 440G -��
(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
worked�' compensation laws of California, and agree that if I should become
2sute:
bAct to the workers' compensation provisions of Section 3700 of the Labor
de, Ishall fort�wit comply withthose-provisions, , % l�, ,,Applicant ! ! l l
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT. Application is hereby made to the Director of Building and Safety
for a permit subject to' the conditions and -restrictions set forth on his
application. 4
1. Each person upon whose behalf this application is. made & each person at
whose request and,for whose benefit work is performed under or pursuant to t;.
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced .within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the'rabove-mentioned property for inspection purrp��osse& • A
4 1 �c_!* �_'s'f Date � /
Signature (Owner/Agent)' T' ^^ '`'
PERM'T"BUILDING PERMIT
DATJ,iii�// /J OALUATION LOT 00 11 "W TRACT
(d W 19
JOB SITE
ADDRESS ` ` 60 DAYkA
APN
769-49"44
44
OWNER
CONTRACTOR / DESIGNER / ENGINEER
N1°C' , Y CROW1i,U, CO1`hlAW_1i 1° 41
t'. i'1`Iik1.Y ("TO FLL comm TIP.[ -12
113; 40.1, Itan6TW$XT,'Unt", 0200
VMSEMARDWO CA, 92A08
aM URNARDIVO CA, 924,08
(90V) -481-()0V Muf 21210
USE OF PERMIT
`OLE FVMMY DWJ� O
),OT T V% PL AN 313; SFD .. PE'Fd.Mn, v0vu we 1Z+IC1., ibr, ELocxNVAu1 S,
P001h OF1, DRIVEWA.Y APPRc;aACF1.
MU1✓f1Y'Li;1SSUANCE OF SAW PIAN TYP?_
C'1JS'1OM CONSTRUCTION Z81+5�.00 of
PoRm/pATIc 157.60 SP
0ARF7MC;IA,1xPORT (R) 96n&40
fr111& fi'iJST OF CONMAkIRUMON
PFAM. T :1I -V SUAIWARY
CONWR2.UCT1010 FEE 101 •(W0_4 1 &_000 $1,101.60
PLA"c4 CHECK. FF21 l o),000.439.318 t $223.47
MECHANICAL FIRM 101.000.421.000
1tl.ZCTX1CAL FEZ 110-000-420-000
PLUMBINO".9 . . 101-000-419-0004sfr .31f
S:TZG3IGMOT 10NFEE •F:ESID 101-000-241.000 W_14
0RA1 ING FRE . 101.000.423.0 f9 520.60
DZWZOPER IMPACT2FEE S3,90?.00
ART tri PUT$L1<` PLA.CkT • R&S.i,L 701.000-255.000 113.38
rte,
b
� �1 2 7sRiE•Pc�If3 X"�XI"�
$0.00
DEC 12 it` 1C3'! s111XtMrr4 P:.u1iIVEROW
RECEIPT^
DATE
r5BY /� r�
4 i
D ALED e
L
INSPECTOR
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 Deck
/ Q
Exhaust Fans
O.K. to Wrap
9 6
F.A.U.
Framing
1
Compressor
Insulation
Fireplace P.L.
�j
Vents
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath 2 S d i
_
Drywall - Int. Lath
�� I
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
steel
Set Hacks
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
OX for Finish Plaster
Sewer Lateral
Sewer Connection
/T' / J
7 /
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.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
0
_ s ( OF LA QUINTA
c�OFTtR��S� ` l8`�L`OINGo�SAFETY DEPARTMENT
A' Q`` V% 77 .7012
GIOPE EQUEST LINE
77-7153
Owner CEN ROWELL COMMUNITIES
Contractor CE Y CROWELL COMMUNITIES
i
Permit Number 0011-262
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 79-650 BAYA
LOT 15, PLAN 313; SFD - PERMIT DOE NOT INCLUDE
BLOCK WALLS, POOL, OR DRIVEWAY APPROACH.
TYPE OF INSPECTION DATE INSP.
FOUNDATION & SETBACK
FOOTING STEEL
MAIN GROUND SYSTEM
GROUND PLUMBING
.PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
CONCRETE SLAB .gyp
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
j ROUGH PLUMBING
ROUGH GAS & GAS TEST
HEATING & VENT- A/C
i FIREPLACE
ROOF
BOND BEAM
O.K. TO'WRAP
GROUT ❑ 4' ❑ 8'
FRAMING
INSULATION
PRE -ROOF
COVER NO WORK UNTIL ABOVF,,AASj3EEN SIGNE
DRYWALL INTERIOR r
EXTERIOR LATH
POOL PRE PLASTER
POOL FENCE & GATE
SEWER SEPTIC TANK 7n7 „A
FINALS
ELECTRICAL .
PLUMBING
FINAL GAS TEST
H EATING - A/C
HOUSE NUMBERS
JOB COMPLETED.
TEMP PnWFR
ABOVE APPROVALS DO NOT INCLUDE IGHT'
TURN ON UTILITIES OR OCCUPY BUILDING
J
JI
I
i
0
_ s ( OF LA QUINTA
c�OFTtR��S� ` l8`�L`OINGo�SAFETY DEPARTMENT
A' Q`` V% 77 .7012
GIOPE EQUEST LINE
77-7153
Owner CEN ROWELL COMMUNITIES
Contractor CE Y CROWELL COMMUNITIES
i
Permit Number 0011-262
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 79-650 BAYA
LOT 15, PLAN 313; SFD - PERMIT DOE NOT INCLUDE
BLOCK WALLS, POOL, OR DRIVEWAY APPROACH.
TYPE OF INSPECTION DATE INSP.
FOUNDATION & SETBACK
FOOTING STEEL
MAIN GROUND SYSTEM
GROUND PLUMBING
.PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
CONCRETE SLAB .gyp
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
j ROUGH PLUMBING
ROUGH GAS & GAS TEST
HEATING & VENT- A/C
i FIREPLACE
ROOF
BOND BEAM
O.K. TO'WRAP
GROUT ❑ 4' ❑ 8'
FRAMING
INSULATION
PRE -ROOF
COVER NO WORK UNTIL ABOVF,,AASj3EEN SIGNE
DRYWALL INTERIOR r
EXTERIOR LATH
POOL PRE PLASTER
POOL FENCE & GATE
SEWER SEPTIC TANK 7n7 „A
FINALS
ELECTRICAL .
PLUMBING
FINAL GAS TEST
H EATING - A/C
HOUSE NUMBERS
JOB COMPLETED.
TEMP PnWFR
ABOVE APPROVALS DO NOT INCLUDE IGHT'
TURN ON UTILITIES OR OCCUPY BUILDING
J
Certificate of Occupancy
City of La Quinta
Building and Safety Department
This Certificate issued pursuant to the requirements of Section 109 of the Uniform Building Code,
certifying that, at the time of issuance, this structure was in compliance with the various ordinances
of the City regulating building construction or use. For the following;
BUILDING ADDRESS:
Use Classification: SFD
Occupancy Group: R3
79-650 BAYA
Bldg. Permit No.: 0011-262
Type of Construction: VN Land Use Zone: RL
Owner of Building: CENTURY CROWELL
COMMUNITIES
Building Official
Address: 1535 SO. D STREET STE #200
City: , SAN BERNARDINO CA 92408
By: KIRK KIRKLAND
Date: 8-16-01
05/24/01 THU 13:21 FAX 760 7727199 JON TANDY
REGISTERED INSPECTOR'S WKLY REPORT
e 014
JON• TANGY
37690 Me jdW Ave.
Palm Desert, CA 9221 i
Office (760) 772-7192
Pax (760) 772-7193
Pager (760) 776-3388
rm of
INSPECTION
PERFORMED
0 REIMFOIICED =NO" S711UCT. STEFI ASSEMsIr o �H 0 p
O POST THrSipNEp COTE O ASPNALTOTHEA `
O REINPOFAM MASONRY O FIRE PROOFING PIt1'I lam'
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CO" SENT TO CUERT 0 COMPMED ON NEYT ►AGE 0
PACs or
CERTIFICATION OF COMPLIANCE
i NEi M" CGWnFV THAT I NAVE INSPEMO TO TME BEST OAFY IAV'
KNWAM RK
NO� 14AYS FOUNDTNAIS WORK TO COWLY WM tW AP EPROVED
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t S, SP9CMICATIOII;, AND APPLWAKE SECTIONS OF TME
RF iE61S?EREO 11 iCTOR ? Q �%
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Certificate of Insulation
Your Home has been insulated with CertainTeod FiberRlow Insolation ttrmiuets,�whioh we designed —_---- --
for teday'b salty standards and tornortoWs enetjW requirernents.
1t berglass is Worgettic anti therefore pemaneittly noneombustibbe, w it does not have to be treated
vQiiki��idant.c�tleal�_�aLiA+illiekely Emse,�eir_a�Activr�asaover_time_.:it.hasnatb:sentrested.—._ _...
with chemicals that can ca mode wiring or metal Fiberglass will not absorb utoisture nor wall it
---. -- settle.oxer-tin@.as-may-odrer-insulation-matewials.------------- ----
This also certifies that CertainTeed Fiber. Ghee hrealatiun has been Professionally installed iio this home
to Provide the fonowejg therrreal p�r6oQdtaa00..
— Job Noma Mandoslns _-- Trael: 2 8719 Plmr #e 3H Pimtte: - - 2 ,--- — ---
---
Calling Area R-38 Blown insulation Gerage.Ceil1W. Non Access:
With Living Above ... dt Sloping Areas.. .. . .
Btterior Walh.- R-13 Unfsced Batts Gveritarrgw Acseae Attie:
------.—....-------------------------------._.._......------........-----------_WiYillJdlrigAbQ'i®---------------�...-----------
------ ------
Interior Waft; R-1 1 Unf'aced Batts Between Rear:
SubCO7JffIW& , OjlashO[ddooll CO., Inc
420 Netlu, Temecula, Ca 92590
Signet
Tony Berry, Geneml Ag e- TenserLak Branch
R- means resistance to beat flow. The higher the R- value, the greater tho insulating power,
Ask your builder for the fact sheet on R values. Keep tips certiricate with your other
valued Rapers. If you ever sell this home, this certificate should ' be passed an to the buyer.