0011-260 (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.
License # Lic. Class Exp. Date
714188''r;� n A n
Date •fir ���✓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.
SeI have and will maintain workers' compensation insurance, as required by
ctl n 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.
GOLDEN RAOIX i,N3.. NWC 444068-02 .
(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
supfect to the workers' compensation provisions of Section 3700 of the Labor
Oode, I shalliforthWith comply with those provisions;
Date: Z2 j- Z Applicant riff
Warning: Failure to secure Workers' Compensation coverage is unlawful and
Shallsubject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation; damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person,upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a. result of this applicaton agrees.to, & shall,. indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced.within' 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all'City, and State laws relating to the building
consyuction, and hereby authorize. representatives of this City to enter upon
the above-mentioned property for inpection purposes.
SfC�r
tgnature (Owner/Agent) Date
BUILDING- PERMIT PERMIT#
1
DATE t Yy�VALUATION LOT 00114W TRACT
JOB SITE
ADDRESS 79"00 BAYA
APN
t9&442
.769-t9&442
OWNER
CONTRACTOR / DESIGNER / ENGINEER
C&NMRY CRO LL CONI MUdam .
C)i$M. 'IR.Y C'ROVMJ. C:14.3y ixiN7 ;s
15:35 �4Ci: °D° �' R1 iy r7i1S, 203
1535 30, T1 ..Tmm."3.W 0200
3A1Y BF"AR DD$U Cly 92408
&41 BEPWARDWO CA 92408
C-BI.A. 2320
USE OF PERMIT
b` ,40L1' FAMILY L DVAULM(
LOT 11% PLAN 3A,, SIW d PERMIT 1 G9b 7JOT ,1NC1XD_ R BWC:X'iV'.AI.:iz,
fH'AQ,, O+y E4 OR UtFprit'Y!E3fd`�ryi�p��'ry��uPPRCy).:1��.fC;H,
M� IRCK �' % REDUCED "P55% FOR
1PI.��Tf
MUL I6' LrA I3SXJA NM, `moi' SAME .i' LA14 T Y, i�K
CUSTOM C014TRUCTION 2„997.00 SF
PCfR.CWPATIO
C3ARAOFUCAP ORT (3F)
)E�S7UI. TED C70ST Oir +C.oRcyJinuc`1.iom
2161993.
•ma y, �.yy�}'g+y y,�y�,
6 Jar,3i,lYG.11.,A, �4aW.42: I.l'iJ.�SIJBC'.M42FF.14
COAYw'fiRUi.f1014 FRE 101.000-4180)0 11,049.00
P.I;.A R CHECK FES 101-000.439-318 $213.26
MRCI-IANIOAL'FEE 101.000-421.000 $91,IH1
I,I. ECTRICNAL-FE9 101.100-420.600 $144.09
PLU,W3811,40 Few! 10& -WO.419.000
STRO'13113MOTION FRE - RESII3 101-CIOD-249-000
OR,F DINO F R . 101-000-423-000
DEVELOPER IMPACT FEE I1i,90'J OL'
ART IN PUBLIC PLACES • KESIL 701.000 -253. -ON) $42.46
r
` Qi
o)wI S0 cldPLWCi'XECK
BUD-TOTALCCA
$3,�T55.92
�,pp
X00
"r00 c
DEC -122000, ._ . WrAL FEES '. � �c3w
.r
�OT ue LA Q61%, - .
RECEIPT
DATE
T BY "
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
zz2—
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
_
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
_l
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
�i�'�"
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
steel
Set Backs
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
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
/ /
Encapsulation
Gas Piping
Gas lest
C�,A
Appliances
Final
COMMENTS:
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)
Contractor CENTURY CROWELL COMMUNITIES
Permit Number 0011-260
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 79-630 BAYA
LOT 13, PLAN ._2A; SFD - PERMIT DOE NOT INCLUDE
BLOCK WALLS, POOL, OR DRIVEWAY APPROACH.
TYPE OF INSPECTION DATE INSP.
FOUNDATION & SETBACK
FOOTING STEEL
MAIN GROUND SYSTEM
PRE-GUNITE I.
DO NOT POUR CONCRETE UNTIL A L ABOVE HAS BEEN SIGNED
CONCRETE SLAB
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING ,.
ROUGH GAS & GAS TEST
HEATING & VENT -A/C
FIREPLACE
ROOF
BOND BEAM
O.K. TO WRAP
GROUT O 4' O 8'
FRAMING
INSULATION
PRE -ROOF
COVER NO WORK UNTIL AB
DRYWALL INTERIOR ,
EXTERIOR LATH
POOL PRE PLASTER
' POOL FENCE & GATE
SEWER SEPTIC TANK
FINALS
t ELECTRICAL F
PLUMBING
FINAL GAS TEST
HEATING - A/C
HOUSE NUMBERS
JOB COMPLETED
TEMP POWER
EEN SIG
IMM w1ta'MING DEP 94T
ABOVE APPROVALS DO NOT INCLUDE IG TT
TURN ON UTILITIES OR OCCUPY BUILDING
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: 79-630 BAYA
Use Classification: SFD Bldg. Permit No.: 0011-260
Occupancy Group: R3 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
N ,
Eh
N
N
OD
0
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Certificate of Insulation
----- lima Home-hambeen insulated wjlh_CcdaiRTmd Fib=lan Inalation pmhtft v4&b ate desigQed----------
for today's safety skndarcls and tomorrov/s energy► regairemeW&
Fiberglms is inorganic and therefore penntew tly neawmbmfible, so it does not have to be treated
--wit�fusarete�at.che;nic�s.ffiotwitfikel�lose- over-time�..3t-hea_teotb�tee�ed--- -- ----- with cue mhmb that tan eo vade wiring or mad. Fibeigbos whit not absorb umigum nor will it
— -----scUl -over fine -as -may -otlwr-insulatiowmatesials—-- -- -- - --- -- -- -- -
- .. -This also certifies that CearainTeed RberCdass kmdzthm has been proksoioaally installed in this borne
to protide the following ftmW peaforartaneQ
------- Job Nun: Pdaadari tm Mmct #211ZI9 Plan ift 2A Fine: — 2 --- -
I—mfA 13--JW-iVddMW79*39-BHWStreet - ---
Ceifing Anes: R-38 Blown Insidation
Exterior Wells: R-13 Utdaaod Bulb
C-UM90 Ceilingr
UV"hangr:
-- WIC LWJng AtrOVB-- - -- -- --
Mon Aems:
dt.Slaplaag Areas ... .
Access Attic .
Interior Wait: R-1 I Unfaoed Batts Retweem floor:
.Subcof!tmaer.. OJf14wda&a C&, Inc
-e-�nElio t9edq T aria, Ca 42990
Sued
Tom Berry, General ager- Temwsd's Baruch
R- meaas resistance to beat flow_ The higher the R- value, the greater the insulating power.
Ask your builder for $te fact sheet on It values. Keep this certificate with your ether
valued gapers Ifyou ever sell this home, this certifx*e should be passed on to the buyer.
05/24/01 THU 13:20 FAX 700 7727193 . JON TANDY
REGMURM EM ECTW'S %VEMY RE CW
a 012
JON TANDY
V MedjW Ave.
Paha GeseM CA
otflce (760) 772-71 92
Fax (760) T72-7193
Pager. (760) 776-3358
TYpg OF
INSPECTION
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a REINFORCED comcftm XSTRUCT. STEEL ASSEWWY O S+40 Q
0 POST TENSIONED CONCRETE OrD ASPHALT
REINFORCED MASONRY RAE PA0004wc, f(
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COPY 3047 TO VARNT O CONTONAD ON tom RAGE O
PAGE OF
CERTIFICATION OF COMPLIANCE
I wGRiYY Ciift9lro TWAT I WAVE INSPECTED TO TNF BEST OF MY
KNOWLEON ALL OF THE ABOW RVIORTED WORK VNUMU Mili1ML4E
NOTED. I WIVE FOUND TIPS WORK TO CONPLV W"M THE APPIgVEp
!'! AIY.i SPEW CATWIM AND APPt.CAM MCMM OF TH$
rfItOY1Y/' IN FWIr NIG
OF REG6TERED R
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