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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
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
714188, B
pa e � �� / %Signature of Contractor s ' � -�V
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
S 'ction 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 GOLDEN KAOLE 1340,Policy No. 1300-"�440iSfi fl�
(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
subl�ct to the workers' compensation provisions of Section 3700 of the Labor
Code, I shallf orthwith comply with those provisions.
gate: . L ,,4plicant�s'
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 dove -mentioned property for inspection purposes.
Signature (Owner/Agent] f✓'�� f ���-Date
BUILDING PERMIT
PERMIT#
. j
DATE ] VA UATION LOTO
h �' TRACT
JOB SITE
ADDRESS 79-625 BAYA
APN
OWNER
CONTRACTOR / DESIGNER / ENGINEER
comaty I=WELL%OMMUNins
MTUPIY CROWLI., COMMUNMES
1535 so. WV'Sill.T:'1;1, 'IZ #2()0-'
1535 30. OD* MFJWTI ME. X00
SAWHERMARDINO CA 92AOS
SAM 1 ERIVVI , IU0 %`•A. 924:043
($309)381.61 71 CAI* 2120
USE OF PERMIT
01NOLL. 2M1vIILY J, DEI. !1]4'0
LOT SS, PLAN 1.F P, SFI3 PEPAIT DOES'NOT INCL.UbF, nock wa? u. ,
P004 OI: DRIVE AY APPRO.&CI1•. PLAN CHECK
.Fgt RFDUC r-0 75% 1~t^ P1
MULTIP1.F.. ISSU HC E OF WAF, PLAN TYPIs,.
CUSTOM C ON11;` RUCTION
7,97.00 SF
PORCHWATIO
212.00 Sig
C}A.;bWMARPORT (S;•f
111818160
'SS",%I:I!1fI{r,►'171} COSIM (XV (VI Ntoy"1f°",OCT101tif
2lPa, l
FEW= Fn WhOAAR
CON8''TRUCTION RE 101.000.4113_000
S.1,049.00
PLAN CHWK ?ME 101 4AW-439-318
$212,26
ItlWHANIC.AR ME 101-000.421-000
$51100
t,.lZCTIUCAL FS.C.
SMA.00'
PLUMBINOPES
$itib,Sib
STRCY'NO MOTION FEE - RMSID 101-000-241
OiCJ $21.70
d.ta'tA, Ii1NC1.t�+s E
$20100
DEVE-11,0PER. IMPAC' Fn
$11,07.00
ART Iii PUBLIC: PUCER • RE811 701.000-255-000
m 1
IT-?,-tOTAT COW, 'I IC°110N A14D
DEC 12 296
$42,46
V9;,AW C':-MCK
$3,655.92
RECEIPT
DATE r K
a.
BY (
DPT ALED I
b /`J
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 Deckl
G�
Exhaust Fans
O.K.to Wrap
/ // /
F.A.U.
Framing
Compressor
Insulation
a dam'
Vents
Fireplace P.L.
f f
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
3 4
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
steel
Set Hacks
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
I I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
/Z —Lp
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
/
i i ��
Pool Cover
Sewer Connection/
rry
Encapsulation
Gas Piping
Gas Test
1p_� Z-7
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)
°�
a os
OF LA QUINTA
OFTI'�'� � V INq & SAFETY DEPARTMENT
O� 7 7012
^� .I�N,SPE `REQUEST LINE
.�`® 777-7153 .
Owner CENT `C�OWELL COMMUNITIES
Contractor• CE Y CROWELL COMMUNITIES
Permit Number 0011-270
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 79-625 BAYA
LOT 53, PLAN 2AR; 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 'L evo
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
CONCRETE SLAB
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
COVER NO WORK UNTIL ABOV HAS BEEN SIGN
DRYWALL INTERIOR
EXTERIOR LATH
POOL PRE PLASTER
POOL FENCE & GATE
SEWER SEPTIC TANK — 6 /
FINALS
ELECTRICAL 6
PLUMBING
FINAL GAS TEST
HEATING - A/C
HOUSE NUMBERS
JOB COMPLETED
TEMP POWER
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING
J
Certificate of Insulation
Your Home has been insulated with CertainTeed Fiberglass Insulation products, which are designed
for today's safety standards and tomorrow's energy requirements.
Fiberglass'is inorganic and therefore permanently noncombustible, so it does not have to be treated
with fire=retardant chemicals that will likely lose their effectiveness over time. It has not been treated
with chemicals that can corrode wiring or metal. Fiberglass will not absorb moisture nor will it
settle over time as may other insulation materials.
This also certifies that CertainTeed Fiber Glass Insulation has been professionally installed in this home
to provide the following thermal performance..
Job Name: Mandarina Tract: 28719 Plan #: 2CR Phase: 2
Lot No.: 53 Job Address: 79-625 Baya Street
Ceiling Area: R-38 Blown Insulation
Exterior Walls: R-13 Unfaced Batts
Signed
Garage Ceiling:
With Living Above
Overhangs:
'With Living Above.
Non. Access: _
& Sloping Areas
Access Attic:
Interior Walls: R-11 Unfaced Batts Between Floor:
Subcontract6r.. OJInsulation, Co., Inc.
Tom Berry, General M
Temecuaa. Ca 92590
ula Branch
R- means resistance to heat flow. The higher the R- value, the greater the insulating power.
Ask, your builder for the fact sheet on R- values. Keep this certificate with your other
valued papers. If you ever sell this home, this certificate should be passed on to the buyer.
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
❑ REINFORCED CONCRETE IKTRUCT. STEEL ASSEMBLY ❑ S" v
❑ POST TENSIONED CONCRETE ❑ ASPHALT '4�16OTHER
❑ REINFORCED MASONRY ❑ FIRE PROOFING 1 l9
JOB LOCATION (� ` �I n -&� u
I
REPORT SEQUENCE N0.
TYPE QF Sj$eU TORE
�(� -:0- -5-3
PERMIT NO.
D3T��j� Q�
DAV OF WEEK
MATERIAL DESCRIPTION � �
�•{1
ARCHITECT
I�$Pb�(�1R,
HRS. CHARGED
,p
Lj
ENGINEER
ASSISTANTS I
HRS. CHARGED
DATE INSPECTION
CONTRAGENECL SUB TOR (f -e-141 l Dv2 Me CONTRACTOR W4 ! 1. ] S —
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COPY SENT TO CLIENT ❑
CONT RED ON NEXT PAGE ❑
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. I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED
PLANS. SPECIFICATIONS, AND APPLICABLE SECTIONS OF THE
GOVERNING BUILDING LAWS.
�i
SIGNATU E OF REGISTERED IN ECTOR
- (o o -V .,I:G3 o 6 O Cl °l �
ATE OF EPORT REGISTER NUMBER
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
79-625 BAYA
Type of Construction: VN
Owner of Building: CENTURY CROWELL
COMMUNITIES
Building Official
Bldg. Permit No.: 0011-270
Land Use Zone: RL
Address: 1535 SO. D STREET STE #200
City: SAN BERNARDINO CA 92406
By: KIRK KIRKLAND
Date: 8-20-01