0011-266 (SFD)LICENSED CONTRACTOR DECLARATION
Ui I hereby affirm under penalty of perjury that I am licensed under provisions of
H Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
04 W Professionals Code, and my License is in full force and effect.
O M License # Lic. Class Exp. Date
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aDate Signature of Contractor
CID 0 111�
J U OWNER -BUILDER DECLARATION
W W I hereby affirm under penalty of perjury that l am exempt from the Contractor's
~ U) License Law for the following reason:
Z ( ). 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).
Tam exempt under Section B&P.C. for this reason
L
N Date Signature of Owner
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d Z WORKER'S COMPENSATION DECLARATION
o1 hereby affirm under penalty of perjury one of the following declarations:
Lo < p () I have and will maintain a.certificate of consent to self -insure for workers'
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— compensation, as provided for by Section 3700 of the Labor Code, for the
• J Q performance of the work for which this permit is issued.
Q () I have and will maintain workers' compensation insurance, as required by
p U QSection 3700 of the Labor Code, for the performance of the work for which this
r, d rn H permit is•issued. My workers' compensation insurance carrier & policy no. are:
N Z Canter Policy No.
w Z GOLD&I ZA01:,E IRIS, N'SNC-5�4D<g -tit
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J (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
subjpct to the workers' compensation provisions of Section 3700 of the Labor
Cotte, I shall forthwith comply with those provisio'hs.
Orate: 1/7�/ia"7APPIicant Z/1 i r
4,1
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for 'a permit subject to the conditions and restrictions set forth on his
application. x
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work. is performed under or pursuant•to
any permit issued as a result of this applicator agrees to, & shall, indemnify
& hold harmless the City of La'Quinta, its officers, agents and employees.
2. Any permit issued as a result of -this application becomes null and void if
w work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I.agree to comply with all City, and State laws relating.to the building
construction, and hereby authorize representatives of this City to enter upon t;
�he bove-mentioned property for inspection purposes.
nature (Owner/Agent) O ' ' ``t' �`^ ° • Dater 2
BUILDING PERMIT PERMIT#
DATE
G I 1)t;�;ZI ALUATION LOT 0011 266 TRACT
/J
{i 1 :SSM 4 29; 19
JOB SITE
ADDRESS 79 -MS IDAYA.
APN
'769-47"22
OWNER
CONTRACTOR/DESIGNER/ENGINEER
C!rNMXilC C'T?Ciir FJ1L COMMIA ti' kz 'S
(14EN 1'LYRY CiZ.O'tAKIL 0101art1kn°C ES,
1534 qty. "Do IMwS. 4200'
1:535 50. %1Y =W.fd VX 4200
SAW BMARDIlao CA3 92409
SAX Mx RSA► WO Oak 94408
(9U13)381.6007 C13116 6 2120
USE OF PERMIT
S1% GXX RAIM3C T.}•tiFJEV.1 G
LUT 0, PLAN SBR; SrID . PERMIT DOPS NOT INCLUDE BLOCK WALl T
POOL, O.R DR1V9WAY APPROACH, PI Ata GiiEtC;iC .'EE ItE;�Ut�ED'1K°4 3�01t
MUL'I'IPLZ ISSUANCE OF SAME PIAN i`YPI
CUSTOM CONSTRUCTION U.131001 OF
PORCt31PATIO 1157.00 SF
0ARAt1II1 ARPORT (9t1+) 9,9:6.40
1� Y`.9 4► C01 A Al ' C:U `$X�4tdTA��?
231,X53.00
CONSTRUCTION .ice 101-000-418-000 $11101.30
PLAN CH;trK FEE 100-t}47Z3-439-•31$ $222.47
MECH"ICAL FM 101-000-421-000 -421.000 S9g. s0
17„LFC:I'RXA L Ift, 101-000.420.000 $143.21
PLUMBING FEE $163.30
.STRONO MOTIONIPM, - MID 101-000-24.1-000
GRADING FU 101.000-423.090 S'LQ.C+i1
DEVELOPER IMPACT FEE: I$I,41U'I.tiO
ART 04 PUBLIC PLACMJ - R=r 7 i -m R m-Cl40
r
ff UD -WrA ,CC31Aa�°rRf3'L�I ('XTMPI WL`:�'�ix.
a3 r -n -r w nV°
$0.00
4 ' yeaMAL y4 dope . PY
,ivy
DEC
LA
RECEIPT
DATE d
BY'' %'
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
W
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck__.__
3
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
_ dV1vW_Z1
Insulation
_Compressor
�
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
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
Z— Z --C-0
Heater Final
Water Piping
_
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Sewer Connection
� � //� /,�
-�`� (p"/Q
Pool Cover
Encapsulation
Gas Piping
Gas Test
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)
j os e%ITY OF LA QUINTA
BUI�FJNG & SAFETY DEPARTMENT
'y OF 777-7012
.CTION REQUEST LINE
' j, 777-7153
Owner C Y CROWELL COMMUNITIES
Contractor NTURY CROWELL COMMUNITIES
Permit Number 0011-266
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 79-585 BAYA
LOT 49, PLAN 3BR; 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 Zy2 �j•-ob
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
CONCRETE SLAB Z-10 - el -
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 d
BOND BEAM
O.K. TO WRAP
GROUT ❑ 4' ❑ 8'
FRAMING
INSULATION
PRE -ROOF 01/
COVER NO WORK UNTIL ABOVCEHAJS BEEN SIGNED
DRYWALL INTERIOR / 0
EXTERIOR LATH /
POOL PRE PLASTER
POOL FENCE & GATE
SEWER SEPTIC TANK - -O
FINALS
ELECTRICAL /
PLUMBING
FINAL GAS TEST CJ
HEATING - A/C
HOUSE NUMBERS
JOB COMPLETED
TEMP POWER
��''���f(J�R�LUDE RIGHT
TURN ON UTILITIES OR OCCUPY BUILDING
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 STRUCT. STEEL ASSEMBLY
❑ POST TENSIONED CONCRETE ❑ASPHALT
❑ REINFORCED MASONRY O FIRE PROOFING
O OTHER so93
Lj ej-0 ' L VA
JOB LOCATION
REPORT SEQUENCE NO.
TYPE OF STRUCTURE LaT
�tiCCll 7
PERMIT N0.
D
DAV OF WEEK
MATERIAL DESCRIPTION p
ARCHITECT
INSPECTO
HRS. CHARGED
ENGINEER
ASSISTANTS
HRS.CHARGED
INSPECTION
DATE
GENERAL
CONTRACTOR � t O
SUB ' .1
CONTRACTOR �O�.Y N
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OCS W e,(-� w Gm
c4, 19 04 SE 4-R
STY05.A —M t
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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
GOVERNING BUILDING LAWS.
SIGNATURE OF REGISTERED INSP OR
l a- 6 I cry .cc's
ATE OF EPORT REGISTER NUMBER
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 #: 3BR Phase: 2
Lot No.: 49 Job Address: 79-585 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:
Subcontractor.. OJInsulation Co., Inc.
Nedo,_'f�emecula, Ca 92590
Tom Berry, General Manager- TpOhj' Gula Branch
R- means resistance to beat 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 youever sell this home, this certificate should be passed on to the buyer.
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 Type of Construction:
Owner of Building: CENTURY CROWELL
COMMUNITIES
Building Official
79-585 BAYA
Bldg. Permit No.: 0011-266
VN Land Use Zone: RL
Address: 1535 SO. "D" ST STE #200
City: LA QUINTA CA 92253
By: KIRK KIRKLAND
Date: 8-22-01