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0011-252 (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 /'71417 F1 ,� 1 Ord 1/2( v ate 1/ Signature of Contractor �d 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-,;IBusiness & 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. '�y() I have and will maintain workers' compensation Linsurance, 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. OOLDEN 'EAGLE 1118, NVt►i°-344098-02 (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 workers' compensation laws of California, and agree that if I should become subject'to the workers' compensation provisions of Section 3700 of the Labor Code, I shaWforthwith comply with; those,provision l 4. Date: �� r%� Applicants Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. r IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his . application.'` 1. Each person upon whose, behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicator agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply -with all City, :and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for inspection purposes.' f -gig/nature (Owner/Agent) •Date BUILDING PERMIT PERMIT# DATE LOT TRACT EVALUATION 2117'19 JOB SITE ADDRESS APN 79-550 fiBAY,A, OWNER CONTRACTOR / DESIGNER / ENGINEER CWITT Y MkOWELL COWAUNITfES C'Wi [MY C.ROWML C:+J.VtdlcyrmS 1535 00, `D" UnUMT,.'?:G x'400 1535 !.SO, woo nmer, m #24 0 SA14 SUNA1 DWO C -Pt 9.1409 SAN BF- ' ARDINO CA 59=8 (909)MI.6007 47SIX 2120 USE OF PERMIT 0114GI 1?. FAIMLY DWF_WN(t L.OT T, PLAN 30; SFD-.P19R.M1T DOItS'A NOT INCLUDE BLOCK WALLA �©L, �ti 17C�1�P.��#L�.Y'.G1�t'i��.f�GtDPIlA� d;H{it:'�: Ppl� �2t;T,liGE137:�;g.Ff�kt MULTIPLE ISSUANCE OF SAME PLAN TVPi CUSTOM CONSTRUCTION z8moo Sig PO1R iiFRATIO 157.00 SP 0AR.AWCAltPORT I�SA`11�1�:I"C;fDisf O C'•C XStRdr C, ION 231.,:WW POWK FEE SUMMARY MN€I'1'RUC TION FEE A01.010.4.1$-000 fl,titl,5a :PLAN CICS. MIK n. F. 101-000-439-318 S2 IA? MECHANICAL IER 1131-000.421-:000 $".50 iii, { I' iCA1L Pft 101-M-0-4.20-0(70 $.142.,W i'i.UM-01-90Irl?E 101'060-4157-000 815 ,30 STRO NO 3/1OTION K72,, • MID SfID ) ill ••t1(I( 4AI -000 $23.14 tiRADING FEE - . 101.000.423.000 $10.00 DI•V.ELL:tPI11Y. IMPACT ME sl,90'7.00 ART 113 PUBLIC. PLACES - RESIC 701 -000-255-000 S"LM-TOTAL 03M. - RUC!LAC,I�i'.E►ND N. A)i ONC`K $3,761.70 1X03 PRE -PAID:' ' .11£0.00 • DEC 12-2000 TO Tk' PPJ=s .xWAh" 1yur 1`0W .;wIT Y uF LA`s W S* RECEIPT DATE 8DA F INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade�/ % p Return Air Steel_ Combustion Air Roof Deck O.K. to Wrap Framing ,3_ / Exhaust Fans F.A.U. Compressor Insulation _2 Vents Fireplace P.L. Grills _ Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath _ Drywall - Int. Lath _01 wl��POOL Final Final BLOCKWALL AP ROVALS - PAS Steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines Neater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Sewer Connection Gas Piping Gas Test / (�- ��� �L Pool Cover Encapsulation Appliances Final COMMENTS: Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit 01 Rough Wiring Low Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) Certificate of Insulation --- -----Yvarit%imchas-been-insulated-wills-Geeta[4Teedr@ibergtesslnautati�trproducesrwhir,bare-designee! ---- --.. for to&jrs so!'ety standards aatl tomorrow's en@W rewilmoaeats. Fdtetglats is iaorganie and therakm pemaauntly noaownbustible, so it does not law to be treated -----•---_-__-- - •--.----..._._ wiBii-fia-f�i�d�lt��ealst$nt�R!'tlhefylos�t�'c�rtivaness-�erfime.-kt�-notToee�rtgas�i---------------------- with cbemlcals that can cortedto vArkg or nodal. Fibecgless vrili not absorb mrABb m aor wilS it —tieiv- CE ov u 0 ibis at9v oerti63es hist CertainTeed Fiber Olass lwolatian lies been protess'soaelly installed in this home to provide the follovvi�g th�uial pertgtmanoe.. Jute Name:lViGmdsrlsra------- Tr$ct: #2871 Ft&i d: 38 Phase: _ 2 - _----- ------._---- hot No.: S -- Job Address: 79 -MO Hsya Street -- — — — -- - ------ -- Ceiling Area: R-311 ltlooahisielation Garage Cealog: Noa �iseess: _ Will. Living Above & Sloping Areas Baterlar Waft R-1 3 U d Baha Aoeeas Attic: With living Above Interior Waft R-1 t Unfaoed Batts between Ftwr: Subcontractor.. OJ Insild OU CO-, Ixc. 4 Mo Nedo, Temecula, Ca 92590 Signed Tom Berry, T emectdar Branch R- means resistance to heat flow. The higher the R- value, the wester the insulating power. Ask your builder for the fact sheet on R- values. Keep this certificate with your other valued papers. if you over sell this home, this emifieate should be passed on to tho buyer. 05/24!01 THU 13:15 FAX 760 7727193 JON TANDY IRECMMM INSPECTOR'S WEMY DEPORT JON °TANDY 376 "ool Ave. P,les art, CA .�1 i office (760) 772-7192 Fax (760) 772-7193 eaW (780) 776-3336 Z 004 TYPE OF - -- - INSPECTION PERFORMED D FIEIMFORCED CONCRETE SMUCT. ML ASSEMBLY [3 O POST TENSIONiD CONCOVI A3 ASPNAIT 1KOTHER rB O REJNFOR= MASONRY 13 FIBe PRa"o (( JOB LOCATM 7 15A 14 .mac _ LA ao t t „� NO. =0T -'L 57 W±L4E M: _MM PE[O1fT 110 'U4/08 08 OAT OF WW ' MAT"M WSOUFDON PC mm ''"'] �yy► .. `` �. W 0UISPOCUOU 1119N�1 �STAATS NOS. � DA 11 $ J ma'"Mm- m I44'Te5 Se __ aj8Se_+RLeUl 1QA.a tidy orV LSA sem' Ss - t�.TNE 6&L tl�Q Gt9 aN avt ��iScia� i�i� �-S' �'�►5 COOV SSWT TO CUpIT 0 CONT9OIED an amff PKE O PAGE OF CEtMILICATION OF COMPUA.NC! I NEREgY Cert Y TouaT i erAVE �wsrlCTED TO TN6 9EST OF M"' KNONfI�rDGE ALL OF i1� ABOYF REP01dTED VrORC U!Bffi OINERVYISE KOM,1 LYE lV3 M TifM WOML TO COMPLYWWH THE APPROYEO PlAltS SPECIFlCATT M ANO APPLICAOU SEMIMMi OF WE ww�NMti.I! pew �WIA \ A\,IC _ OF BEGRSTFpiD ca T!A WFPTIRT RCfAATPa MI�O�nFO