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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
7141 Fi B 1 tR1.14 112
/Date -;1) �lta/T4° %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 urSder 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.
Se( )e I have and will maintain workers' compensation insurance, as required by
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 Policy No.
C.10?.t DE,1I MCfIX 114.4, WWC_Mk"+ _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
Co • e, I sha I forthwith comply with those provisions
D9te: L';L_• Applicant—
Warning:
pplicant Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, ih
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. r.
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 t
& 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 1
the above-mentioned property for inspection purposes. t�
/,qnature (Owner/Agent) Date
UILDING PERMIT PERMIT#
DATE VALUATION LOT TRACT
�e^
4 M 19
JOB SITE
APN
ADDRESS '
794"t't DAYA
'76.9-490-042
OWNER
CONTRACTOR/DESIGNER/ENGINEER
TLTRI CP..C3WE13,COMMi%3N:is313
1539 Bro. TV 1TrftWr .5M1 #200 '
1535 30. Illy MMLT, UIX #200
SAN BERNARD11 O CA 92,409
4.1M REWAI;;.�1. TO CA 92408
(909 i>s 1 <ttCCCtf3 i 2120
USE OF PERMIT
1" C&'L
LOT a, Kr1N 2C; SIM. 1�ZRMIT 0093 NUP IN LIDE EIIX)CY' WAI ay
Pt') ).4 OR E3Atf.VEVAY-A'0PROACH
J �
CUSTOM CONSTRUCTION 14M.0 SP
!'0RCWPAT1 2.91.04£1 Sr
0ARM"1IUCAR-PORT (00 9.1,855,00
AIiREA&JD Pollyl 41+ CYq7d6IUCI3OC
df•.f 9:r�r7t.w+w d
XtMX E RAMMARY
.
CONSTRUCTION FEE 101.1900-416.00 $3,049,00
PLAN CHECK Y!' E 101-000-43.9-318 311 0.31
MYCKKOICALYEIv 1E41-000->421.000 $91100
KLEC RIC'AL F'P,E - 144.08
Pi.UMBINO tom►. 101 �OtJ 1-4<1 Ot4E? 5113.."+a
S1��'.�Ko'l,,���til!f4yyt��7101`I 08? - :R.E,S11D ''101.0�tq?/0-24yy'1-/Q�t00 $11.70
ObL.19,17MO 11•'d 9 101-!000' 23.WWO) $20100
DEVA..WPER.IMPACT PEZ 91,9f1"1.00
AR1' M POBLIC PLACES - 1i 31E 701.000=234.000 t>42,46
M -TOTAL C(.�}&fCslrX-RON ANO RAN 011750K
U.294.57
x MEW PRE -PAID M
$0:00
0.0TAPPFXMn,' -01011;
110,
YMS Now
•157
DEC 12 2000
c ,r"
RECEIPT
DATE '
BY,rr
DA FI ED
INSPECTOR
l
t
-
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
/
Underground Ducts
Forms & Footings
Ducts
Slab Grade
—/%—Q
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
Framing ,� Z 9 Q�
Insulation /
7 6 /
F.A.U.
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
7j
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 I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Z �47>
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 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. 100,
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
I
CENTURY HOMES
K I I I - I .
Century Crowell Communities
.i,
TRACT I
LOT I
Century Homes hereby agrees that, in consideration of the buyers of the above
referenced lot and tract supplying their own floorcoverings, a credit of $ will
be given in escrow towards Buyer's allowable closing costs.
All payments to suppliers and installers of said flooring shall be the full responsibility of
the buyers.
Buyer(s) understands that the Seller will not warrant either materials or installation of
flooring purchased from any outside subcontractors nor will the Seller be responsible for any
damage sustained during such installation.
Buyer(s) further agree(s) to deposit any funds necessary into escrow in the event a
flooring withhold is required by the Lender.
BUYER DATE
BUYER
DATE
SELLER DATE
tdeptVnktg\addendum\byrflrcrepSB6� South "D" Street, Suite 200 • San Bernardino, CA 92408
(909) 381-6007 • FAX (909) 381-0041
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-.--- You-Hoiae-hns-becn-insulated-whit-Gettain't'eed-ki�gtays-Enstelatlnn.produs� vetbGr�.��ed
for today's safety staadar ds and t awmew's anera itigttl4emeMIS.
Fiberglass is iaotg&nie cad tkembm peetmently mearcombutiirta, so it does not have to be treated
with eben deals that can eongde wiring or meteL Febergbm will not abm& at®lsdu+e nor will it
es.may
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m
*MIS also cetdfles tliatCa taieiTeed Fiber Giese Imlatioa has been, piefessiaaally imstalt(A in this Thome
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.. tb provide � foltoveiog theronai per�aao�_
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Job e:l`iaaslarlm Tmet: ►28719 PISnit:2C l ham -2
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C Ift Areat R-38 Blown Insulation Garage Ceiiing Non Access:
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. - .. _ .. .. With Living Above - --- .. _ .11c Sloping AneaB
U - _ - - -- - ----
lialerlotr Valls: R-13 Untiaoed Betts Oveffhas Aems; Attic:
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Wkb Living Alcove
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Interior Wally R -t t ikttacedBetts-
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� SUbC,@m&VC(OA-- OJIRMtShi R C�.9Inc
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426 uls, Ca 922390
0 Simed
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Tom ferry, <s"~,@t 1 a i Temend a Rrand,
R- means resistance to heat flow. 'ibe higher the R- value, tiro 9mater theiasuiati% p®wer_
Asir your builder for the fact sheat on R- values. Keep itis cerilftcate with your other
valued papers. Ifyou ever seri Als home, Ibis eerti8cato shouts be passed on ,to the buyer.
c.;.
TYPE OF
INSPECTION
vcvcnva•!n
O REINFORCED CONCIRVE
0 POST TENBIONED CONCRETE
❑ R AIFORCED MASONRY
JON TANDY3MO "001
.:;;;.:
Reset Deserl, CA
Office (M) 772-7112
Fax (760) 772-7193
pagw ) 77
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CERTIFICATLOIii OF COlAPLIANCE
I HEREBY CERTIFY THAT I MAYS INSPECTED TO THE bFST OF MY
KNOWLEDGEALL OFTHEA MEPOR41eDWORKU;Mt0 H
NOTED. I HAVE FOLINOTHIS Wom TOCOMPLY WITH TMEA"NOM
FLAN& SpECw4cxnaw AND APPLICABLE 66MOM OF TILE
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