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LICENSED CONTRACTOR DECLARATION
1,Jiereby 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 S8 [3 ti .f,. 10/:31l2C
j/Date f+z / Signature of Contractor' f 4* J t t -
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
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 COLI3EYi XA01,g INS, Policy No. NWC•544069-02
(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 shall forthwith comply with those.provisions. a -
Date: �_�L, Applicant -`/
` i j t rt�yl-r �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.
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.
ti
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.
VSignature (Owner/Agent,,-- Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOTTRACT
111Um.w 26 27519
JOB SITE
APN
ADDRESS CAmwo visTA
CG41 -XI-W9
OWNER
CONTRACTOR / DESIGNER / ENGINEER
(MITUR f. ROVM-L COMMUN1Ti,Es
CENMRY ILIAto ?-L CO1vi1V1iJidS'.rm
1535 8.0, *Do `3TC + < 1'; SIM '0200
1 53:.90. -Y). b eru, mis 4200
SAN }aERW k DWO tC'A 92408
SAN 1: ERUPYS )NO CA 92 449
(909)381.6w, MIA 2120
USE OF PERMIT
ObTaLE 17A)&Ly vVdE l mo
SF1D- LOT 26 P1,0 N 500 PEY.MIT DOES NOT INCLUDE BLOCK WJ6.L.LS Oil
POOL. 750AP•!A14 C.`I'IRCK R1? UC:T014 FOR MULTIPLF. ISSUANCE
TRACT CONSTRUCTION 21008.p0 SF
PORCH/PATIO 49.00 Sly,
OARAGWARPORT (SF;) 8,171,20
ES'lI1C1.14J'►1)7J) colv_r OF coi s' 1p"UC1'.LON
1.17,046.00
,PFRWi' M. gU'1VCA4ARY
CONSTRUCTION FEE 101-000-41 8;;000 M2.50
PI..A14 CHECK FEE 101-000-439-318 $146.03
MECHANICAL FEF, 101.000.421.000 $43.$0
tLECTRICA.L ME 101-000,42MOO $127.1.2
PLUMBING'! IRE 101.000-414-000 $146.75
STRONO MOT1014 FEE- RESID 101-000441-000 $11.78
GRADING F E 10.1.000-423-000 $20.00
DEVELOPER IMPACT FEZ $1,901.00
SUB-I)OT T CON°SY1.'iit M -W ALSO PLM CMM.
�3,114.fa8
LE 33 PRE -PAM M—W.
$0100
• !{ :. {,• { t�i�s ., .wn r-••�•�p ���il��c •py�ryy�y�y`y�
t. ls,f A�j _�..9 e'4'YS Ti�Sl Vlr d:Fi YB
$3,11y4M_ �cy�
e
RECEIPT
DATE
DATE FINALED
INSPECTOR
r 4_.
INSPECTION RECORD
OPERATION
DATE I
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
16
CA
Ducts
Slab Grade
2L•f
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
a Z (o %4
F.A.U.
Framing
�>ti�
Compressor
Insulation
ilia(�7c`�
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
pp
Drywall - Int. Lath
�pFao FSC
Final
Final a
BLOCKWALL APPROVALS
= POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground PI . Test
Final
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 LateralPool
Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
CSL
Appliances
Final
Final 2
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 2
Utility Notice (Perm) c
COMMENTS:
01/22/01 09:08 FAX. 760 546 7276 PAPUGON INSUL.
IA
INSULATION DERTIFIDATE j IC -1
45.695 CAMINO VISTA LAD INTA
Number and Street I city
Riverside 27519 I 25
County Tract No rL-et-tZ.h r
Description of Installation
1 ROOF
Material
Thickness (inches)
2 CEILING
Batt or Blanket Type . BATT Brand Name
Thickness inches 12 Thermal Resistar
Loose FII Type BURN IN Brand CERT
Contractors min installed weight square 0.615 Ib Minimum thickne
Manufacturer's installed weight per square foot to achieve Thermal Resistance (R -Value)
3 EXTERIOR WALL
Frame Tvoe
A. Cavity Insulatlon
Material
Thickness (Inches)
B. Exterior Foam Sheathing
Material _
Thickness (Inches) '-
4 FLOOR OVER GARAGE AREA
Material
Thickness (inches)
5 SLAB FLOOR/PERIMETER
Material
Thickness (inches) ..
6 FOUNDATION WALL
Material
Thickness (inches)
inches
Name
Declaration
I hereby certify that the above insulation was installed in the building and the above location in conformance with the current
Energy Efficiency Standerds for residential buildings (Tile 24, part 6, Califronia Code of Regulations) as indicated on the
Certificate of Complian , where applicable.
2 1/19/01 PARAGON INSULATION
Item #s ignature, Do Installing Subcon ctor (co. Name) OR
General Cortrakt (Co Name) OR Owner
Item its Signature. Date
Item #s Signature, Date
I
Installing Subcon`ractor (co. Name) OR
General Contract (Go. Name) OR Owner
Installing Subcontractor (Co. Name) OR
General Contractl(Co, Name) OR Owner
$ept6mber 27; 1999
Mr. Tom Hartung
Building and Safety Director
City of La Quinta
78 495 Calle Tampico
La Quinta; CA 92253
RE: Tract 27519, Aliso I
Dear Tom:
CENTaRy HOMES
Century Crowell Communities
Coma- Vt5�a�
2 7 R c'[j
HAND DELIVERED
As per your request,. we will notify the prospective buyers of lots 22-26 of the above
referenced tract that they have a rear yard drainage area that they must leave free and
clear at all times. This notification will be in writing and the buyer(s) will sign at the
time of purchase. We can send the City a copy of the notification if you request, otherwise
consider this letter as our intent to comply with the above referenced condition.
Sincerehv,
CENTURY CROWELL COMMUNITIES
yx-a- -ae-
MARTY W. BUTLER
cc. Gary Weintraub, Vice President Operations
Tony Scimia, Vice President Marketing
1535 South "D" Street, Suite 200 - San Bernardino, CA 92408
(909) 381-6007 - FAX (909) 381-0041
I