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LICENSED CONTRACTOR DECLARATION
I heree y 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
01 i 1418/i� B �' 10/31/7(
ate. f//7:2}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 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 OOLDI;N FAGLE rt S, . Policy No. NWC-144063.42
(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
Vbject to the workers' compensation provisions of Section 3700 of the Labor
ode, I shall forthwith comply withjose,provisions;
Date: -1'.7s Applicant_e
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
Vth/above-mentioned property for inspection purposes.
gnature (Owner/Agent�J'�' �' .� `'Date�'�
BUILDING PERMIT PERMIT#
DATE VALUATION LOT �kr TRACT
$117,846M 23 27,519
JOB SITE
APN
ADDRESS 44--75sE:e710 Y A
604µfl6y: .
OWNER
CONTRACTOR/DESIGNER/EN (NEER
CIMxURY CROWFLL COIVI1Ati;KrMS
CENTC Y CROWE.L CON1;AWN17W
1535 30. "iY UrREETr 5"M. #200
i535 so, "DO S1'ROrr, 9=1 #200
SAW 90iAl'.A'E DING CA 92408
SAN BURKAFe.lD, INO CA 97A08
(909)381.6007 (ML4 2120
USE OF PERMIT
511, OLE I+AMLY D IM(3-
SFD• LOTTS PLAN 551911 P&RMIT DOF.S NOT INCLUDE BLt:)C9`:WALLS OR
POOL, 75% PLAN CHECK REDUCTION FOR MULTIPLE ISSUANeZ
TRACT CONSTRUCTION 2,008,00 8F
PORCH/PATIO 45.00 SF
0ARA.OrYCARPORT (3F) k173120
E�"T1t fA7.TJD C09d`k O COJ r' 21?G'J!3i014
7117,846.00
y� y�yry�,�
d�.�lF.�lY11JFFEE'6747AURY
.
CONSTRUCTION RUCTION FEE 101.000.418-000 S 2.50
PIAN CHECK FRE 101-000-4:39-318 $146.05'
MECHANICAL FIZZ 101-000-421-000 $53. so
ZLFXTIUCAL lVl;l 101-060-420-000 $127.12
PLUMBING CE}? 101.060.419-000 $146.75
STiONO MOTION ",E- RESID 101 -000 -241 -NO $11,78
GRADING FEE 101.000.429.0.0(9 $20,60
D»ELOPER. IMPACY FE $1,907.00
S U13-TCYrAY_ Ci9M1<rCr 0341 ACID PI.W CIMC K
$3,114.68
i&Zkt pt1'37►trrX n.Lq DV-P, now
V; 114
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
2
Underground Ducts
Forms & Footings
Ducts
Slab Grade
_
15 Zq
Return Air
Steel.
Csa
Combustion Air
Roof Deck
o\2 tQ
Exhaust Fans
O.K. to Wrap
Z, Cw
F.A.U.
Framing
C..Q�`
Compressor
Insulation
I
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
LLx
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
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Gas Piping
G
Encapsulation
Gas Test
) eJp
Appliances
Final
COMMENTS:
Final Z I. -VO I
Utility Notice (Gas) 7,1-,0-
1..rELECTRICAL
ELECTRICALAPPROVALS
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 tZa
Final v
Utility Notice (Perm) Z8
0
Fw
01/22/01 09:0 FAX 760 346 7276 PARAGON INSUL.
INSULATION CERTIFICATE
45-755 CAMINO VISTA
Number and Street
Riverside 27519
County Tract No
Description of Installation
1 ROOF
City
Material Brand Name
Thickness (inches) Termal Resistance (R -Value
2 CEILING
batt or Blanket Type BATT Brand Name CERTAINTEED
Thickness (Inches) 12 Thermal Resistance R -Value R-38
Loose Fill Type BLOWN IN Brand CERTAINTEED I
Contractors min installed weight square 0.615 ib Minimum thickness 14 3/4 inches
Manufaeturses installed weight per square foot to achieve Thermal Resistance (R -Value) I
3 EXTERIOR WALL
Frame TYDe
A. Cavity Insulation
Material
Thickness (Inches)
B. Eidedor Fpm 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)
z09
IC -1
Thermal Resistance (R -Value)
Brand 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 Standards for residential buildings (Title 24, part 6, Califronia Code of Regulations) as indicated on the
Certificate of Complian, where applicable. I
2 1119/01 PARAGON 1NSULTION
Item #s ignature ate installing Subcontractor (Co. Name) OR
General Contract, (Co. Name) OR Owner
hem #s Signature, Date
Item #s Signature, Date
General
General
0
rector (Co. Name) OR
(Co. Name) OR Owner
Name) OR Owner
$eptember 27, 1999
Mr. Tom Hartung
Building and Safety Director
City of La Quinta
78495 Calle Tampico
La Quinta, CA 92253
RE: Tract 27519, Aliso I
Dear Tom:
CENTaRy HOMES
Century Crowell Communities
I f f Il'
ca'�':'-' V/�
r. F 2 ! tCT
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.
Sincerelv,
CENTURY CROWELL COMMUNITIES
MARTY W. BUTLER
cc. Gare 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
4j
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