0101-202 (SFD)•+ _ r . LICENSED CONTRACTOR DECLARATION
U).1 hereby affirm under penalty of perjury that I am licensed under provisions of
w Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
W Professionals Code, and my License is in full force and effect.
O I M License # Lic. Class Exp. Date
I- Q LO
t�41Li� �0 1f2C
Z � Date t �a� �'i{- Signature of Contractor'
I.- (D� 7 OWNER -BUILDER DECLARATION
J
W rl-
a I hereby affirm under penalty of perjury that I am exempt from the Contractor's
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).
M () I am exempt under Section B&P.C. for this reason
L
N Date Signature of Owner
ON
0)
Q WORKER'S COMPENSATION DECLARATION
CL
o< I I hereby affirm under penalty of perjury one of the following declarations:
U.)
H O ( ) I have and will maintain a certificate of consent to self -insure for workers'
X. W �= compensation, as provided for by Section 3700 of the Labor Code, for the
�
Q performance of the work for which this permit is issued.
<W, 1 have and will maintain workers' compensation insurance, as required by
O QSection 3700 of the Labor Code, for the performance of the work for which this
0- LO L Z permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
(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.
Date: r Applicant �••-':� * r ?- f-'9� . ,
\ iii ` .. . 4 . s.., ,....r..a.
/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
11bof 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 ori' 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
the above-mentioned property for inspection purposes.
n
§nature (Owner/Agent] �+ EtaZ!�� Date
. LDING PERMIT PERMIT#
DAT VALUATION LOT�� �} =TRACT
JOB SITE
APN
ADDRESS
"-340 CANTRIMMY'
OWNER
CONTRACTOR /DESIGNER / EN INFER
Cir MIUt.Y C'1.0 Vri-"L L C:C)7vgM1,11d71'3IJES11
CENTURY CROWE :I
1.5 35 V, 1), =Ensr, M 4200
153." 30:11412 xIMMIM I�'M.. 42101
SAM BRR3uA1t�3:I.NO ".A 9,24 a8
8 ,94 -REi?NATO.XWO Cly 97AO8
9E>9)S� 1, ��rt�t9 YG11 2120
USE OF PERMIT
SFr.-, %'L,A24 3., LT OR 1..01VI 4 PERM; DOES'NOT ?T1C:f.111�ro
OLOC:K:WA1AJP00 DR1VFV1AY.rt4.i'PROACH.
'€k3ACT C,t 'Wr ,'Tr'3.LIi"TKM zno.00 SIS
PORCH>rd>r TIO 166.00 Sir
CJAK,WFOC.A.RP47K (M) 11,1.52A0
40;11•E17,A, 2
MOSTRUC TIOM FEY, ? 01 _000 -41t 8.000 U14.06
.F1,AN C HVIC FV.9 101-000-439-1,118 $61M.19
91' 1W"NAMCItt1.PFEE 101-1000-421-000 $83150
1'A.At-TRIC,A.;.1TE 1011-000-41.110-000 $1:33.29
P1.1.1marga WWF, 103.000.419 -OW SASO.50
`.t'R0110 WIOTIOI1 PEZ,, t1}3.SID 101.000-241-000 $15.05
0 0 f H 0 F1.K,+. 101-0( 0.423•000 $20.00
NE DEPOSIT 103 -000-439-37 8 4731110
R
�t� �•� 1'.ag.. �:�1��s'�'.�1,1'�'3'ic�1� a •3.�1..��T C1�`1c��
�%,�1 � .5�
. 1
_ JAN 18 2001 '-zorrALnmrnamD Now
4'%9T•Y 04 LUOy I
f V
RECEIPTN
DATE //
BY t
DATE FINALED
INSPECTOR
N
�
1�/;i
1' 1 VO
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
�� D/ '.9T 4v1/j
Return Air
Steel
Roof Deck �j�
_ _
1p / /
Combustion Air
Exhaust Fans
O.K. to Wrap
/ L
F.A.U.
Framing
�j/
Compressor
Insulation
Vents
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath�(/
_
o /Gy
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
Gas Piping
PLUMBING APPROVALS
Gas Test
Waste Lines3�Q0�0�
_
6�t/
Electric Final
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
�/2� (
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) .
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: Canterbury Lots Tract: 24317-1 Plan #: 3BR-ALT Phase: 4
Lot No.: 1 Job Address: 79-340 Canterbury - La Quinta, Ca
Ceiling Area: R-30 Blown Fiberglass
Exterior Walls: R-13 Unfaced Batts
Signed,
Garage Ceiling:
With Living Above
Non Access: _
& Sloping Areas
Overhangs: Access Attic:
With Living Above
Interior Walls:
Subcontractor.. OJinsulation Co., Inc.
Tom Berry, General M4
Rio Nedo, Temecula, Ca 92590
Temecula Branch
Between Floor:
R- means resistance to heat 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 you ever 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: SINGLE FAMILY DWELLING
Occupancy Group: R-3 • Type of Construction: VN
79-340 CANTERBURY
Owner of Building: CENTURY CROWELL COMM
Building Official
Bldg. Permit No.: 0101-202
Land Use Zone: RL
Address: 1535 S. D STREET, STE 200
City: SAN BERNARDINO, CA., 92408
By: GARY HARTMAN
Date: 11/20/01
POST IN A CONSPICUOUS PLACE