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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 a I��MPA,(
r f Signature of Contractor
1
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 owher 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
sec., ion 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.
0011D In, FAA, 11F IND.
(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 hall forthwith comply with those provisions.
Date: f Applicant
,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.
A..
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.
/Signature (Owner/Ageh�',-"A 162 Date`f''_
BUILDING PERMIT PERMIT#
DATE VALUATION LOT f10 TRACT
JOB SITE
APN
ADDRESS
79,350 C:AMMtM F? ZY
? 471-cD�4
OWNER
CONTRACTOR / DESIGNER / EN INEER
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1535 so, T OUMMI, tir1 .0200
153.5 20, TO ±�`4. )MM VL 0200
RAR R11 a` YxT[31 CA 92409
SA14 &MMATcDLNO CA 92408
(909)381.600_' U1, 2120
USE OF PERMIT
5170-P'LA i 411111 LtYPA? - PZRMIT I30US A1C, T1,NCGJ;00E
M3tJ)CXWALI'OOIJD' itiVn"e ,Y APPROACH.
TRACT COMTRUCTION 5F
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BGfa"JAMA "ED COST OF f't-AN.STi:�:lTC.'°'d1C)X
F191472MFEE, SUMMARY
CONMUCTIONIjEE 1101«t700-41><iv000 S 0
Pl..tts:,w CHEIC9. f;FF, MO.%
XIE;CtM1t:'AL' . 1Q3y(90t3- %)l-QQO 10 41 54
P.11+tX'f'RICAL fret $142.1.8
PLi3MSINO FEY. 101.000-419.000 Siftx@.
ST'l1.0)i0 iV1(Ji 3S3$ ZFPf✓ < YF5I3U $116. �vl
Cd AfflM YEE 901 -000423 -WO SA+_Etif
J3VV9. C3 ZR f.MPACT FIEF $.1,9W7.00
FE8, DXP0,1'1T 101 -OW -439-318 4750.00
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Ti's-'tiy3'1"AL C%),t4.-rKR1'JCrdON' D P, -i A'�T CHECK
$1,929.19
LEW TIRE-PAiIDJEE `'
750.CU
iaVOTIALPE !LIT.Cr,1LRs.SDUE "W
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JAN
_AA AN 118 2001 '
RECEIPT
DATE +
BY
DATE FINALED
INSPECTOR
'int` FG`{t
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings
Underground Ducts
Ducts
Slab Grade
y /` D/ 6
Return Air
Steel
Roof Deck �jC�
_
Combustion Air
Exhaust Fans
OX to Wrap
_
� �! � (,�v,(�(�
F.A.U.
Framing
Compressor
Insulation
�( �/f�L
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
_
�f�0�
Drywall - Int. Lath
1��6�
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
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection/2��
/
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
COMMENTS:
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�pd�
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 #: 4BR Phase: 4
Lot No.: 2 Job Address: 79-350 Canterbury - La Quinta, Ca
Ceiling Area: R-38 Blown Fiberglass Garage Ceiling: Non Access: _
With Living Above & Sloping Areas
Exterior Walls: R-13 Unfaced Batts
Signed
Overhangs:
With Living Above
Interior Walls:
Subcontractor.. OJInsulation Co., Inc.
Nedo, Temecula, Ca 92590
Tom Berry, General Mg%lger- Temecula Branch
Access Attic:
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:
79-350 CANTERBURY
Use Classification: SINGLE FAMILY DWELLING
Occupancy Group: R-3 Type of Construction:
Owner of Building: CENTURY CROWELL COMM
Building Official
M ki
Bldg. Permit No.: 0101-203
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