0101-187 (SFD)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
WProfessionals Code, and my License is in full force and effect.
O =) ch • License # Lic. Class Exp. Date
r< CY Ln
LLJ
~ Z r-- Date r Signature of Contractor' -6,
r- I.— C:) OWNER -BUILDER DECLARATION
m
W W I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ U) 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).
( ) I am exempt under Section B&P.C. for this reason`
O N Date Signature of Owner
rn
Z WORKER'S COMPENSATION DECLARATION
C) 2 I hereby affirm Z under penalty of perjury one of the following declarations:
U-) � O () 1 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
mJ Q performance of the work for which this permit is issued.
d C)( I have and will maintain workers compensation insurance, as required by
O 0 Q S ction 3700 of the Labor Code, for the performance of the work for which this
a F— permit is issued. My workers' compensation insurance carrier & policy no. are:
? Z Carrier Policy No.
cob O GOI,�EN E6S,.O&W TNiv% 2� WV4S44@4b-02
J (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
3 subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions.
Date: , 1 • I Applicant --- �• 1 -
I` 1 ti (f3 a l:i;C 4� LLQ
ft �jVllarning: 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
11110 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
the above-mentioned property for inspection purposes. t
S' nature (Owner/Agent) M�—\;%, Date
BUILDING PERMIT PERMIT#
E VALUATION LOT (1>i+�,»;i>Fi�. rM TRACT
-:�iR �a2>titD 24317- t
JOB SITE
APN
ADDRESS
'
OWNER
CONTRACTOR / DESIGNER / EN INEER
a;;`li2dQIURT CRIOWML CsJ)"M'hT TIF -10
MINTURY.OWML COMMLN Z
35i S. 90, IrD, YME1'i `'IR 102001
1535 so, ny #_ 0o
(909)381.6007 CS1,41 2120
USE OF PERMIT
�K�1'C1'L3�w:%1?,h6:I1'.•�1' T°r�►1� J':�+1C�
S'PD,;PIAN 3 ALTAR WT:3 � PERMIT DOZS NOT INC d7DS
81A5=17J1bL4 P00.1/Dft1VZ1f�'.; Y hPPRO+ CH,113% P4:{&W C,HKCK "M
REE 1=014 FOR 1ALpa1TIPLE R,"SE4ANt;IY, OF :f.RME PIAN `i''YPF.
aTB.ACT CONSTRUCTION Z526.00 SF
PORCIOPAVO 166.00 SF
G AR.A.*WCARtPORT(S9) 1)Rtl?240
ROW.:Jf:I~ C09,11 or CONS, BT+C"F, ON
1150;Y22.00
.y�, p•A+�r X,Mt;r I¢�{,p6
���rAiYtt7.6.�1 .77AWCi �Y 4.iCl..iitl�A�
^
CONSTRUCTION PI .E 101-10CM-4.18.000
PLAN CHECK PER 101-000-439.131€
MECYiA141C AL F ROZ 101-000-421.000 SOV
WAC;T.R IC;AL k=e 101 _00114210-1000 4210.1000 $133.29
1"WMBINQ 1i1E 101.000.419.000 >nS,iai.SO
STRLWO MO` 13N Fels, . RESID 101-(M-24.1-000 $15.05
ORADING TfIlk 101.000.423.000 520.00
I)EV101.[))' 4R IMPACT 12K $3,9t)7.lbfd
a y�
ilA4MALC0140 RM,"I.'XY0,'ANDPLA CITECT',
.i,.¢EW 1?P.&RAW I s�k,'Z
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RECEIPT
DATE �y s
BY ;}i
DATE FINALED
INSPECTOR
�d.
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
I INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
(,/)/
Ducts
Slab Grade
Return Air
Steel
Roof Deck�p�(
O.K. to Wrap
_
_OO�(�/
_ /�y
_ ,�,�_
Combustion Air
Exhaust Fans
F.A.U.
Framing
�pb
l(��,Q{�
Compressor
Insulation
_�/���/
ljj�L
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
_
/
v
Drywall - Int. Lath
b(
Final
//�ZB�/
6_%
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
_
N
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
_
Pool Cover
Sewer Connection
}�/Z�/Q/
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 M 3AR-ALT Phase: 4
Lot No.: 3 Job Address: 79-360 Canterbury La Quinta, Ca
Ceiling Area: R-30 Blown Fiberglass
Exterior Walls: R-13 Unfaced Batts
Signed
Garage Ceiling:
With Living Above
Overhangs:
With Living Above
Interior Walls:
Subcontractor.. OJInsulation Co., Inc.
'Nedo, Temecula, Ca 92590
Tom Berry, General Man -Age r- Temecula Branch
Non Access: _
& Sloping Areas
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 Quin.ta
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:
Occupancy Group:
SINGLE FAMILY DWELLING
79-360 CANTERBURY
R-3 Type of Construction: VN
Bldg. Permit No.:. 0101-187
Land Use Zone: RL
Owner of Building: CENTURY CROWELL COMM Address: 1535 S. D STREET, STE #200
City: SAN BERNARDINO, CA., 92408
1� By: GARY HARTMAN
Date: 11 /28/01
Building Official
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