0101-200 (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
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
'► x43 s� � _ •, � f .11"33 X
L .Date f ; !s; t Signature of Contractor �` I:., r '
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:
Cartier Policy No.
001 �T)KA CSf, . llliis 3t NIX-5424M-II2
(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: 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.
1. Each person upon whose behalf this application is made & each personat
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/Agent) ^`'+9 Date),
BUILDING PERMIT PERMIT#
DATE VALUATION LOT ��}k TRACT
11 y
lD i'L� 'i7 �YYW l 7� .k•4317-1
JOB SITE
APN
ADDRESS
-79-440 CAiMERHUR— ki
OWNER
CONTRACTOR /DESIGNER / EN INFER
SAWBERNARI WO CA V2408
ISAN BMWA$1 WO. CA 92AOS
(9ff"v)3631*i> i MA 2120
USE OOF(�.PERMIT
p Ary[ Sp qAM fs�fy
►7 ft cY3.ai'.� IFY'alt`1A�A..+1 1% VIF1!.�i1.t�vG
DOo-dAtiO3OO!DEUVWAYAPK40AC►/t PLANCHECK E
FSDUCtION FOR, MtI*TIPIX iSSLIYNiS 0$'SAMS Xin(N TpIPF.
TRACT C C1'? S RtitMON Z8kF IN 114E
1110PIM�Ip^p.P.`I'10 189.6-0 SSP
CKVIORT (910) 91815&"
x'057 (W CON�'1 MU=01i
3.0, 376.60
00113xA1 CTION ff*.n 101-000-418-000 >;m.50
PLAN CHLECK FM I.01 -000-A39-311.8 SIK24
MECRiVNICAL FEE 101-000-421-000 SUM
1�.rgCT gIC,,pj, Fgeg 101-0170-420-000 $1412.19
pSAJMB0110 F99 101-0100-419-000 Wall"
STRONCI MOTION VVI • SIO 101.000 -244* -0 0 t $1.5.54
CiR&1y NO FIVE 103-0004230100
IMPACT FZZ
i
TALAN 09,10K
$&3,38A.41
1XIIS MM -MD FV.33
$0.00
t
,lpy
JAN, I
RECEIPT
DATEi
Bye
DATE FINALED ;4
INSPECTOR
fi vi !
X11
a It,
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
.. - MECHANICAL APPROVALS
Set Backs
Underground Ducts
_ _
Forms & Footings �p�,�� D
Ducts
Slab Grade S _�(� b!
Return Air
Steel_
Roof Deck �r7�/
Combustion Air
Exhaust Fans
_
O.K ;o Wrap 3�(/�
F.A.U.
F.aming /
Compressor
(insulation f,/U� �'Y
Vents
�•`replace P.L.
Grills
Fireplace i .u.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Dw--" - 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 Pibg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
_
Waste Lines �!()� _
Electric Final
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral _
Sewer Connection /2G
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
I 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 AV
/�/�6�
Utility Notice (Perm)
0) V I - �).00
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 wiringor 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: Tournament Coll.- Canterbur Tract: 24317-1 Plan #: 4A Phase: 4
Lot No.: 11 Job Address: 79-440 Canterbury- La Quinta, CA
Ceiling Area: R-38 Blown Insulation
Exterior Walls: R-13 Unfaced Batts
Signed
Garage Ceiling:
With Living Above
Overhangs:
With Living Above
Non Access: _
& Sloping Areas
Access Attic:
Interior Walls: R-11 Unfaced Batts Between Floor:
Subcontractor.. OJ Insulation Co., Inc.
42620 Riq-ftedo, Temecula, Ca 92590
Tom Berry, General Manager- Temecula Branch
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 (inform 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
79-440 CANTERBURY
Bldg. Permit No.: 01.01-200
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL
Owner of Building: CENTURY CROWELL COMM
Building Official
Address: 1535 S D STREET STE 200
City: SAN BERNARDINO, CA., 92408
By: BILL GORDON
Date: 1/25/02
POST IN A CONSPICUOUS PLACE
f
REGISTERED INSPECTOR'S WEEKLY REPORT
JON TANDY
37630 Medjool Ave.
Palm Desert, CA 92211
Office (760) 772-7192
Fax (760) 772-7193
Pager (760) 776-3338
TYPE OF
INSPECTION
PERFORMED
O REINFORCED CONCRETETRUCT. STEEL ASSEMBLY ❑ S 1
❑ POST TENSIONED CONCRETE ❑ ASPHALT OTHER
❑ REINFORCED MASONRY ❑ FIRE PROOFING �G•G(�
JOBT/at.7��1 `
_ �� •; L�y
n
6
REPORT SEQUENCE NO.
TVPE�F �iRyCTURE
.. ��`QV\
/ �.
L
PERMIT N0.
.,.
DA (
DAV OF WEEK
MATERIAL DESCRIPTION
A-3 (o
ARCH I
TOR I
HRS. CHARGED
ENGINEER
ASSISTANTS
MRS. CHARGED
INSPECTION
DATE
L SUE'
CONTRACTOR N ote CONTRACTOR
l
e2tjW bje,c)D iO o 119> ase
tas
(g + v��
w tk03
C,c> LS Q-l� I O O-� CD N v i
A'L'E S 025
S N -a U'k�L4 c 4 G
lnTra
Ca.,
912-1
O �e r - -
-ems
�� eta et_+ocv�
ern.
e co a -res aN OC,4
�c. I►► ��.d &24S eA&z
S S'i�
S S lis
+ 0 37
COPY SENT TO CLIENT ❑
CONTINUED ON NEXT PAGE ❑
PAGE OF
CERTIFICATION OF COMPLIANCE
I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MV
KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE
NOTED. I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED
PLANS. SPECIFICATIONS, AND APPLICABLE SECTIONS OF THE
GOVERNING BUILDING LAWS.
IGNATURE OF REqjTERED
INSPECTOR
n
6
(oz
DATE OF REPORT
REGISTER NUMRFR