0101-192 (SFD)LICENSED CONTRACTOR DECLARATION
U) .1 .hereby affirm underpenalty of perjury that I am licensed under provisions of
F- -3 of the Business and
_,Chapter 9.(commencing With Section 7000) of Divisior.
rJ
04 LLJ Professionals Code,'and my License is in full force.and effect.
License # Exp. Date
C) = ch Lic.'Class
1- 0 LO
LU
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IZ
-Signature of Contractor 4
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to 0.
C:) OWNER -BUILDER DECLARATION
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LL! LLI I hereby affirm under penalty of perjury that I am exempt from the Contractor's
U) License Law for the following reason:
Z . 1, as owner of the property, or my employee ' s 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).
1, as owner of the property, am exclusively contracting with licensed
contractors to construct ct 'the project (Sec. 7044, Business & Professionals
Code).
( ) am exempt under Section
LO I
B&P.C� for this reason
C\J Date Signature of Owner
Orn
< WORKER'S COMPENSATION DECLARATION
C)
CL
2 Z I hereby affirm under penalty of perjury one of the following declarations:
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, FZ 0 1 have and will maintain a certificate of consent to self -insure for workers'
X LLJ compensation, as provided, for by Section 3700 of the Labor Code, for the
0 _J performance of the work for which this permit is issued.
M _J <
< 0 ( )� I have and will maintain workers' compensation insurance, as required by
C5 F
L) <
LO S&tion 3700 of the Labor Code, for the performance of the work for which this
0) permit is issued. My workers' compensation insurance carrier & policy no. are:
,It z Carrier :Policy No.
cb -n&4OLF *fkjo.
0 RWC$4400-02
< (This section need not be completed if the permit valuation is for $100.00 or less).
_J ( ) 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: I 6'Lt) Applicant -
�'Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal -penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person ate
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quints, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation,
I certify that I have read this application and state that the above Information Is
• correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the,above-mentioned property for inspection purposes.
77- D'atei
Signature (Owner/Agent)" . .1 . V_ 1. 1 �' 11 Z��
BUILDING PERMIT PERMIT#
VALUATION LOT., 1ID1()J...-J92, TRACT
12 2A317-1
JOB SITE i
ADDRESS
'
APN -
.769-501404
OWNER.
CONTRACT( R DE IGNER (�INEER
cowAu.mTrwa
(�swmwy mo WaL cammumms
1151.4' 5 T, 9TRENIT, MIX- MV) . 1
1 5as:,5 ao" 02.0o
RAW;0.r%NAfW-W0 CA 92408
;SAN'PXR'XAXbUW CA 92408
109, 81 107 -K I 120
-6C C %L0 2
USE OF PERMIT
tYr11TGi17 YIMAnllf DW10 jlwla
oxrmr,-I�AH 3 ALTA ILM 12 PEWMITDOP.5 NOT INCLUDE,
FfiVUCTIOV FO1c-MU1.TIP11, 1=7ANC$ OF SAME PLAN TYPt
TRACT ("O"WIDTRUCTION 9,526, 00. OF
166,60 Sr
0MUORICARF0M (,10) 11,152,40
no DUNIM) cou'r Mir
I nmoo
15MMT FELI 9UMMARY
CONDMUMON FEE 301-000-41V-000 W&04
PLAIN CHECKRZ
MIXMANSCAL PU 101-000-421-000
101-000-420-000
X1..1 1l 391�1C3 EQar 101 _(300141 19 4000 slu-so
VYRONO 'MOTTaN ",R - R-ESID 101-000-241.4)00 $15.05
0RIADING FE1, 1X91.000 423.000 $20101
DEV'BLOPER. IMPACT VZBO s3'OV1.90
4
AND) MAN C-kM_-X
$3,302.68
I -MV
TMAL rkVNff_ n-lus'Mr, _NQW
JAN 18 2001'
A oluo t.
RECIIPT-
DATE
/!
BY
-, —7
ATE FINALED
INSPECTOR
I t.) t( b
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings _jfL✓fi
Slab Grade
Steel
Roof Deck
O.K. to Wrap
Framing 0
Insulation
�jfid1
��/Z��( ��(/
//6(
Underground Ducts
Ducts
Return Air.
Combustion Air
Exhaust Fans
F.A.U.
Compressor
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall -Int. Lath
MEE��
T-1-1.
Final //�s�a A/�d/2Q0N
BLOCKWALL APPROVALS
Final
POOLS - SPAS
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
Waste Lines
Gas Test
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
Gas Piping
Gas Test
/f/� d�
Encapsulation
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.F1
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: Tournament Coll.- Canterbur Tract: 24317-1 Plan #: 3A -ALT Phase: 4
Lot No.: 12 Job Address: 79-450 Canterbury- La Quinta, CA
Ceiling Area: R-30 Blown Insulation
Exterior Walls: R-13 Unfaced Batts
Signed
Garage Ceiling:
With Living Above
Overhangs:
With Living Above
Interior Walls: R-11 Unfaced Batts
Subcontractor.. OXInsulation Co., Inc.
42620 Rip Nedo, Temecula, Ca 92590
Tom Berry, General Malfager- 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.
Olol -lea
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
79-450 CANTERBURY
Owner of Building: CENTURY CROWELL COMM
Building Official
Bldg. Permit No.: 0101-192
Land Use Zone: RL
Address: 1535 S D STREET STE 200
City: SAN BERNARDINO, CA., 92408
By: BILL GORDON
Date: 1/25/02
POST IN A CONSPICUOUS PLACE
Desert Sands Unified School District
Notice: 82-879 Highway 111
Indio, CA 92201
Document Cannot Be Duplicated 619-775-3500
CERTIFICATE OF COMPLIANCE
Date 3/13/96 APN # 604-263-001
No. 14246 Jurisdiction La Quinta
Owner Name Roger Snellenberger & Associates Permit #
No. 79160 Street Canterra Ct. Log #
City La Quinta zip 92253 Study Area 223
Tract # 23913 Lot # 30 Square Footage 2015
Type of Development Single Family Residence No. of Units 1
Comments
By
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports;
covered patios/walkways, residential additions under 500 square feet, detached accessory structures or
replacement mobilehomes. It has been determined the above-named owner is exempt from paying
school fees at this time due to the following reason:
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to Government Code 53080
in the amount of 1.72 X 2,015 or $3,465.80
the property listed above and that building permits and/or Certificates of Occupancy for
this square footage in this proposed project may now be issued.
Fees Paid By Roger Snellenberger & Associates 'Tele ►hon, 777 K?766
Name on the checky
J L
Dolores A. Ballesteros -
t
Superintendent `
Fee collected /exempted by Pauline Pearson Payment Received 1 1$3,465.80
Check No. 11437
Signature {�� x I Qa nn G V c u MAIQt 61K_
Collector: Attach a copy of county or city plan check application form to district copy for all waivers.
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting