9908-139 (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
%1 1 B 10/31191
Date ignature of Contractor
OWNER -BUILDER DECL ATION
I hereby affirm under penalty of perjury that.l 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 isnot 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 f
WORKER'S' COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following :declarations:
() I have and will maintain a certificate df 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:
Carrier P61icy No.
WC EN EAACi .R iNra`:V"NC", W06841
(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/n`ot employ any person in any manner so as to become subject to the
wor ers' compensation laws of California, and agree that if I should become
Swett to th w rke'rs�ompens 'on provisions of Section 3700 of the Labor
Mode, I s i t Wmply with rov�c� s.
Date: Afpplicant
Warning: Failure to secure Workers' D pensation 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 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
tt a above-mentioned pro a or inspection purposes.
`Signature (Owner/Agent)' Date� � • t
BUILDING PERMIT PERMIT990X139
DATE VALUATION �' �r �P},J � LOT 2 TRACT b(j1.58
f
JOB SITE '113,A60 CALLE •ORT E
ADDRESS
APN 70-022-039
OWNER
CONTRACTOR/DESIGNER/ENGINEER
CENTURY CRONVELL C:OA, 4NCUTH iES
CENqUR'Y CROWEL.L, t:.'O&IMit.3N IES
0-15 SC. n"V' .81'� E, T, STS":. QMG
SAN BE RN.ARDINO CA 92408
SAN C:& 924014
(9013)381-61107 CRUN 2120
USE OF PERMIT
"1•�•:l -1.OT 32, PLM4 `iR .. P( A41T D0RSS NOT R4CLUIDE GLOM WALLr
GIG POOL, 79�16 R.ECDUCTIOX OW PL NN (_WMK PM OR W)Lp.C.1Y?LE
I3,SLRMCE OR SANIF .PLANT °Lt -7L b x
cusro'bf C"G►NS`f RUC"i 10:14 2,107.00.&F
POS HtpATTO 206.00 Sr.'
C' iARAGELGAR;PORT 494.00 •S '
f�i » b
MlfI A1ED 4T OF C()N8 Ri1Cd".�SDY�.
11Cr �a"l,:�i9
PERMIT r, EE SU A:RV
CONS' RUC 1011 F 1ITZ, $• 9 0 190.ti0
PLS CiffiC"K FEE 101-000-439.318 $187.62
tMECHANl•CAL,FRE i 99-J0Ei-4^sl-: t3 $ .ga?
("IEC! 1t7CAL LV
3PLlRVIBlNasFEE 101-0 419000
STR.0140 3u (XnCj. F4 AE t9 &W, 101-000 231-000 3 ,7.66�
GRADMIG FEE i n i QO0-12 f30t} �`3a3,(st
ART'3N1'UBIL (: PL ACES - RUSIO 701-000.253-000
IDEVE110 EP, VVIPACf Vila�e1,9ffi�,0(T
LST Ry 'e`1i Ct,'tNE-FR [(" tit liV �:i5� 3a t�LYt ;�'3 (�� Z
Sr t9�s go
i, 'SS iliiS?AIL, FE.
'q OTA9I., @'Ltl ig Yr FEES Li11.M •s?di)W
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
-z/lo��
Ducts
Slab Grade
Steel
��_��—dJ� �',d
Return Air
Combustion Air
Roof Deck
O.K. to Wrap
r yv.
Exhaust Fans
F.A.U.
Framing
— _p -a 4G
Compressor
Insulation—/,f
��J
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
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
Electric Final
Waste Lines
Water Piping
�p
��� �— /
Heater Final
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Sewer Connection
_ /�
r'�/ � ,�7 —
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
`�l/iinne o� ok 6'ed"-
Final _
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring ,
Low Voltage Wiring
Fixtures 000,
Main Service
Sub Panels
Exterior Receptacles
G. F.1.
Smoke Detectors
Temp. Use of Power
Final �¢
Utility Notice (Perm)