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LICENSED CONTRACTOR DECLARATION
i hereby'affirm'under:penalty of perjury that I am licensed under provisions of
Chapter 'g (commencing with Section 7000) of Division 3 of the Business and
Professionals Code, and my License is in full force and effect.
License
v�#n /gPp'by bc9. llaa/ss / Exp. Date,
�7i?�Y/'.74.„T,NliC---�„
f Date ri ��"'--M Signature of `Contractor
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OWNER -BUILDER DECLARATION ~ '
I hereby affirm under penalty of perjury that I am exempt from the Contractor
License Law for the following reason:
( )
1,. 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 off, Bred for
sale (Sec. 7044, Business & Professionals Code).
( ) I, as owner of theproperty, am exclusivelycontracting: 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.
(;r) 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 Policy No..
• " �.,ti�li;k� .F��41C'� • $>1�CSY,#e�'�6.0? .:. .
(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-iss Lied—
1 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+pr siogn, ,
Date: #" j`4 t41— Appllcant'e'.°.J�: �.•� ?�
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to. criminal penalties and civil fines up o $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorneys 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
appjication. tf
1. Each person upon whose behalf this application is made & each person-iat
whose request and for whose benefit work is performed under or pursuant:to
any permit issued as a result of this appl icaton. 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 it
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 cancellations . .
I certify that l have read this application and state that the above information Ise
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. �•,
A
�' i
ASi nature (Owner/A�ent)-•'�``� Date t'C'1 t '
/BUILDING PERMIT PERM TN
]VALUATION
DATE f i LOTTRACT
111
W Mal
JOB SITE
ADDRESS
OWNER
CONTRACTOR/DESIGNER/EN INFER
Ex HOS
2280 W AX)IOW CIRCLE. SM, .150
a,,mom. CA, 91720
CORONA ICA 91720
(909)7,79«41DOO m?,L# 5761
USE OF PERMIT
01y, FAM` LY DW L ING
MO.- .lamT Sia PIAN 40L MRIMIT DOWS NOT INiC,i 101, ktt=K WA. LI.%
MULTIPLE is SUAN, CE OF SAME, MAN `L''4"PE)
CUSTOM CaNSTYkUMION X142.00 VF
RCI'3i ATIO 454.06:F
CiiARAM9tAARTORT 699,00 8F
WMA31."ii.) OOFf OF COMMU ION2,64,28
20
RMIT IME SUMMARY
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MAIN -CHWX pug VA9,29
MECHANICAL nX101 •®00•� �i •'tt00 �3�2•QB
R I.ArirRIC.'A; .Tome, S176.23
MAJU NO VER 819.711
,tA��OTION FElt• P',.S91D 101-OW241-000
�STROQqgqi9Cqq yy$26.43��
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WPRAMttCTURZFZZ 2255 000-"3-U2 I�vt� ti
A Y FO PUBLIC B'LA.MS - WIC 701.000-255000 Si.160M
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JAS O2 2002 1' Wr" rMaW.M, Ca S DUE. NOW
54.047,41
RECEIPT ' '''
DATE
BY�r'`
.._
DATE IN L
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set BacksUnderground
Forms 8 Footings
_.
_ �- � �p�a., �
Ducts
Ducts
_ _ _
��_
e2
—
Slab Grade
a9
Return Air
Steel
Roof Deck
Combustion Air
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing''
Compressor
Insulation
O-
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall -insulation
Condensate Lines
Party Wali Firewall
Exterior Lath
4� V -
Drywall - Int. Lath
7�
Final
_
�9_�
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
_I
�f�i
Heater Final
Water Piping
b �Oiu
Plumbing Final
Plumbing Top Out
%pZd „0 Q
Equipment Enclosure
Shower Pans
4
O.K. for Finish Plaster
Sewer Lateral_
Sewer Connection
s�� lv 5 2
Pool Cover
Encapsulation
Gas Piping
Gas Test
_
-/
Appliances
/ `
Final
COMMENTS:
Final
�G�Z Sl O x
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)
WED 1.0:1.6 FAX
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INSULATION CERTIFICATE
This is to certify that insulation hay horn installej n zorif nmanr� with thei nurrent energy
regulation, Calif„:n;,u AG';`;: it list; Z..Iivks L;Cwia, 7A, St..Ate & Ca!1forma, in the building located at.
80-3�ll qpa.ninh isay, Lot 37, La Qui.nta, California
CEILINGS:
TYPE: BLOW MANUFACTURER: Certainteed Thickness: R-38
WALLS:
TYPE:BATTS MANUFACTURER: Certainteed Thickness: R-13
GENERAL CONTRACTOR: CENTEX HOMES LICENSE 4
BY: TITLE:
PARAGON .13CHMID'BUILDING PRODUCTS, A MASCOCOMPANY LICENSE # 632072
T\T
INSULAT10"N. CERTIFICATE
Thris i -s to cert fy that insulation has b-3en rxinfxrnance with the current energy
71z: 7'the building located at:
re6olation, ('aliforni.a Administrative (' :)de,
Spanish
CF11 lNrS-
TYr---- i7itLOW MANUFACTURER: THICKNESS: R-38
WALLS:
-ryp;T,. imrr'S, - MAN i_.17A CERTAINTEED THICKNESS- R_1:;
GENERAL CONTRACTOR: CENTEX HOMES
BY: TITLE:
PARAGON ISCHMID, BUILDING PRODUCTS, A MASCO COMPANY ,LICENSE 4 632072
BY: T'TLE: AC%4lNVIX-iVE ASS!STANT DATE- 10/18/2002
■.
e-rdiricate
Oil
City. of LaQuinta
_ I.K0101
Building'and SafetDepartment oFti
y
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:. 80-319 SPANISH BAY
Use Classification: . SINGLE FAMILY DWELLING Bldg. Permit No.: 0106-201
Occupancy Group: R-3 -Type of Construction: VN Land Use Zone: RL
Owner of Building- -CENTEX HOMES Address: 2230 WARDLOW CIR, STE 150.
City: CORONA, CA 91720
- By: DANIEL P. CRAWFORD JR.
Date: 10/29/02-
Building
0/29/02Building Official
1
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