0106-202 (SFD)LICENSED CONTRACTOR' DECLARATION
I .
hereby afflrm�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"
--"Date' it6 Signature of Contractor
OWNER -BUILDER DECLARATION`"
I hereby affirm. under penalty of "perjury that I am exempt from the Contrator6s
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 COMPLNSATION DECLARATION .
I
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: -
Carrier Policy No.
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(This section need not be completed if the permit valuation is for $100.00 ortes's).
—H-1-certify-that-in-the-performance-of=th e•work-fo r -which -this -perm it -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 p�rp.t/isions.,:�:Z ._
•~Date: t f: rf a.. Applicant.;
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 cosY'of compensation, damages as provided for in. Section 3706
of the Labor Code, interest and attor'ney'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., q
1. Each person upon whose behalf this application is made & each person.�t
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, indemklify
& hold harmless the City of La Quinti, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if s
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 insp ctioV purposes..
Signature (Owner/A ent) �^� ' Date
BUILDING PERMIT PERM T#
DATE ' VALUATION LOT �Ii�fFD . TRACT
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JOB SITE '
APN
ADDRESS;.
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OWNER-
CONTRACTOR/DESIGNER/EN INFER, _
,1280 WATMOW C&C.AE., ME 1,50
2280WARDLOW 0=111350
G�9 oiat, CAS, 917710
coltoATl ..917:0
(�4Y9�a'�91-40.00 suF3.LO 5761 .
USE OF PERMIT
M - i,a�, i'N P`LA14 3CR PERMIT non Nar Ih1vji um L�EACk:'�lALLS, .
MOW Off,I�Ia.l�d'1�'S AYAPPROAM
CUMM CONSTRUCTION 3,0 3,00 81?
PORCIVRA IO 335.00.1%F
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UNMYJAi! CO.T' Ole° 001�'3,°`i�U't.�f3l`3''
U20,
T'� CIMOC K 11'99 101.000-439-318 ffi 9,5Y
MECHANICAL FEE 101.000.421-000
FA.'F .1TR. CAL FEZ 101-•000.420-000 �l A2,96
�'I.+ilI�1orwo .nF, 103.000-419.00 'Stec."
STRONG MO IC rN .i ZE • RESW 101-000-241.000
MAl INO FEE 141-000.423-M M.0ci
3'.�ip`i�.F�ST3i'UCTUR �' ME 225-000-443-•342 sZ,4+t�'7.00
ART Il+i PISi�i w iPt�t cia ., . %In wiat)� 0455-0Dt1 51410
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RECEIPT
,i
DATE
BY;-
,2� ,,r r-
DAT F ALED
��Lill
INSPECT
6 }��
g
J:.
INSPECTION RECORD
OPERATION
DATE INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set BacksUnderground
Forms & Footings
Slab Grade
Y/ /
��
Ducts
Ducts
Return Air ✓
Steel I
Roof Deck ��?jv Z
O.K. to Wrap �j .b7-. _
Framing - / _
Combustion Air
Exhaust Fans
F.A.U.
Compressor
Insulation
_
0 �3��p'y
Vents
Fireplace P.L.
_
Grills
Fireplace T.O.
€ Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
_
_
Final /3
BLOCKWALL APPROVA.ILS
Final
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
I I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Water Piping
/ _ _
`�%���/i�%(}�
Heater Final
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
_/
j%(o t b2
Encapsulation
Gas Piping
Gas Test
Appliances
i C
Final
COMMENTS:
�`� -314P 4
I
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring E_
Low Voltage Wiring OOOCCC
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
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Budding anal='-
-SafetyDepartment �2�oti°Vn
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' This Certificate_ issued pursuant i to ahe> requirements of Section 109 of W& Uniform Building'Code,,
certifying that, at "the time of issuance," this structure was in compliance, the various_ ordinances
of the City-regulating.-,building construction` or use. "For the:fo
•� A
BUILDING ADDRESS: n.. 80=337-' SPANISH .BAY
Use Classification `SINGLE'FAMILY DWELLING, �'BldgV. Permit No.: 0106-202 V
Occupancy Group: R-3 Type of Construction: VN' Land Use Zone: RL t -
Owner of Building -. CENTEX'HOMES. y�, Address.,' 2280-.WARDLOW CIRCLE,.SUITE 150"
City: CORONA, CA 91720
dt,1 'By: DANIEL P. CRAWFORD>JR*.
,Date: -1/15/03
Building, Official
POST IN 4 CONSPICUOUS_ PLACE