0106-204 (SFD)LICENSED CONTRACTOR DECLARATION
I. hereby afflrrim tinder 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
'# t. t t fl ALiic�.:Cyllalis Exp. Date 1103'
Elate «; . Signature of Contractor.�w�
OWNER -BUILDER DECLARATION
I hereby affirm.under penalty of perjury that I am exempt from the Contracto s
License Law for the following reason:
(.) I, as ow6e'r 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 parjury 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.
(This section need not be completed if the permit valuation is for $100.00 or less):
(—)-I-certify-that-i n -the -performance -of -the -work -for -which -this -pe rm it-is-issu ed—
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 prov sions
� Date �f' J : A
Pplicarit� '- "
Warning: Failure to secure Workers' Compensation coverages 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 upori-whose behalf this application is made & each person aY r`
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 buildings
construction„ and hereby authorize representatives of this City to enter upon
the above-mentioned property for Inspection purposes. y`
6� „
Signature 1Owner%Agent) - K �"`t +� "`` M .-�. Date t i , 1 i
BUILDING PERMIT PERMIT#
DATE VALUATION. ' - LOT Y�C`i TRACT
a.;• s ' '`
, auk }
y iS•.-16�,p,� l�, F a � 41 t•.1,. 97•*..�ur ''4
s1
ADDRESS
APN
y +
OWNER –
CONTRACTOR/DESIGNER/ENGINEER
,�',41'.i`k i�'.'.�i3a�•
>:;F.�.+d`3'3�,.il° g?CC",ii
Z280'+�Al�h?�.OW C,'8 IC7.;21:11WITf 150
2280 "+�i'ARDIA)W CIRCLE, i5VTg`F A 50
C=ONA CA 91720
CORONA. CA 91 "120
p0q)279-1000 C� 5761
USE OF PERMIT
LOT' 41 :KAN :¢3K PERNUT DOSS NOT INC;a- OB BLOCiK. i+td;L�rl'4 I !
PWLS OR DRIVRWAYAPPROACHvPLAN s HWK PIE iV-D.UCED FOR
MUIZIPIX ISSf�ANCO OV SAM, PLAIR Y>��
CUSTOM CONSTRUCT, T.0W X033.00 SF
P69�;t;E•f A T ate 115.00 SR
GA,I�iC4:f? ARlt�iRT 620,00 SP
;7:9' 01r CO�i�'I E VCTION
'.Z: ,7'%2•.29
qq��ggy paad� yy y��7}•• yy � �y trX�.��`MATEi3
.��JA�.0.Ny .Y'.7�.UskL i9'WiO.YJWA,�L6'U.
PIAN CHECIC lZF, 101 -MO -439-318
M W.H WIC°AI,V9E 103.ODO.421-000 9I.f,31.00
�.: C;O`i�TClA,S.:tP JT 101-COQ-420••R?00
iP;i:;1,i{Pr7 10 E`V'E I Q1 -fl00.41,0.000 �b3t3,S0
SyTP, C�.M011'`f0N PHS RZ.QIV
1q01-t3C00-241-/000/0�p���y^/��ry3
L7El.891�I.L`f lF ,i' t o i �`o' o,4- za —' 000 $X00
..
TNFMA13 RU•CTUREf� F, 225-000-443-342 $1,90'9.QFi
AT al PUBLIC PL�k - Ri'8i1C'701-000.25.5.0 0 S14S 6�
j . JAN 021002
002
RECEIPT'--.
DATE /�
BY
DATE Fl)(ALE
IN P C OR
r //�.
03
.rte S' �✓`— � —'` � ,
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
. BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings
_
/ ��p(�
Underground Ducts
Ducts
Slab Grade
c� �
Return Air
Steel
Roof Deck
h p�
��
Combustion Air
Exhaust Fans
O.K, to Wrap
i
F.A.U.
Framing
Compressor
Insulation3
_ _
Z
Vents
Fireplace P.L.
_O
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Z
Drywall - Int. Lath
_
_ 7i(
Final
/ _
Final
`173 _
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
I
Gas Piping
PLUMBING APPROVALS
Gas Test
Waste Lines.
%%-6�
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
5 1(0 �L. .t U
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
!
Utility Notice (Gas)
j
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
C/
Temp. Use of Power
—
Final
Utility Notice (Perm)
Ara
r
r drt�caof -0ccupancy.te
a_ W�
7�C- t of,La",Q t>�
tiBuilding ,and ',Safety DppartF_vment . V:o
• {.? �y This' Certificate issued pursuant to the requirements of Section 109 of the =Uniform Building, Code,
certifying 'that, at thee of issuance, this structure was in compliance with the various ordinances
' z of the City regu/sting bui/ding construction or use. For the, following:
BUILDING ADDRESS: -80
'731,3SPANISH BAY': E a
.,
Use Classification: SINGLE FAMILY DWELLING Bldg: Permit No.: ,'0106-204
Occupancy Group: R=3 Type of�Construction: VN �. Land Use Zone: RL
Ownerrof ;Building: `CENTEX HOMES - a Address: 2280 WARDLOW CIR; STE150.".
City: CORONA,'CA 91720'
r B DANIEL P.=CRAWFORD.JR.
Date: 1/17/02
•3J .
Building Official f i
'? = -POST IN A CONSPICUOUS PLACE f