0204-132 (AR)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
73409.4 .A,B'.MC 313110.3
DateSignature of Contractor?
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt,frorri 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 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 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.
( 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 ZU11U1rH.ME ICAN Policy.Nq;,�� WC8322090-4.1
(This section need not be completed. if the permit valuation is for $100.00 or less).
—(-)-I-certify-th at -i n -the -pe rformance-of-the-work-for-wh ich-th is -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 provisions -
Date: ;rr'��62
'-"Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines upto�$100,000; in
addition to the cost of compensation, damages as provided for in Section 3.706
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 ori"•:his
application.`
1. Each person upon whose behalf this application is made & each persoh at
whose request and for whose benefit work is performed under or pursuant to !n -
any
any permit issued as a result of this applicaton agrees to, &-shall, indemni (�
& 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 voider
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 1.80 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.
Signature (Owner/Agent)-f? " ``��ts " k"" G Date
s.
PERMIT #
BUILDING PERMIT
DATE VALUATION $13.,,q. LOT � r:---- - TRACT 2.896fl
.-.d ;P
JOB SITE—
ADDRESS �.i^,�JT.� e9�`iY
APN
OWNER
CONTRACTOR /DESIGNER / EN INEER
C{.t�I1EX, HOW. "S
CIDTMX HOMES
2280 WARD SOW 01RC1:FE SWIT 150
2280VIARDLOW.CIRCLE, SJlfi'1�' 150
CORONA CA 91720
CORONA A '91':420
(9019)279.4000 CIBLO.5761
USE OF PERMIT
CAOIXT1014 0tp=Z32,"a:R: MINIi SUITE, WHILE Ui�IDER CONSTRUCTION,
LOT 41, t,`1'i.4�1W 1D3�PLbT FR O It 1WHI TO .i.JRT. 79% PiAW C1" 9CX
FEE AADUCTIf, N FOR XULTIPLE YE5UANCE OF SAME PLAN TYPE
CUmm CONSTRUCTION 252,00 off
E8'1U, UTX i COST OF C'Ox7UFRUC°I`.ION
FRMWr Fmoi SUADIA :Y
PLM CHWK nz 103^-100.439.318 W73
ELECTRICAL FVF IV! .000.420.000 $148
PTI M,rfSI1`0FFIE 2'01-0Qf?-+4k�l-t1Uf9 $fi:tiP
I. T. QN01t?C3'. 1014 Mr • R,r.4°° 'C? . 101=00(-24:1.000 $1.r3 i.
ART IN PUBL.If: PL.A.4:fO • EPuir 270-000-445-000 S.33.91
'rt :.•. t7�"q♦t Y� �,y q �• �,'y �; }7q� ,.k
. i' �'..'�,J41Av4.7 .ivlltJX.9J .t•►AW 4�1.rS'fi�1.L�a i
(y L1 �q
gr!y, LY 7
TOTAL PM, 'Iff M
0 3 8
/�
CITyOFL QUIWA
FINANCEDEPT
RECEIPT
DApT�Ew, F. l'+
BY
DAT F LED
INSPE
/ I
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
1 F.A.U.
Framing
Compressor
Insulation
' Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
t
Final
Final
BLOCKWALL A PROVALS
f POOLS - SPAS
Steel
Set Backs
1 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
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
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)
COMMENTS:
uUG l,LU Lu:1D lHA i IA004
t
INSULATION CERTIFICATE
This is to certify that insulation has been installed in conforrnance with the current energy
regulation, California Administrative Code, Title 24, State of California, in the building located at:
80-373 Spanish l3ay, Lot 41, La Quints, California
CEILINGS:
TYPE: BLOW MANUFACTURER: Certainteed Thickness: R-38
WALLS: -
TYPE: BATTS MANUFACTURER: Certainteed Thickness: R-13
GENERAL CONTRACTOR: CENTEX HOMES LICENSE #
BY: TITLE:
PARAGON SCHMID BUILDING FIRCDUCTS, A I ASCO COMPA111Y LICENSE # 632072
TITLE: ADMINISTRATIVE ASSISTANT DATE: 10i18r002