0106-205 (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 r
77340194
/Date ��)Signature of Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from theContractors .'
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). r
() 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:
Carrier 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_fo r_wh ich-th is_pe rmit-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
bode, l hal forthwith comp:w,.ith„those provlsl S.
' Date: ^ Applicant'"_ '
Warning:. Failure to secure Workers' Compensation coverage fs unlawful and
shall subject an employer to criminal penalties and civil fines up to $1.00,000, in
addition to the cost of compensation, damages as provided for.in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety_
for a permit subject to, the conditions and restrictions set forth on his
application. r
J. Each person upon whose behalf this application is'made & each person at
whose ,request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold.harmless the City of La Quinta, its officers, -.agents and employees
2. Any permit issued as a result of this application becomes null'and void If
work.is not commenced within 180 days'from .date of issuance of such
permit, or cessation of work for 180 days' will subject permit to cancellation..
I certify that have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to.the building
construction, and hereby authorize representatives of this •City toenter upon;
the above-mentioned property for ins ection purposes.''. f
'rS' t (Owner A ent) � Date
BUILDING PERMIT PERMIT #
DATE/Y ' 1� VALUATION ` LOT i! 2-y�� TRACT ;
A � � ^` =.272.10'' X321 — — 2€900
JOB SITE '
ADDRESS' !y
=PN
OWNER
CONTRACTOR/DESIGNER/EN (NEER
• 2280 Wi�-4° 1,0 MMA STME i 50
2180 WMDLOVI 031=.eM,- Zr 150
C CeC S% dA 91720
CORONA CA 91720
(R09)Z79-4000 CB):J$ 5761
USE OF PERMIT
MID - IDT42 PLAIN 3CL PI RAUT DOU NOT TNCLUt» 81,OCK kMALLS,
P001.1 OR £9ON,EWAY APPROACH (PLAN CHECK Me REDUCED FOR
1.1l:iD:f1PLE 1S8U,ANC'u OF RAMP, PLAN TYI?F,)'
�';tttpp5551//I`y�i��'.i'RUC� ION ,1,it.{4�3,(Q�a� ay:Y
'
9C�WyTPO�Mj�y
P9� R.C. 7J i(• A T10 �J.i. Wli X71•
GARAM )VORT 68010 OF
LI':1T' MI COST OF. CONSMUCIT014
25932,12-20
CED?f8M:00"TION FFE 1€1.000416.000 61,196,00
PLAN CHHXK M. 101-000-439-318 112AS-13
UPCHAWCALKEF, 101r000-42.1-000 S114.00
&JECTRIC.A3 Fti 101-000-470-000 $11t2.96
_.
P1X1MOMO VEE 101-000-419-000 $iY1 50
STM40 &lMION PFX ,• W,'1D 101-000-241-000 ' $25.83
ORADWO FER 101.-000.423.000 $10:861
r WRASTRUC.," i`Uk2;8 FEE 22.5-,000-6143-342 $1,90700
-
.ART W PUBLIC PLC15 - 701- fl0-7513.000
e J
. . /AS./I... V 639/:. �iJaCV V'.Al:�!.J °.+lA�A•0 d`4N�L� .f.'A.M-Lt� �rSC. tY.
$4,011-10
•�s..
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JAN U �QO� _AL �Y�rY DUETTOW
St.g6317JO
p ` '
RECEIPT
DATE J j
By.
DAT iL r
INSPECTOR'
Igna ure g _ �• f,NJ
•
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS.
Set Backs
Forms &Footings
�! _ d)��
Underground Ducts _
Ducts
Fs_-11�
Slab Grade
Steel
30
_ _
ReturnAir
Combustion Air
Roof Deck
O.K. to Wrap
G 'p2/- a pZ .
�i
ExhaustFans
F.A.U. / �J
Framing_
(r
Compressor
111
Insulation
_ s
6�
vri 3 1p Z
,
✓
Vents !�
Fireplace P.L.
-
Grills I
Fireplace T.O.
€
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath1io/
_
y D
Drvwall - Int. Lath
j.� Zn -7
Final // /aL 171
BLOCKWALL APPROV
Set Backs
Footings
Bond Beam
Steel
Electric Bond
Electric
Plba. Test
POOLS[-. SPAS
Final
I I
Gas Piping
PLUMBING A PROVALS
Waste Lines �/�
Gas Test
Electric Final
Heater Final
Water Piping
Plumbing Top Out
Shower Pans
_ _ _
Plumbing Final
Equipment Enclosure
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
_
Encapsulation
Gas Piaina
Final
COMMENTS:
ELECTRICAL APPROVAL
Temp. Power Pole
Underground Conduit _
Rough Wiring
Low Voftaae Wirina I
Fixtures A_
Main Service
Sub Panels
_
Exterior Receptacles I—�
G.F.I. / (r
SmoKe uetectors i t / 6
Temp. Use of Power I IN X16 9 !..
Notice
INSULATION CERTIFICATE
'This is to certify that insulation has been installed in conformance with the current energy
regulation, Califomia Administrative Code, 'TRIe 24; State of Califomia, in the building located at:
80.391 Spanish Bay,'Lot 42,.--La auinta, California
y CEILINGS:
TYPE:� BLOW MANUFACTURER: CERTAINTEED THICKNESS: R-38
W L .
TYPE: BATTS MANUFACTURER: CERTAINTEED THICKNESS: R-13
GENERAL CONTRACTOR: CENTEX HOMES LICENSE #
F!
n BY: TITLE:
a PARAGON SCHMID BUILDING PRODUCTS, A MASCO COMPANY LICENSE # 632072
o BY. TITLE: ADMINISTRATIVE ASSISTANT DATE: 10/18/2002
F
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