9907-540 (SFD)$ LICENSED'CONTRACTOR DECLARATION =
I hereby affirm under penalty of perjury that I am licensed under provisions of
Fm- Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
N W Professionals Code, and my License is in full force and effect.
C) License # Lic. Class Exp. Date
LO
t W 'U�.'� 1 �J3afFiji
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C) Z r D to � � Signature ofContractor'�a. e -
CO 0
J U � OWNER -BUILDER DECLARATION '
W LU I hereby affirm under penalty of perjury that I am exempt from the Contractor's
N License Law for the following reason:
Z_ ( ) 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).
CY)() I am exempt under Section. B&P.C` for this reason
LO_
O N Date Signature of Owner
U. Q WORKER'S COMPENSATION DECLARATION '
' 2 Z I hereb affirm • under penalty of -er ur one of the following declarations:
o ,Q Cc Y P tY P., 1 Y 9
I have and will maintain a certificate of consent to self -insure for workers'
j� U LL compensation, I as provided for by Section 3700 of the Labor Code, for the
O � Q performance of the work for which this permit is issued.
CP Q C) (")II have and will maintain workers' compensation • insurance, as, required' by
' O U Q Section 3700 ,of the Labor Code, for.the performance of the work for which this
H permit is issued. My workers' compensation insurance_ carrier & policy no.. are:
�..Z Carrier Policy No.
oo 5 t € R XUARNTRE, ri a �!+�•T1�..
Q (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 issued,-
I shall not employ any person in any manner so as to, become subject.to the
workers' compensation laws of California', and agreE thati�,l should become
subject to))the tworkers' compensation prod ions o'fection 3700 of the Labor
Code., I stSall forthwith comply with those pr vi Ions.
• Date: _ d Applicant
i J
Warning: F (lure to secure Workers' Compensatior)!co ,grage is u�lr awful 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 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 I have read•this application and state that the above information is
r • 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 -menti i propertN r Inspeetion�purposesr
I natOre (Owner/�ht)-•
BUILDING PERMIT PERMIT; w_ -
DATE VALUATION LOT / TRACT{
JOB SITE ""— " ' "— —
ADDRESS Qe1�i �� .6BA;( ^
APN
3••0105
769-653-005
OWNER
CONTRACTOR / DESIGNER / ENGINEER
22,90 WAkWX✓{.3W C':Xi3.(,ix, Sut nc- 130
22M Vb d1RD.LOW CIPWLE, SUrrZ- 130
i:':(Dit.C'IN' A CIA, 91720
t MUNA CA 9020
%20
( 1'274-4M +' ALA 5761
USE OF PERMIT
SINti tX FAMILY WELUNG'
SF0 . f,C?'t, M, fli -14 10-C& - P,hRttk:fn* DOES Pim t :Ca�i`� ill QCs OLOC
WALL OR K)OJL ,
CUSTOM � 144TMUC'.1 MAT 3.2.110 SF
:E+--1AGkllPil:TIO $351 1? 8F
iaARA.G:ICAI$IO:XX 438 0) W -
EMIMAMEED CM"T OF COI; MUM.Oa 3
PERMIT PUB-SUM—MAR-1111,
--C«��dS'Y'Ft,ti�;`�i{:G►I�IFt�..., .. _.. 1f)t•k9(3il•' Affil-�f'11? -_'. �_,�...�-;'.;:`t�1:Fttd,:
__._. ._._ _.. ;—+---
gnT,,AN MCK FEE W 14,01 .439,) t8 $1.00173
M-12XI,M TCALF1Ds 103.000-421-41130
E3',:LA:1`#:3.WAL.Fi ! l(?1- `120-000. ST$r71Pj
Isd t3iidCc 1:' ' 0 QW 19-000
f331�f�,tl1<:T�1i%(kstiif«1i;, 1tF4tfl(�( d111i) �Q-4 `�s��QiI
CRAT)rNa FEE $210.0
:t:c�r�����Lns��a�f��:�x��w.r�i�� �r�-�o�-����•�#�:� �m,.�'�s.as
A:WY .tM f+ti"3LIC lq %: 54 e 4
..
,'i"
_%7.
�T.l43•'t'�:�'.t�'3� t,:f��+9�5"T`42,i.1�:'t`;C�.3�3��i'i� i?]�,;�.Pd G��J�E:�.
$�.b,Q:g7,
fr'j'/
L
RECEIPT
DATE
BY i' ' "DATE
�;�
INA D
I INSVOCTOR
k1.
`ATL
INSPECTION RECORD
OPERATION
DATE
INSPECTOR OPERATION
DATE
INSPECTOR
BUILDING APPROVALS MECHANICAL APPROVALS
Set Backs Underground Ducts
Forms & Footings o Ducts
Slab Grade Return Air
Steel Combustion Air
Roof Deck i Exhaust Fans
O.K to Wrap ? F.A.U.
Framing i Compressor
Insulation ; Vents
Fireplace P.L. 7 Grills
Fireplace T.O. Fans & Controls
Party Wall Insulation Condensate Lines
Party Wall Firewall
Exterior Lath I
Drywall - Int. Lath
s
t
Final
Final POOLS - SPAS
BLOCKWALL APPROVALS . Steel
Set Backs Electric Bond `
Footings
I Main. Drain
Bond Beam
Approval to Cover
Equipment Location
i Underground Electric
Underground PI . Test
Final
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 / DD
Appliances
Final
COMMENTS:
-0 K B`1219q 614
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)
6-hicyCertficaoOccu,
1C
0�
Ar
low
.,� Cit ouinta r +�
Buildin-E and .ASafety Dep"artment a: ti
�� �O F
y A�* w
1 -This, -Certificate issued pursuant to the requirements -of Section 109 of the UniformBui%ding`;'Code, w
certifying that, at the time; of issuance, this Structure was io vcompliance" with the variousr ordinances
of the City regulating building construction or use. For the following: .
:� BUILDING ADDRESS: J ':80-400 SPANISH BAY"
v -•; Use Classification: SINGLE FAMILY. DWELLING t TF Bldg. -Permit .No.: '-9907-540
< Occupancy Group R-3 Type'of Construction WN Land Use7Z6ne: RL
4 `Owner of Building: CENTEX,,HOMES ` Address:` 'x2280 WARDLOW,CIR, STE 150
_ k City: CORONA, CA 91720 °
' d -�r '•, - - -
�.� By: DANIEL P. CRAWFORD JR.
77
-46
Date: 3/14/03
_ i _ V ti.• -. .: ., - .�a .. .. W.•` .. .. s - 5- - '
yr u Building Official
'
PLACE
POST IN A CONSPICUOUS 3