0106-206 (SFD)LICENSED CONTRACTOR DECLARATION
I hP.eeby affirm under penalty of perjury that I ar licensed under provisions of
Ch's ter 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
714094 A B Raw.
Date ,? geil Signature
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contrac E°ts,
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).
O I am exempt under Section B&RC. fo_r;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.
.. UITICH AM013W W=32299643
(This'section need not be completed if the permit valuation is for $100.00 or less).
- A-)-1-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 that if I should become
subject to the workers' compensation provisions of Section 3700 of the Labor ..
Code, I shall forthwith comply, with those prove ions.
Date: ��' Applicant"r
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to. 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.
1: Each person upon whose behalf this application is made & each personat'`
whose request and for whose.benefit work is performed under or pursuar tIo .,i'."•
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 isnot 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 inspection purposes.
- ,, Signature (Owner/Agent)" Datei-
IL
BUILDING PERMIT PERMT#
DATE VALUATION LOT TRACT
JA
4,
90960
JOB SITEAPN
ADDRESS
CwsdR�
7 14
OWNER
CONTRACTOR/DESIGNER/EN INFER
g2Ad'�A .'4-b�ZiY:1.G.:iA'.
�i66 �i1.tP1:1X.C:.nl7 .
X280 W'AIMLOWC-MC E,(ir.!'.�s 150
226 P110"LOW CTFICIZ SunE 130
CLOROX-&. CA 91720
CORONA, CA 91120
M. 9)279-4000 C) V#e 3761
USE OF PERMIT
Cly 1'1.U1Y,-Y .DWF_1Lfl.£t 0,,
0 - .i.:CaT 43 N NP. `P9,P.M1T l3f,?RS NOT INCLUDE BLOCK W-AL.L,S,
SC 0i$ OR DkIVEW Y APPIZOPX1.1
CIURI U Ca MSai"RUCTION 2,973.00 se
P0MC1itVA,T10 3MOO E!
0ARAOWARPOkT 641100 O
x9ra"M COST OF C ONMRIJM1 1014
Chi'!'-�.ilC:'!`t•L�a+i 'i�#+..� - - 3 C61 �i1L��b ] i.�-t'�36�- -- - - -�"l,k 69:10-
-- - - r -- - -- -
PLAN CHI= rFF.
WC HANiCAL F)?9 101-000-421-000 00.421.000 SHI Q0
�:�,C"1''fdt��L. �� • Y � }-t3#'9�•"G 20-i�t20 $1.{30.
1'f LIMB111C1
o`s`•FV�,01.10 MOT101.4 FZE a 0.51Y) 101-000-2411-0100 Man;
4:1RA:1;a1'1 O 171.72 101,k000423-000 $20,00
INFRALSTRUCTUP.E. PEE 225-000443-342 $1,007.00.
.ART W PUBLIC PLACES - RMIr 701.000-255-000 $120,87
Siz
SUB-TMAL C OWE TTZ B'C!"C0MAND PLK19 MM=
LiEW PEE -PAM EW
$0.00
• WrAL FKAUM,1�".+QF. DUE NOW,
01953A1
JAN 02 2062
A
RECEIPT
DATE �.
BX�r :Jf
DAT
��T[�
INP TO
//JN
H 61 om o
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings
_
Underground Ducts
Ducts
Slab Grade
p2
Return Air
Steel
Roof Deck
_ _
G �� r _(
Combustion Air
Exhaust Fans
O.K. to Wrap
F.A.U. '
Framing�
_ _ _
/A
Compressor
Insulation
Vents
-J_ __
Fireplace P.L.
Grills
Fireplace T.D.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
.Exterior Lath
Drywall - Int. Lath
Final
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
Gas Piping
PLUMBING APPROVALS
Gas Test
Waste Lines
-��— ����
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
_ _
lID Z
Encapsulation
Gas Piping
Gas Test
/,p7
Appliances
Final
COMMENTS:
FinalpLS
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)
_
•.:Nx•vi:•v;til:'f'��'A'l.f.'.:!::�I'fi/;fJ:'n:I•'mI NR�JI'A-N•:Y//./Y`/.d"J_'l.u•.yYnCN Y.:X'C'A:::✓%N'Ji!:-i..vi: o+i �!;a'%✓:A:O':•f:✓:vr...Y.vr: �R•R/.'!.'�'%IN%:N':f_rir.r.m..rflA:q:1 •Y/.!i/.i•li.r'N.v.>i: l .
INSULATION CERTIRCATE r
+This is to certify that insulation has been installed in conformance;with the current energy,
regulation, California Administrative Code, title 24, Stbte of California, in the buildinglocated at:
SO.409 Spa sh Bay, Lot 43, La tluinta,'California l
CEILINGS:
TYPE BLOW MANUFACTURER: CERTAINTEED, THICKNESS: R-38
WALLS:
1 TYPE: BATTS MANUFACTURER: CERTAINTEED THICKNESS: R-13
x _
GENERAL. CONTRACTOR: CENTEX HOMES LICENSE # _ F.
` BY. TITLE: ,.
PARAGON SCHMID BUILDING PRODUCTS, A MASCO COMPANY LICENSE #"632072
8Y: TITLE: ADMINISTRATIVE ASSISTANT DATE: 1/10,'2003
1.Y!i l.+,:Y.'./.:✓."r. ✓Jour.=s.!u': ri�;•,:l'I.'!. •T ://iii/wY .v ._.- 'rilli*.:rJY%'>.YYi:�::livxe:.ti.:✓.v.:�lY,:�:fAY,:llfr .'i._ ll.r i.�.v r.%../lT'/.:i.f'r..vr.:r`�.:r. r.i.�w.'v..s:✓.s. rii.%:/liv.
4
r 'u
C-aT. 4tifiatd,dj coupancy,
Yuin.t oBuildngr.. and SafeDrtm doty pp en, 6F,This,.Ieriiiic�gteissuedpursuant to. the requirements -of Section 109 of the Uniforz� Building Code;,
•
derdfyin�r-that, a Wdt th me of issuance,' t, is structure was in complianC6'with,the various ordinances
of the City'regulking buildingonstruction or use. For, the t6116Wing:,BUILDNG ADDRESS:j. 80-409 SPANISH BAYUse Classificatiop: -SINGLE FAMILY DWELLINGBldg. Permit,No.: 0106-206Y,61p �o NOccupanc rbu R-3 T'p�e `n`struction:!r-.' VI Land, Us& Zone-- RLYOwner of Building:-, CENTEX HOMES Address: 2280 WARDLOW CIA, STE 156
City: OORONA,-.CA 91720
17 By:7 DANJEL P.. CRAWFORD JR./11/036ate: 3Building OfficialINCer
7
-.POST1N A CONSPICUOUS PLACE