0106-209 (SFD)IT,.......r.... _ _
LICENSED CONTRACTOR DECLARATION
I hereby affirm'urid'er 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
'ate t ^+ •1 'Signature of Cont actor -z4E;Z Z �-
OWNER -BUILDER DECLARATION �`
I hereby affirm under penalty. of perjury that I am exempt from the ContractoK,
License Law for the following reason:
( ) 1, 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). -
() I am exempt under Section B&P.0':for this reason
Date Signature of Owner
WORKER'S COMPENSATION DECLARATION.
I hereby affirm under penalty of perjury one of the following' declarations:
( ) .l have and will maintain a certificate of consent to self -insure for woirkers'.,
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 in the performance of the work for which this permit -is issued,
.1 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: t!" `r i 3 ^ Applicant.,,..:xi��:
Warning: Failure.to secure Workers' Compensation colrerage4is unlawful and
shallsubject an employer to criminal penalties and civil fines up�o $100,000, in
'addition to the cost of compensation, damages as -provided for I*Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
fora permit subject to ' the conditions and restrictions set forth on hist
'application. r
1: Each person upon whose behalf this application is made & `each person ate
whose request and o* r whose benefit work is performed under or.pursuant'to_
any permit issued as a result of this applicaton agrees to, & shall, indemnify? {
& hold harmless the City of La Quinta, its officers, agents and employees
2. Any permit issued as a result of this application becomes null and void if
.work isnot commenced within 180 days from date of issuance cf such
permit; or cessation of work.for 180 days will subject permit to cancellation:
I certify that I have read this application and state that the above -information is
correct. I agree to comply with all City, and State laws relating to the building
construction,'and hereby authorize representatives of this City to' enter .upon • _.
the above-mentioned property for inspection purposes.
Si"natue
re (Owner%A nt)~•' �""t•�"''��� "` -`��g Date
PERMIT PERMT#
.BUILDING
DATE / f VALUATION, LOT B$:. TRACT "
28960
JOB SITE Y
ADDRESS
APN
769 3
OWNER
CONTRACTOR/DESIGNER/EN (NEER
(MIXSC HOMRZ
enriv. Homm
2280 WATWLOW CMCIAK, 3JTI° e, 151D
2280 W',R,T0L0WZcVLz', HT?m 150
CA 911120
COPIO A A. 9,1720
(90S1} 751-40 0 CBV� 5,761.
USE P(E}R�MIIT�
�OyFF
N.7M'd �'h.[�' .CE'RALikL$J Y .i.9 VE.:S8J27
-
3.8'rD . ISAYP 71 PLAN XR PERMIT 'DOES Nx'2' I'X- C,Lb* Eit,.C1CK WALLA
*POO $ C,IR DR1VWAY APPROW1,11 (0'LAX CHECK�kM REDUCED WR
i�C11.',!`IPu 2SsisAwer Of SAME PLAN T P.,Z)
' .("UST M 6NS P,UCT101H '%053100 SP
if(91ti'CWPATIO 535.00 SP
0ARAOWARPORT 6M.00 8F
RM+',I TRD COIFF OF CONSfR BC"i'ION
, ITA oIi o
PM- M .' YTS iUP "Y
CONSTRUCTION FEE 1411-000.418.000 SLI9610
P1�AX %)NiWX IMF, 2 Q2 WQ00 �i• WSJ -3l �' S.3:v
MECHMUCA1. % 101-600-4Z1,000 R 2 ,Otl
1?1XCTPJ.CA L l?li F 101-000-420--000 $ l?1,9d
ParldMBINOFER 101`000.419.000 1a .3m
STRONG IMOTION .FEE, nk11 SID 102-000-2-4.1-00 $2183
0.tt, DINO FRE 101-0004234000 120,00 .
TNFRASTRUCTORP, FVZ 1,25.060-447-341 st„9 uo
ART I514 PUBLIC ,VLACHS _ RME 701-000.255.000 11�� tib
. Ma -TOTAL V"1�.404.P.RN�JJ,V d'0.WD :['L MVI M./ ,7:
$4,01-7.10 .
EM 1'`.1 Z— AM =13
JAN
J 02 Or
ECEIPTDATE
By.�
SPECTOR031
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings/,
�/ 7I
Ducts
Slab Grade
Steel
����Z
Return Air
Combustion Air
Roof Deck
/
`
00-1
Exhaust Fans
O.K. to Wrap
Framing
_� _
_
_ _
F.A.U. .7 /
Compressor
Insulation
8 3o a
Vents1.0
Fireplace P.L.
_
Grills 4_
Fireplace T.O.
Fans & Controls 0
Party Wall Insulation
Condensate Lines /
Party Wall Firewall
Exterior Lath
_
Drywall - Int. Lath
-
Al
Final 1 2-17—
Final
— — — —
POOLS - SFAS
BLOCKWALL QP ROVALS
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
Electric Final
Waste Lines
�(p�p Z
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
Sewer Lateral ��/),�--0 �,
O.K. for Finish Plaster
Pool Cover
��
Sewer Connection
Encapsulation
Gas Piping
Gas Test
f�/ -
Appliances
Final
–
COMMENTS:
Finalyd12O0�-
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
114
Final
_ -
Utility Notice (Perm)
A
INSULATION CERTIFICATE.'"''-
This is to certify thatinsulation has been installed in conformance with the current energy .,
regulation- California Administrative Code; Tide 24, State of California, In the building located at:
80.454 Spa6Wh Hay, 'Lot 31,, La QuInta, California
CEILINGS:
`
TYPE: BLOW MANUFACTURI.R: CERTAINTEED THICKNESS: R=38
ALL ;,
y: • TYPE: BATTS MANUFACTUREWCERTAINTEED THICKNESS:;R-13
GENERAL CONTRACTOR , ..CENTEX HOMES a LICENSE #
BY, - TITLE:
_ PARAGON SCHMID,BUILDING,PRODUCTS, A MASCO COMPANY LICENSE.# 632072
F i
d BY: ?•� TITLE ADMINISTRATIVE ASSISTANT r DATE: 10/18/2002
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