0010-079 (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
7,3103
Date 0-1 k « Signature of Contractor
yr ..•l - t i,_ •�....,...—..gin: -.
.OWNER -BUILDER DECLARATION
I hereby affirm .under penalty of perjury that I am exempt from 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).
( ) I, as owner of the property, am exclusively contracting with licensed
contractors to construct ,the project (Sec. 7044, Business ,& Professionals
Codej.
( ) 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.
,( ,)r l have and will maintain workers' compensation insurance, as required'by
SerCtion 3700 of the Labor Code; for the performance of the work for which this
permit is issued. My workers' compensation in carrier & policy no. are:
CarrierPolicy No.
L'U1€2C;1•I�•.IA1,4�1�ICA1d ii4iiG`�3x�C9�•42� .
(This section need not be completed if the permityaluation.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 that if I should become
subject to the workers' compensation provisions of Section 3700 of the Labor
C,cJ'e, I shall forth ith comply-with^those"provisions.
Wate: s Applicant
arning:'Failure to secure Workers' Compensation coverage is unlawful 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
tpermit, 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 pr�oPerty fo inspection purposes.
Signature (O wner/Ageri t y --Date'
V �. s.
BUILDING PERMIT PERMIT'N
DATE VALUATION LOT tv `C7f� TRACT
S'%56,� 4613Q a "j"� I 28960
JOB - t•.. _
APN M0
ADDRESS
OWNER
CONTRACTOR/DESIGNER/ENGINEER
CM%X T 10NUTS
CEIMM HC)MFS
22MO WA1' D1,0W.MCM, MI'M 150
2290WARDLOW (.MC M. =19 M0
C01"2C:i1+ .k C& 91720
COR,C 0111 CA 91724
(909%Z79-4000 CBL4 .761
USE OF PERMIT
MNOL• ; FAMILY DWMU O
SFEI-LOT 15 PLAN XR-PEU . IT DOES NOT MCLUDE
WAL.T.W00L14'A3?PRC1AC:HI D3:.'!'t rWA5''...W% PAN C`HFICK ?UMUC,111ON FOP.
MULTII LEL 18b'U:,fANC E OF SAME PLM4 TYPE
CUSTOM CONSTAUCITON V15,00 SF
PO13.CHIPATIC ,g3uto sw x
(ilitaltAC3P.ACtA,RI'O 1' (SIF) 5
v"1'11 .' T CONT OF COMTRUC1'tON,
266,148.
FMAIM F",, SUVAdARY
j
CONST RUCTION YVI 101-000-418-000 9)1214.013
PLAIQ CHECK T°,�u''L 101 -OW -439-318 $2,50.03
)RC HANlt:.e.1L M 101«000,421.000 $113,00
I1„9CTRICA:E•..I M 101-W-420-000 $17339
1�1,��T1�1�•fC# �. - 10I�CfOSS,►�fi�t9�000 $195.50 .
Vii'➢: wwa mGvow FrF. - amm 101-000-241-000 $26.61
OR.IS.WNG 1 �1 •pOt3 f 33-t6C X10
M1R/!STRUC;T"i FARM 22,5 -WO -443-342 $3,907.00
AV M FUBUC PLACES - MR[ 701«000.255-000
SUB -TOTAL A L t:O)dMMiiC,'. ON 1M PIAN CCK
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
fl
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms 8 Footings -�/�
Slab Grade
_
����
(/�7/�
Underground Ducts
Ducts
Return Air
Steel
Roof Deck
O.K. to Wrap
_
��
Combustion Air
Exhaust Fans
F.A.U.
Framing L ���1,.
Insulation
_
8%l/a
Compressor
Vents
Fireplace P.L.
_
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
_
, Ahl/ _
_
Final
BLOCKWALL APPROVALS
Final
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
A
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
—
Electric Final
Waste Lines
Water Piping
_
/� _
/
Heater Final
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
_
���3/
Encapsulation
Gas Piping
Gas Test
_
Appliances
Final
COMMENTS:
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)/��
:R.
Certificate of Occupancy
City of La Quinta
Building and Safety Department
This Certificate issued pursuant to the requirements of Section 109 of the Uniform Building Code,
certifying that, at the time of issuance, this structure was in compliance with the various ordinances
of the City regulating building construction or use. For the following:
BUILDING ADDRESS:
Use Classification: SINGLE FAMILY DWELLING
80-772 SPANISH BAY
Bldg. Permit No.: 0010-079
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL
Owner of Building:. CENTEX HOMES
. Building Official
Address: 2280 WARDLOW CIR,-STE 150
City: CORONA, CA., 91720
By: BILL GORDON
Date: 2/8/02
POST IN A CONSPICUOUS PLACE