0105-057 (SFD)LICENSED CONTRACTOR DECLARATION
U)~ I hereby affirm under penalty of perjury that d am licensed under provisions of
lam•
. 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.
License # Lic. Class Exp. Date
17340.14 A.BMCC.1.�°! 0.3441321
oZG,Date otic o Signature of Contracior-7,-
OWNER
-BUILDER DECLARATION4•.
co1.,
LU
: ; I ;Hereby. affirm under•penalty of perjury that I_ am exempt from the Contractor's
License Law for the following reason:
Z (.) '::.I as_'owner of, the property, or my employees with wages as their sole
k ' porripensation, will do the work, and the structure is not intended or offered for
sale: (Sec:,`704.4, Business & Professionals Code).
() I, as -owner of the.property, am exclusively contracting with licensed
contractors to,construct.the project (Sec. 7044, Business & Professionals
Code).
C`')' O I am exempt under Section B&P.C. for this reason
.Lo
CN! 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.
Zi'1iiMH AMERIC0 WC93220
(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 that if I should become
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those pro isions.
Dater }. jr., AppIicam`t=�_...:�_M , :,w«• -h, �C
/warning: 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
application.
1. Each person upon whose behalf this application is made & each per
whose request and for whose benefit work is performed under or purs o
any permit issued as a result of this applicaton agrees to, & shall, ind ify
& hold harmless the City of La Quinta, its officers, agents and empl es.
2. Any permit issued as a result of this application becomes null and oid if
work is not commenced within 180 days from date of issuance o such
permit, or cessation of work for 180 days will subject permit to cancel ation.
I certify that I have read this application and state that the above informa'
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) Date, 'lie)1 1
BUILDING PERMIT PERMIT# '
DATE VALUATION LOT S�b71#1ai-Q1t57 l TRACT
28960
JOB SITE _ ..
ADDRESS 8"41 OPANTSH DAY T
APN
7�� �-
OWNER
CONTRACTOR/DESIGNER/EN INFER
Ms)f ,�,�ixH€Jly HOMES.
C''XWEX H%M
22801M I -,t°} Y MCIA, O"[Y. E 150
2280 "MMM W CC14 MMS I ;so
CTor,40NA. CA 91720
CORONA CA 91720
(9(39)279-4000 CEO 5761
USE OF PERMIT
et G1,9 YAMMY Dw1�i.,Lwo
SP`O , T07 67PLAN A)L a P MMIT DOMS INCLUDE SWCK WALL,
P00f., OR DRIVEWAYAPPROACH. Rib PLAN C!H'.l;CK WXMT1f39 FOR
i'd111 L-TIPLZ ISSIVANCE CLF SAME PLAN TYPE.
CUSTOM C:O1NSTR13MON 11,21-5.00 OF
PC?RC."Hi.P.F TIO . 535,00 E
0ARACEMA&POPT (SIP) M84,30
F,61!,.1.4"13M CCD9r CYF C0A*1 1RUCr £ON
GC'3NS'1 RUC`1'ION FEE 101 lCi00-41; •-000 $1.224.00
PLAN CH�'''11. M 101-000.439-318 $250.98
MUCHAN PER 101-000.421-000 $11g.0#
t�1.; t;`1'T21C.PcI�: L 101-000-420-100 $173.W
13T.tT1 i1d136 1} �. 101-000.419=000 41418150
SUMMO MOTION FEE • 1 ESLD 101--000-241--000 $26.61
(1it;l lS.YNO FEE 1.01.000.423-000 01.00
DBJ 99°RCfOTURE "M 225-000-443-34.2
ART IN i'tJBLIC 6'1..Ai UNd - RERIE 701.000-255.OW 165,�#
Ui1 O
8UP.-M , COMIJ"MOWAMMIL"CHEM
M AY 1 0 2001 LIWS PRE-PA'U) Mai
CITY OF LA OUINTA
FINANCE DEPT
RECEIPT
DATE j
BY
DATE INALED
SPECTOR
1 v O?i
IJL� N
INSPECTION RECORD
.':OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
". BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs_
Underground Ducts
Forms & Footings
3O–
Ducts
Slab Grade
Return Air
Steel
Combustion Air,
Roof Deck
Exhaust Fans ..
0. K. to Wrap
F.A.U.
Framing d�L1�/t6 v`
i —_–
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wail Insulation
Condensate Llnes
Party Wail Firewall
Exterior Lath
_
Drywall - Int. Lath
Final
Final.
-S, 02 c,s:. G40 lAoJ
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
256
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
����8/!A
Encapsulation
Gas Piping
I
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Law Voltage Wiring.
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility
Z.
Notice (Perm)
Certificate of Occupancy,
City of La' Quintalwow-rW
09
�
� Building and Safety Department
This .Certificate issued pursuant to the requirements of Section 109 of the Uniform'Building Code, .
.,This
that, at the time of issuance, this structure was in compliance with the various ordinances
of the City regulating bud/ding construction or use. For the following:
BUILDING ADDRESS:. 80-84.1 SPANISH BAY
'Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0105-057
Occupancy Group:. 13-3 Type of Construction: VN Land Use Zone: RL
Owner, of Building: CENTEX HOMES Address: 2280 WARDLOW CIRCLE, STE 150
Building Official
City: CORONA; CA., 91720
By.. BILL GORDON
Date: 5/10/02
POST IN A CONSPICUOUS PLACE
ME MEN