0112-054 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
G;tiapter 9 (commencing with Section 7000) of Division 3 of the Business and
- P'r'ofessionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
7340 ABTHC _ 3/31ir03
!7�
Date i "24 $4� Signature of Contractor^ -`'
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
Code). .
() I am exempt under Section B&P.C. for this reason
Date Signature of Owner
- WORKER'S COMPENSATION DECLARATION
f
I hereby affirm under penalty of perjury one of the following' declarations:
() I have and will maintain Ia 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 , a , Policy No.
��i31:gC,ii ��ir..1.If.A� WG-22e[f9fj.03
(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 I rthwith comply with those provisions.
,-Date: i- ( ti 01 Applicant.,:.
Warning: Failure to secure Workers' Compensation coverage, is unlawful and
shall subject an employer to criminal penalties and civil fines up,fo $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. ;t ;'•
1. Each person upon whose behalf this application is made &each personat -
whose request and for whose benefit work is performed under or pursuant" o''
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, ,its officers, agents and employeel'�
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 sud
permit, or cessation of work for 180 days will subject permit to cancellatio .
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 buildi
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent)— > "w' Datej -'
if.. ir•. t
BUILDING PERMIT PERM T#
DATE VALUATION LOT TRACT
28960
JO S TE
ADDRESS
APN
OWNER
CONTRACTOR) INFER
22180 W:P RDLO�W ��: Z01. 9 5131M S,0
2280 WARDLOW M. ME,, MT17.150
CORONA CA 91720
CwCYRbjalA cA, 91720 ,
<M)279-4000 0A10 5761
USE OF PERMIT
sam:l:I' d11XylD' ELLMG
.
S,l�f.3.1�,F.?'P � �^i�1.i�i afC�', �k12' 1�.'•Ts>S �;t;3�' .Y'S�C;Y.�tX>�"� �1.>�lx ��1.�4,
k` �t>CUSPIA OR i3W&WAY AY'PWCH, 75% 99DUC' ION TO PLA14 t",FMM
CUM Oji CONSTRUCTION iION 7,973,00 V
,
a bO9+�CHi.P:ATIO SF
O:&.Y`�"s+DM639t.t'C;U:1.3 �It,
i`.aSLLYA.tvA.r'� .Yk D C8rr OF C".ON.SUR'H.)' t)H
24%346.W,
P 1441' F T , SUMMARY
CQUOT11UC3TION FRE, 101 -000418-000 31,jaw
PLA14 C HFICK ITE, 101-000-4319-219 $339.08
MECHANICAL FEE 101 -WO -421-000 $1111150
fil:e>z'+rr'PF'� CALM."IF 101-000.420-000
101.000«419 -OW $M.73
:r"i'P'i.C5NCI MOTION t8F • °R&SI0 101-000-241-000 $24.93
MADYNIO F*1111 101-01V-423-000 %X00
31dIPRt?3MRUCTIU.PF. 1"1:'' 225 -00O. -W-342 $).,9n7.00
,PAT IN PUBLIC 1' LA.0 S -1<ii R11270-000.4 45 -Ow
DEC 13 2001 ;�'.rAL MRW t` 1•:t'lu' s � `3�
.
:WVOFLAQL.��e� i
�� a� Fir
RECEIPT
DATE "=
l ��
BY
D ID
NA
�� aL/
INSPECTOR
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings�J/L
�/ by
Ducts
Slab Grade
�� 6Z�
Retum Air
Steel
Combustion Air
Roof DeckJ7Q�
�Ap
Exhaust Fans
O.K. to Wrap
_
•.Sani
F.A.U.
Framing D 7bUL
�
Compressor
Insulation
?
Vents
Fireplace P.L.
Grills
Fireplace T.O.
i
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wali Firewall
Exterior Lath
Drywall Int. Lath
-
S /
`s
Final
"Final
�/3/ Z
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
4
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
_
Appliances
Final
COMMENTS:
Final
��Tlj . 3��SFldZ Yi�(i�7Oh1
/
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) '
004
INSULATION CERTIFICATE
T his is to certify that insulation has been installed in conformance with the current energy
regulation, California Administrative Code, Title 24, State of California, in the building at
-80 934 Spanish Bay, Lot I La-Quinte, California
CEILINGS:
TYPE: ' BLOW MANUFACTURER: Cert-c'nteed THICKNESS: R-38
WALLS:
TYPE: BATTS MANUFACTURER: Certainteed THICKNESS: R-13
GENERAL CONTRACTOR: CEN'TEX HOMES
LICENSE*
BY: TITLE:
PARAGON SCHMID BUILDING PRODUCTS, a MASCO Company LICENSE 9221517
BY: = "^`'• TITLE: ADMINISTRATIVE ASSISTANT
DATE.- 8!13!02
-...>L,.^iY':Y::�:Y'Y.:v.:.�:'..•Y"✓.N•O A•.N.�..n-•-y/(/� t..
�s-•r v',re.;<^:; v.: vYro :r:✓-r••:rn;.�....r: :. .r. -r. v•r ru:. , r/ v rY r .. r -
I
a
INSULAnON CERTIFICATE
This is to certify that insulation has been installed in conformance with the Current energy
regulation, California Administrative Code, Title 24. State of California, in the building located at
80-9S2 Spanish Bay, Lot 5, La Quints, California
CEILINGS:
TYPE: BLOW MANUFACTURER: Certainteed THICKNESS: R•36
WALLS:
v TYPE: BA7T8 MANUFACTURER: Certainteed THICKNESS: R-13
GENERAL CONTRACTOR: CENTEX DOMES LICENSE #
•
BY. TITLE-. --�
PARAGON SCHMID BUILDING PRODUCT, a -MASCO Company LICENSE #221,517
B - = =- - TITLE. ADMIN�STRATIVE ASSISTANT DATE: 8/13/02
A