0112-056 (SFD)LICENSED CONTRACTOR DECLARATION
I here] -,v affirm under penalty of perjury that I am licensed under provisions of
ChapteY9 (commencing with Section 7000) of Division 3 of the Business and
..Professionals Code, and my License is in full force and effect.
Licebse# Licc. Class Exp. Date
734JM 3/3 1 dy
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� r.
abate t." � V310S Signature of -
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 pioperty, 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
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.
X( )' I have and will maintain workers' compensation insurance, as required by
S ion 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 11)p)CH
Policy No. dC�322i��6-d
(This section need not be completed if the permit valuation is for' -$1 00.00 or less).
( ) I certify that in the performance of the work for which this ermit 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.
�6ate: t it -An Applicant
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines p`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 phis
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
permif, or cessation of work for 180 days will subject permit to cancellation.
1 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 �I
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes. 1 �.
Date; .
Signature (Owner/Agent)' ' S
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BUILDING PERMIT PERMIT#
DATE ,VALUATIONLOT TRACT,
JOB SITE �`..'
ADDRESS 80.9+0 8FARIM,]RAY
OWNER
CONTRACTOR/DESIGNER/EN INEER
Cw=11YO 13- IwLkm 1�'t azi, MVir"TT
w C mmy, TAO1�'S
12380,wi-a : y,W 10MCLE" WIM.1.50
2280WAMLOW G'I VIL 1=171150
CORONA CR, 91.720
CORONA CA 91920
(90,9)279-000 OBTA 5761
USE PERMIT
��OjjF�� [1�y��y q
1-M4 ls, Pi .h11.t�.4S4/yz. A.✓� 1:✓.i.Q'il.J
S", • LQfi4 PLAN 3L;R.. PFRM)T X, ES'IgOT INCL.UOtBLOCK 'E>;T.ALU1
1yOOUSPA, OR. ORVfi:WAY APP11.OJAM 75wb "I DUCTION TO PTIAN, 4`NWK
F 17PCYA MULTWIS ISSUANCZ OF SMAR PLAN TYP'
CUSTOM CONS'1'.Al:lfM1011 '053.00 SP"
PORi.`p1.M.d TIO 535.06 SP
• CSP, A.CI�,Al2Pt�Fd7' 6$30 R
ERDMAM C,OS'1 OF CC?PdMUON
=,27220,
COPS s.rRUC TIOAi RIX 103-000438-000 11,196.04
PLAF3 CHECK FEE 101-000.439-318 545.13
KWHAl•XACALFEE 101.000-421.000 1118.40
ELECTRICAL VEX 101-000-420-000 $17.46
P1,C1TaSD1NO YPIN 101.000.4.1, 9.0009 S10$.30
STROMO MOTION FU 4 MUM 101-0300.241-000 $25.83
OR:d DITNc WE 101.000,423.000 $20e 0
11+1FR,?iSTR,UCTU',RY, M 225-000-443-342 $1,9t7zEW
Aikr 10 PUBLIC P'l,aACES - RMIL ZM.000 445..00' $10.68
Mm _T'tYrAL C:3`O�CTIO.l~1' :ARD PLAN CIWX 0
$4,017.10
:ESS T'PX PAID V M'
$10100
pp �
RECEIP��-t� V K `,OATE M
BY
IN INSPECTO
-
J�'
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
It BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings
��- �d��
Underground Ducts
Ducts
/
, `'
Slab Grade
3 0 Z _ ((,pp1J
Return Air
Steel
Roof Deck
/%Qj.
Combustion Air
Fans `
O.K. to Wrap/
_ � � .Exhaust
02 -�
F.A.U.
Framing
Insulation
� 1 &"&j
Compressor
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
_
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath���
- —
Final
POOLS - SPAS
BLOCKWALI, AF PROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
I
Gas Piping
PLUMBING APPROVALS
Gas Test
Waste Lines
_
����� y�� &t/
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
Gas Piping
•`tom
Encapsulation
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
r
G. F.I.
_
/
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Penn)
OF
06/20/2013 '21:32 FAQ. X005
1'
INSULATION CERTIFICATE
This is to certify that insulation has been installed in conformance with the current -energy
regulation, California Administrative Code, Title 24, State of Califomia, in the.-buildilftq at
/'80-970 Spanish Bay, 4, La Quinta, California ,
CEILINGS:
TYPE: BLOW MANUFACTURER: Certainteed THICKNESS: R-38
WALLS:
TYPE: BATTS MANUFACTURER Certainteea THICKNESS: R-13
GENERAL CONTRACTOR: CENTEX HOMES LICENSE#:
BY. TITLE:
PARAGON :>CHMID BUILDING PRODUCTS, a MASCO Company LICENSE 9221517
TITLE: ADMINISTRATIVE ASSISTANT DATE: 8113102
`.:::/:, i::::0".nQ :r "••-/.'r /"x✓:if.F/.:r.n.. ..fy..t.a.. y-. ,l.. v.. •:G.
f
INSwL LION CERTIFICATE
J
This is to certify that insulation, has been installed in conformance with the current energy
regulation, California Administrative 0:)de, Title 24, State of California, in the building. located at
56-295 Winged Foot, Lot 3, La Quinta, California
CEILINGS:
TYPE, BLOW MANUFACTURER: Certainteed THICKNESS: R-38
WALLS:
TYPE`. BATTS MANUFACTURER: Cerlairiteed THICKNESS: R-13
GENERAL CONTRACTOR: C£NTEX HOMES
LICENSE #
BY: 'T'ITLE:
PARAGON SCHMID BUILDING PRODUCTS, a MASCO Company LICENSE #221517
B` . �._•-- -' TITLE: ADMINISTRATIVE ASSISTANT DATE: 8/13/02