0003-292 (RPL)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
ti l 2% A/ 1 31
Date �� L'� Signature of Contrator f "�`��'�
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
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.
X111'Vi'I: l"UND ' +1416-0)4400733w
(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 provisions.,
Date:-�'Applicant
r .
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 on his
application.
1. Each person upon whose behalf this application is made & each person at 4
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
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 authori'�
zerep�resentatives of this City to enter upon
the above- mentioned'property'for Inspection purposes.
Signature (O Lr/Agent) ""' Dat27 f C�,>�
irr L
BUILDING PERMIT PE MIT# �=f'
DATE VALUATION LOT TRACT
JOB SITE APN
ADDRESS M-462 TANGLEW000
0
OWNER CONTRACTOR/DESIGNER/ENGINEER
'F'f CIRNANIEN'I'CO .tS#'1 VF: DODSC)N
IS3 S. "1')'' ! 1'RIiEI""of I Ct:JU-N TRS'' 1"T.UI DR.. Si ►111C..f 4
SAN i3{;,l�:lliAKI)INO CI 1. 92408 PALINF D1 5EII IT Ct! 9Q,260
POW3416-4032 4:'811 1044
USE OF PERMIT
ja,{tr.N, & .315A'YNl. f -M AtbNf.` 8ARRGRS :iI•iiLL RE lla PLACE JiCP
PRE -PLASTER KSPEC'1' ON
VAI,IJAY I()K
-22.tiC0 06 LS
E,,iTI[iM-!ATE V 'l.6/,7 Q''4.r11 \.L✓1MWI P!•tT"
ION
PEIITMIT I<<'EW SiiMilsfa,RY
MAN F1 Ii
40)•x{:39-31fi
2.16
ONSTRIX.710N [Th
W400 -418-M)
12�,4.00
M):t 1IANIc;A1.1 !:E -- W)OL
104.000-421.000
SSI oa
1.:1.1i(."1'}2I AL [IX -• POOL
101-000-12(14M)
tiZS.IA)
fjT UN113)NO IMV -- PCY.X,
101-000-419-M)
$27 04)
[t;..
Si.IL-'Ii7I_1kL, CONST'RUC-7110N AND PLAN CHECK -
��'� i.;itiS F'I;.1'-F'A.1Ul�i�1;��
•.' 9 "1 ! ...
MAR 2 9 2000
RECEIPT
IY .1P " f/� DATE
0
27-600.09
$0.t)0
$482.10
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INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
Compressor
Insulation .
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
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
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover.
Sewer Connection
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)
SIZE 13 X 20
NOTE: ALL WALLS TO BE
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AREA B2EAc1i POMETER
DONE
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BY CENTURY ' GOLF COURSEIm,
that Qem 'e .�� r<II
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DATE_ signatuTr
P_04LCAPAC[M... -.SMI GALL'
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PtFd�eA-QCD _ ID-GPM
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RACKHOE ACCESS
MO
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3'-6' ... S'_g^ - STACKED Q UARTZrTE SPLLWAY
NO R&R REQtXRED
FILTER STA R1rE 300 Fr
.
o
ROLLED EDGE
AT BACK
FfLTER RATE 102 GPM
EAM2LAABS.-S1 2% ER11N
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SIZE 7 NAISED YES.t8'
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LIGHT SWITCH
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15•-6•,•-
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DATE
DA14WALL - STACKED
ALL T[W
3-20-00
ARTZITE
SPLLWAY SIZE 3 "X 12' WIDE
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Name: CENTURY HOMES lrOURNAMENT
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DECK - BEACH
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CROSS SECTION
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PALM DESERT TEMECULA
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73-011 COL TRY 28910 RANCHO
L
SCALE
CLUB DR STE F-4UfORKA R0.
PALM DESERT CA. STE Z06
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NOTE- LANDSCAPE AND FURAT7'URE
92260 9LA CA
2590
92590
ARE SHOWN FDR II Li1SIBATiON
f76o1 u
1
ONLY AND ARE NOi INCLUDED.
57
I
- 4127
A RE INSPECTION FEE OF $30
T
BUILDING & SAFETY DEPT.
WILL BE CHARGED IF THE APPROVED
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APPROVED
PLANS. AND JOB CARD ARE NOT ON
THE SITE FOR A SCHEDULED
FOR CONSTRUCTION
INSPECTION,
.NO EXCEPTION
DATE By