0106-345 (SFD)CV W
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LU LLj I hereby affirm under penalty of perjury that I am exempt from the Contractor's
N License Law for the following reason:
Z. „( ) 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
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
6,2. C
Date <' •rf Signature of Contractory.
ar i'
OWNER -BUILDER DECLARATION -`
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 3760 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..
rTSNr-��I�flti�••o�
(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.y-
Date:.� Applicant
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 fort
application.
1. Each person upon whose behalf this application is made & each
whose request and for whose benefit work is performed under or pu!if
any permit issued as a result of this applicaton agrees to, & shall, i
& hold harmless the City of La'Quinta, its officers, agents and em2. Any permit issued as a result of this application becomes null awork is not commenced within 180 days from date of issuancepermit, or cessation of work for 180 days will subject permit to can
I certify that I have read this application and state that the above inforcorrect. I agree to comply with all City, and State laws relating to th
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
f
M •"
Signature (Owner/Agent) Date
BUILDING PERMIT PERMIT# '
DATE VALUATION LOT TRACT
$176,4WA0 18 24197.1
JOB SITE
APN
ADDRESS W-764,9HAIMM M&
604-072-W)
OWNER
CONTRACTOR/
CONTyR�ACC�TrO�gRy/yD�E/S.IGNERw/EN INrEER�y
oyp�p�(yq`�q.�y��q
'�e.LcYM WRIT l..r.4YJgil A:�.S.L cVAv:1.ICv'S.WJ.'lrl lm
�..L•SV d.4'IGz CR-Ov9AFiv- C()b,S1VJlMd. JrrfE19 •`i-•� -
�y�yy`,�•e(.l��G
153.Aac), "rr vrRimS, 7'M Wo
135 00. OD" PiR1 '.R', Z"E, 0201D
ISS ' . " MAMINO CA 92A08
SAN I311"ARDIX0 CA 924:08
(909)M-6007 M-14 2120 t ,
USE OF PERMIT
WINGLE WiMFLY DWIK UNG
SF0 � 1,DT 18 PLAN M - ;P'6R.M11'T WES N(Yf INCLUDE SIXICK WAt ly ,
POOL OR f')R1VKrWAY AP11R0,ACH-. 75% fq.,04 CHWK Fr% iilrlr►[1c'; Y10
"PIAED .Fr011' MULTIPLY, PLI.AO TYP'F4?* aUBV416'TZD.
TRACT CONSi1;,UMON 012.00 IV
PORCTIV A.TIO 25.60 SF
GAA,C1x:IOARPORT 640,00 9F
PX=T dT22 S rMMARY
C1014 -al RUCTROP M 103-000418-0100 $949.00
PLAN ACHEM FEE 101-000439-318 $387:92
I"AXC4 W RCAa1. F91t 101>*.;0..421-000 .Utt
XPI:;if=919',AL FeX 101 -000 -420 -WO $166.V
t
P.Rk11MTt11NG per. 101-000-419>400 %161.2.
S°'1`RONO MOTION PRX a At= 101-000-241-000 $.17.64
03tAI)MC1 WE 101-0004.13-000 $20.00
DF,VRWP9R..TMPACT F10 Sp,Si�.tlt)
t�
OU I d L Ct?MMM11C N. AND PLAN CHECK
$3,448.5.3
JUN 2 5 2001 wv a.-PAr D :F=
$0.00'.
CITY OF LA OUINTA
FINANCE DEPT
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
rt
3
INSPECTION RECORD
OPERATION j
DATE
INSPECTOR
I OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings
Slab Grade _
Steel /3�/tel _
Roof Deck /�/L��
O. K. to Wrap -
Underground Ducts 1
Ducts ,
Return Air
Combustion Air
' Exhaust Fans
F.A.U.
Framing /p Z Q/ �.�
Insulation `�.c7 (_
'; Compressor
i Vents
Fireplace P.L.
3 Grills
Fireplace T.O.
Fans & Controls ;
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior lath/ a `i /
Drywall - Int. Lath 2 _ p�
s
Final
BLOCKWALL APPROVALS
Final 2
POOLS - SPAS
,steel .
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location'
I Underground Electric
Underground Plbg. Test
Final J,
Gas Piping
PLUMBING APQROVALS
_
Waste Lines
Water Piping
Gas Test
Electric Final
Heater Final
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection �/ per!
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
-
-
-
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp: Power Pole 11
Underground Conduit II
Rough Wiring ;I
Low Voltage Wiring i
Fixtures �(
Main Service I
Sub Panels Il
Exterior Receptacles �[
GYN. II
Smoke Detectors
Temp. Use of Power 1,
If
5�
Final
Utility Notice (Perm) /�
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 California, in the building located at:
7.9-764 Shadwell Circle, Lot 18, Monticello -Heritage, La Quinta, California
CEILINGS:
TYPE: BLOW MANUFACTURER. CERTAINTEED THICKNESS: R-38
WALLS:
TYPE: BATTS MANUFACTURER: CERTAINTEED THICKNESS: R-13
GENERA CONTRACTOR: CENTURY CROWELL COMMUNITIES LICENSE#
BY: . I'AAZZ TITLE: Geer 47�
f. PARAGON SCHMID'BUILDING PRODUCTS, AMASCO COMPANY LICENSE # 632072
TITLE: ADMINISTRATIVE ASSISTANT DATE: 12/12/2002