0106-346 (SFD):'` LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that l 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
7141" � B 2fiisi�;ic
DateSignature of Contractor
41'.!' .��� �� kms' v` Sr�1 ' E'.}uiL%'+�'4:�Y..•i':..�`�'
ti 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:
Cartier Policy No.
(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: �' r r'd 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 forth on his
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
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 authorize representatives of this City to enter upon
e -
the abovmentioned property for inspection purposes. }
,n r
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t)
Signature (Owner/Agen%';� �' +•�- �'t. ' < s Date I. °
BUILDING PERMIT PERMT#
DATE VALUATION LOT 01M,346 TRACT
1 Q�9fr 3,7t1 1 241197-1
JOB SITE
APN
ADDRESS79,478 SHADWELTO 10=1,9
29
(*4-0p ow
OWNER
CONTRACTOR / DESIGNER / EN (NEER
C." �;:r�1C1"1Xgy CR0�'>I?:C.L COMMUN sMS
amm' Ry CRUW&L C011r04UM1 *JFS
SAN BMWAIMWO C.A 92408
SAN BMWARDWO CA 92408
(909)381.6007 MIX 2120
USE OF PERMIT
M - LOT .19 PLAN OR,. PERMIT DOES NOT 3NCLY3DE aILDCK WA1,.1,, .
F001, ORD13WK1�'.�.Y`APPRO.AC'_t4, 75% PLAN r `T1RCK FER RZ.C71.tC'ri tOw-
.iAPPLME) IMR MULTIPLE MAN TYPW SUPMIYTVD,
TRACT CONSTRUCTION 11300,00 SP
PC3RMPATIO 49.00 SY
0ARA0r4(. 1RFORT 420.00 OF
111a:r YET 903GURY
C:c,1?S '.i't1. 1Ci'iO i IrOM 101 -OW -418 -DOD UK"
�:"f1FC1C C�I, t 1101-000-439-318 $11,39.06
pPL.APi
EE 1 -WO -421-000
.i�'A+a'..4I7<a1M.Y1r.YAL Fy01
ELECTRICAL TICAL FEE, 101-000-420-000
1�1..'�Y.1�i��i 1tiisi Y€11rot�L��'419.0f'F0 3130.��
-
M'ADI1' O FU 141-000-423.000 120.09
JCi3fWRVOP.. R.114PACT FEE
t I')N' .41a,19T�:r��yP „f�'yaT CdT1�§4K
�t)-3,O�49.6�.F2
�t�
:1' 1:13.' 21"5 DUF. STOW
of 3�9,k52
JUN 2 5 2001
CiiY bF lA oUINrA
FiNA'
RECEIPT
Y
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings
Slab Grade
Steel
Roof Deck
O.K. to Wrap
Framing
Insulation ���
Fireplace P.L.
Fireplace T.O.
�7" _ _ _
/_Zy_�
_
/ d l
9- /� _ _
_ _ _
��
Underground Ducts
Ducts
Return Air
Combustion Air
Exhaust Fans
Compressor
Vents
Grills
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
Water Piping
Heater Final
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
Gas Piping
_
-�� ,�
Pool Cover
Encapsulation
Gas Test
Appliances
Final
COMMENTS:
Finala �� -Q2
Utility Notice (Gas) i9�,
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) �S
12/12/2002 THli 13:27 FAX 006
r....:.::'J%:4`�F.�.:::PF.:::"%::i<>�.•.%i:t6%J'lJ�/.0%.lt%AC:;U.:V. {%.i!ACG'%"i%%i✓4�l/i'A[.+.'I:FAI/�%i.:'�N)L�:JYi��.•..:W:4'h'�.�•.�.�J. M:1%V3�'3VJ:CT.C.:%F%/V:.%:•JliY':'%!%a•:4.%JY.i'<.1I/1n'd'i..'.:h(i;rW.Y..r,:,fl.;ev�)'e .•.'!M!':J'ldi✓%J
1 j
INSULATION CERTIFICATE
This is to certify that'insuiation has been installed in conformance with the current energy
regulation, California Adininlstrative Code, Title 24, State of California, In the building located at:
79=778 Shadweil Circle, Lot 19, Monticello -Heritage, La QuInta, California
CEILINGS:
TYPE: BLOW MANUFACTURER: Certainteed Thickness: R-38
WALLS:
TYPE: BATTS MANUFACTURER: Certainteed Thickness: R-13
f J
GENEML CONT CTOR: CENTURY CROWELL COMAAUNITITES LICENSE #
BY: TITLE: [9 S.a�
PARAGON SCHMID BUILDING PRODUCTS, A MASCO COMPANY LICENSE # 632072
BY— — TITLE: ADMINISTRATIVE ASSISTANT . -DATE: 12/12/2002
::%'i'n%>�'/.•/.?•Yl.**/,'ll.:'•: /: «i :�'i ".:'% K.:.%!:%4%e'er"!b.'..�::r.,: �T<. y u•'%: %1/, fOn•/.:-':.�'!�:.: % :/,.'f„!/,Fi );W_/•: h":::1/f.•:;✓%l/:/n�/.A%%::%71/S.'J•l�%.'v:.%1r%'/:.'ii/.; i �.t%.`%Qiy::6%F:9.�i/n::: [A'Yy/.xTa�/9%v/b/('%+'r/.:�.U/ �i 3:�%Jl