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0106-342 (SFD)LICENSED CONTRACTOR DECLARATION 1 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 f Date/ ..'r! Signature of Contractor _;rr1' f:., P,"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 a 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. -- 001,D31-1 EMU IN& NWC-$44"8-WJ (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 it 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: f �` -Applicant 3 � f.� `,'ji<.f�,�' � P � r �.;d„ •irk.. �;,s 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 for a permit subject to the conditions and restrictions set forth o application. 1. Each person upon whose behalf this application is made & each pers whose request and for whose benefit work is performed under or pursu o any permit issued as a result of this applicaton agrees to, &shall, inde . I y & hold harmless the City of La Quinta, its officers, agents and employ es. 2. Any permit issued as a result of this application becomes null and v 'd if Work is not commenced within 180 days from date of issuance of s ch permit, or cessation of work for 180 days will subject permit to cancellat on. I certify that I have read this application and state that the above informatio 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 the above-mentioned property for inspection purposes. Signature (Owner/Agent) It ii f�f-"l3 t. r Date r t ..... .. .. v, r..... f BUILDING PERMIT PERMT# DATE VALUATION LOT Elf1�h^o-s�, TRACT 7 �} JOB SITE APN ADDRESS 9-783 S. VIM. . MUM,' &M -W72 -Mb OWNER CONTRACTOR DESIGNER EN61NEER 4riJRI.L {� 'MnY>`wt��j µI.l.A �ii iliiLUj� +vM+ ✓Yn Y CRoWiT L1FNrt ", `' -T+ 1335 1810� TO VRML Mr 3i (K) 1535 30, OVUM= MR 9200 UAW DBRN ,k7JWO CA 92408 &AM BME N.tR1` INO CA 92408 (g09)381.6007 ('33191 2120 USE OF PERMIT POOL, OR, J 4Y1V'f3'F AY APPfR()ACH ' M MAN CIMCK. RE fit. DUC a Iow AP1'1,,1ED MIR MU1.5"IR Y, PLAN TYPE -S SUBMITTED. ; IRACT OONS`i°3;3.11CTION Zoom SP PO Rf;%dP.6iM 62.06 SP A&RAC UCARPO Rx 604,00 ON M, UM =1 C0111;r or COAMUCITON CiONSTRUCTiow FEE 10,1 mw0,418.00 S03100 PLAN CHECK ME 101-0.0&,439-318 �li'�•Mg MFICHMNICAL R 101w-000-421-000 SK50 . 9LF,CTPJC q,L FU 1041-000-420-000 $133:31 PLUM RrNej = 101-000-419-000 S142,00 S'T);DN0 pMQd3 lO1.d 9 -RUM 101-000-241-000 $15.66 GRADINO MY, 101-000-4.23-000 $20.00 LiNVOL47'i• ER, EI;W; ACS' FLOE �I,fZO� Ofl ��I KIB-7) , _1014KS`k�.l�'�' ON� 6� N C�il:-,C;Ci :JUN2 5 TUU1� $ 3,316,08 1SS3 YRF.-P-AIDM $0100 OF LAOUINTA .�4���]d'PER &I' IES DUE NOWINANCE: E DEPT RECEIPT DATE. BY DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Forms & Footings _ _ _ !� Underground Ducts Ducts Slab Grade _ _y _ / _� �� Return Air Steel Roof Deck " _ _ '/� Combustion Air Exhaust Fans _ O.K. to Wrap,A, F.A.U. Framing/L��,,,�L _ �p/jy "Compressor Insulation /fj % �3 Vents Fireplace P.L. / Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath6 _ 0� q Drywall -Int. Lath !_ Final Final POOLS - SPPAS 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 7� 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 Encapsulation Encapsulation Gas Piping Gas Test 4 -21 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 ohPower Final i'j — YaZ Utility. Notice (Perm) _//_ ©Z 12!12/2002 THU 13:25 FAX 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: 79-785 Shadwell Circle, Lot 15, Monticello -Heritage, La Qulnta, California CEILINGS: TYPE: BLOW MANUFACTURER: Certainteed . Thickness: R-38 WALLS: TYPE: BATTS MANUFACTURER: Certalnteed Thickness: R-13 c 2 • GENE%L CO 'TRACTOR: CENTURY CROWELL COMMUNITITES LICENSE # BY: TITLE: PARAGON SCHMID BUILDING PRODUCTS, A MASCO COMPANY LICENSE # 632072 r BY: _ TITLE: ADMINISTRATIVE ASSISTANT DATE: 12/12/2002 �': 1::: :_....:».: ..'•::::�/. i.. •...::.^%'/. .. /c. ...::'.-:"/vi: : ;'ym'/..%:.... �....•.J'C,^.....i%a.'/..�:d:;F%Na).•/1:.. ...i�...1,r.:%f.:.�..�'%�.'a� :: %::... /.Y/..::J^_�/. %�•.. r..r!.%rT:v::..a^..�.,........�e.. ^. rr::4%iw.ri_.......