0106-228 (SFD)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
Date Signature of Contractor i - / 7r'
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 r:�y 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 acertificate 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.
INJ.�9A�3.03
(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: °147 i Applicant 1r Ay+` . ha ,�✓a � �
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
the above-mentioned property for inspection purposes. ,
Signature (Owner/Agent) Kf +1Date
BUILDING PERMIT PERMIT#
DATE d�� VALUATION LOT OJ,06.2218 TRACT
'
29586
JOB SITE v
APN
ADDRESS
OWNER
CONTRACTOR / DESIGNER / EN (NEER
C11WTi3RY CRO YLL CON ULn3I MS
Ciaw1't31 y CROW L Cf'JMMfJN11irMs
, VrX 0200
)535 SO.Er" LTER 9r, MT, ft00
SAN BER.W'&R1:Wo C .A. 92408
S,A1tN EW-RWAi.I: WO, ' c �'-, 92409
(909)381-60T/ csvf 21-2o
asoe
USE.OF PERMIT
STMIGIM VAMILY'.+w=2HO
3.990 WESTERLY PLACZ
SrJ, 14T A €7Lk'N IB'- .PE+.i it IT 1 Ew `A2OT INC:d, UE& BL, -ICK W'A.pJis
PCAX Oft iaiil".rZ? yAY A>i+PROlsCM 7W PLANe"`.Mr'SCK 17U� 0. ' I E n
1.101 ANCE O T=' SAMI� MAN°;1"PF, A.i'V5 IE",D ln1
L./
MCUSTOM
Mfg.1fTRUC ION Z-195.00 sy i �
_ — 6 2001
17opwWRwrio 21.3100 SP
0ARA lEiCA"M $64.00 8E.
CI
OF LA OUINTA
DEPT
L__FINANCE
X1TMW1T9 D COWS' Or, CO�f">�'�T:��`M"1,1014
200,457SO
CONSTRUCTIOli;'EE 101.-000-4.16.000 (993100
,1�.L,�.�r tef�ECli� r�� 1�➢1-00��-31� �3fJr.?,�
MWk1AM�; Al FV% 101 !000-421 �0(3ij
F LIN,7.RIC'AL. FBIF �t:duSy.t;x
y101-/O��00420'-0
Q01)
]F"Cotij �F��f'!1 �..6 ��$w 7146 sV�®1°'1'.t STaW'Wi3 �Y'•pk.��
.rl MONO MOTION JELL:; • ktES10 101-000-241-000
�3 AE INO RITE -1 101.-000-423.000 $20.00
IMP. CT PES
ART IN PUBLIC MAWN • 0.41E701 o000-255-,000 �2i1,t3t>
MR1,4X)TAL Cts rRUCt10*t4 WD PLA4 (UIECK
LESS PIR.F`rPiff.)FPM
Saw
,�e� U.ryM.yyr {y�r{�' DWHOW
RECEIPT
DATES/ /
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
' OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings
_
8� �
Underground Ducts
Ducts
)
Slab Grade
Return Air
9
7 G�
Steel/�
Combustion Air
Roof Deck
`U —` �/ ( /
Exhaust Fans
O.K. to Wrap'
Framing
_ �_
F.A.U.
Compressor
f _d/
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
�S
Final
Z
POOLS - SPAS
BLOCKWALL APPROVALS
steel
Set Backs
Electric Bond -
Footings
Main Drain
Bond Beam
Approval to Cover
(
Equipment Location
Underground Electric
Under round Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
//�
Heater Final
Water Piping
l
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
0.K. for Finish Plaster
Sewer Lateral/
H � ���/J�
//O_ �/
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.L .
Smoke Detectors
Temp. Use of Power
Final
—2, E
Utility Notice (Perm)
_ s. o -X
FEB -18-2002 14:10 WESTERN INSULATION 909 686 8786 P.05%24
WESTERN INSULATION, L.P.
4211 Laem" Street, F4vaside, California 92601
TeL (909) 686.8760 Fax (909) 686-8786
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:
TRACT/PHASE;—D UNA FAIRWAYS TR#29586 PHASE 4
�OT #: X27 �'
SITE ;4DDRE55: 7&� 274 CALLE LAS RAMBLAS, LA QUINTA , CA
EXTERIOR WALLS:
MANUFACTURER: JOHNS MANVILLE THICKNESS: 3 5/8 " R -VALUE: R-13
CE BATTS BLOW
MANUFACTURER: GREENFIOER THICKNESS: 8.1 " R -VALUE: R-30
CEILINGS- BATTS BLOW
MANUFACTURER: JOHNS MANVILLE THICKNESS: 11 " R -VALUE: R-30
GENERAL CONTRACTOR: CENTURY HOMES
BY:
TITLE:
DATE:
INSULATION CONTRACTOR: WESTERN INSULATION, L,P,
LICENSE NUMBER: 794484
BY: 066"..
TITLE: PRODUCTION VANAGER
DATE: FEBRUARY 18. 2002
4
T -
Certificate of Occupancy
City of La Quintal
Building and Safety Department
This Certificate issued pursuant to the requirements of Section 109 of the Uniform Building Code,
certifying that, at the time of issuance, this structure was in compliance with the various ordinances
of the City regulating building construction or use. For the following:
BUILDING ADDRESS:
Use Classification: SINGLE FAMILY DWELLING
Occupancy Group: R3 -U1 Type of Construction:
78-274 CALLE LAS RAMBLAS
Owner of Building: CENTURY CROWELL
COMMUNITIES
—r �K
Building Official
Bldg. Permit No.: 0106-228
Land Use Zone: RL
Address: 1535 S. D STREET, STE. 200
City: SAN BERNARDINO, CA 92408
By: GARY SHOWALTER
Date: FEBRUARY 27, 2002