0108-033 (SFD)LICENSED CONTRACTOR DECLARATION
Iiiereby 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 a n-',
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.
t3�D3����'t�T. t�.cfiiy:6`�,iT>r�+. ;�''►'�bw�44�fla oR•��
(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: Y 1` r Applicant' " :1 "'•a ,rw1 i,�+ .�' .
Warning: Failure° to secure Workers' Compensation coverage is Unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.'
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or.pursuant to
any permit issued. as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) n 6;1 4 1411: ;s Date r •l7 f
• avr e p
BUILDING PERMIT PERMIT#
DATE ; VALUATION LOT (J'� {�� TRACT
JOB SITE (
ADDRESS f
APN
44-732. TJ99XrT AWEMIX
604-97-94)(N;
OWNER
CONTRACTOR / DESIGNER / ENGINEER
�p9+:I�,awQ�"fir`ic',�gg��'^^(,��:'•R��.yc^�++'rr�,,Si��'j�,.yy.L� CppCyy�.3i��yQU .i' FF3
s��.Wi"f�,ird,'.��y.'irykt.tfy',1021 1',+9SCi1q�'!=17's
.1 _5315 130. 11. , A7JLAl.LKET, 1� E, 0.2100
^�3��'rwt��J:RY'���,,
3 5:� 5 31-1, To R� n), �S , x717- V 200
85
( )IJB1.600JIif; 21Z0
USE OF PERMIT
} LAW ItlRav,.d 0 T IO > PLMMIT DOOM MIr rNICL 3iXiiwIck,
W:T9.l.,J, ff10 3 , � A OR IDPWWAY .4%PPRO A.C.ff!"79% PIAN (;.41E= FEE
ME011iCTI-01T FT:1'R IS'SWANCE OF 'SAMR P3: A14 TYPE
`t`iXAXT CONK RUCTION 420.00 SIF
MkCHAVtTIO 20.00 "OF
CIARA 3UFCARI POR MID
, I ��EI) COST O� d�'�3�'�"� ►�,°��GlliF
13.�'9✓.T�t�'f)
qqaiR� g�g%py'jj��$/� a
1.kVW,.F1 i1= p�4.afv.�.{. .�N.1yAi�..�
M? i 0-a00��a0s.t�a
$lQld{ifA):
yi.p3
7T,rpli{��y1,L%yptgp��id}tq�/tO:A�':ry'.t�yg'a[[y�f:��y�� y$0���3�3Gg1•�pa3q y�••ingi'��
,rkYS11+'h.d'Y:Xy'FS�u�AM .l'.yyYA7% L/��y/V��F1t3f%�liy+Vlyi/�a dIPVICN
,�.tatfi'�»i �alii�✓ iifi 1101-fi:00-420-(300 $13843
FLUMSTNA1 FFIR MI -000-419-000 WOO
Stt`Y�1�t,�nn.�?T4�ppi+���y'l[l[ea��pp°��.TCta POP - MID 01-000=24�1.7�p{{C00/t?
t x�$33p.2p9
4.1t�s:fi.���•IO f.' 4" -, t�i"i.'U'44'°'p1b. "W�l6l $203to
157XYMOI';i';R. IMPACT "W4�a,#f0'7:Oti
RIM .11C.110114 AND PLAN CHO=
$3,177.93
1=4 PRDIFAID TOO
$0.00
fII
' � ) ' a.�39�4�' FFI<S DUN; Now
I; AUG - 3 2001
;1. 7 7 ��
C 1 OF LA 0UII5
FINANCE DEPT
RECEIPT
DATETµ
BY,,-- i
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings
_
27 d%
Underground Ducts _
Ducts
Slab Grade
����
Retum Air
Steel
Combustion Air
Roof Deck
_ _
`
Exhaust Fans
`
O.K. to Wrap ���
_
F.A.U.
- _
Framing �_ .�/ _
Insulation
Compressor
Vents
_Zp_ �/ _
/
Fireplace P.L.
Grills
Fireplace T.O.
_
_
Fans & Controls
Party Wall Insulation
_
Condensate Lines
Party W611 Firewall
Exterior Lath
'Drywall - Int. Lath
Final 2-2
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
?il3l
Heater Final
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
/Z _17
Low Voltage Wiring
_,�
Fixtures
_
Main Service
Sub Panels
_/z --—
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
10/17/2013 01:05 F!1B
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 Celifomia, in the building located at. -
44 -732
t:44-732 Liberty Avenue, Lot 29, Monticello -Heritage, La Quinta, California
CEILINGS;
TYPE: BLOW MANUFACTURER: Certalntecd Thickness: R-38
WALLS:
TYPE: BATTS MANUFACTURER: Cadainteed Thickness: R-13
GENERA.16 CONTRACTOR: CENTURY CROWELL COMMUNITITES LICENSE# 71,1119k
BY: TITLE d-f�w Sv,�Ler/
PARAGON SCHMID BUILDING PRODUCTS, A MASCO COMPANY LICENSE # 632072
121016/019
B TITLE: ADMINISTRATIVE ASSISTANT DATE: 12/12/2002