0108-034 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Cha; er 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
d ARI . 7 Owl
Date :tri �% `� Signature of Contractor.-,.
r' �fi+�
d
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 affirrn'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.
00W.RWAAAng INS,
(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, l shall forthwith comply with those provisions. 'p
Date:C Applicant µ 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) " a t'�"'-a� Date'
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 0;' Ott Q34 TRACT
gyp((
}App g ;ry /� p y ry�
241.97-2
9142,9MIM JCA .f41.9 -2
JOB SITE
ADDRESS
APN
I 49-760W F3is PrY A'sJ.42
604 -072 -CM
OWNER
CONTRACTOR / DESIGNER / EN (NEER
emarmy, epo' $ha.;F commuvri s
0.10WRIU, Co'vlkJ MTIM9
1.535 31 0. "`'di ° �11T3'rX.° ,€, VIR 0200
15 35 UO, T" XTRE k7f, WE #200
ISAWK11RHARDINO CA 91A.09
VInT BMARDWO CA. 92408
(9.09)30-6007 Zu DIX 2120
USE OF PERMIT
�. PL. -W 44,1 f 3a . t:,.ERM T DOMS NOT MCt UDE BW -CK -�..
KKIIUCTIONI FOR ISSUANCE Ole SuAtME 1'1.AIN't'' PP,
TRACT COa7>BT. UCTIRJd"i sal
0AR,ftiWfd°,ANPORT 609,00 SY
t
CONSTAUCTION M, 101'-000-419-0.60 S79011"
PLAN CHECK me Im -000-4.11)-m. V65.20
WCHANWAL FRY. 101-000.421-000 S66, 1.1p
ZLECTAIC.A,1,fW8 101-00", 20 -ft-) $ 44.58
PLlit DWO.IAF, 101.000.419-{300 $142,00
NT3lW40MOTION F'88,1 919 101-000-2,41-000 $14..30
c !-A'DWO FOR 101-000-423-000 &20.60
EMLK.IMPER AM PACT M$1,9ia7.00
M,,10 �4qPqtW:TWX
$3,249.66 .66
jti
MIS PPXPAW MS S
313.00
AUG — 3 2001
T( J .1E IT9.111DAWKNOW
CITY OF LA QUINTA
FINANCE DEPT
RECEIPT
DATE
BY
DATE (I (LFA - /
j o G�
INSPECTOR
�,
04
OPERATION
DATE
INSPECTOR
OPERATION
DATE
I INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs _ _
Forms & Footings (2_ 8I / �� _
Slab Grade (% �� 6Z _
Steel _
Roof Deck !6 �/
Underground Ducts
Ducts
Return Air
Combustion Air
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing f,a� -dl
Insulation
Compressor
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKU ALL
APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Ptbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Waste Lines 3 dJ /
Water Piping
Gas Test
Electric Final
Heater Final
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping �� �3 • V� S
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring /2 — 3 _v/
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm) 49
r
JAN -6-2003 12:08 FROM:MONTICELLO 7603609389 TO:97777011 P:10/10
r
PITY A QUINTA
I ! i F ~"BC71L�IfVG'A TY DEPARTMENT
' 1117-7012
AUG _ 3 IRVEC»IP i AEQUEST LINE
. I 77 7153
i r r C1'�ViX J
'CRO LL
Contrectoi CENTVRy--CR LL
` Pwmlt Number OZ 0$-034
POST ON J08 IN CONSpICUOU S pLgCE
f INSPECTOR MUST SIGN ALL APPUCA.3LE SPACES
JOB ADDRESS 44-760 LIBERTY �VCNUE
SFD-PLAN 4B, LOT 30 - PERMIT DOES NOT INCLCIb$
$FOCI( WALLS/POOLS, SPA OR DWEWA V APPROACH
f
i
TYPE OF IN.Qam-;....
SIGNED
GROUT ❑ 4q88
FRAMING
PRE -ROOF
COVER NO WORK UNTIL ABOVE HAS BEEN SI3NE
DRYWALL INTERIOR
jXTRIOR LATHOOL PRE PLASTEROOL FENCE 8 QATEEWER SEPTIC TANK
' FINALS
. ELECTRICAL
PLUMBING
FINAL GAS TEST c9�
HEATING - A/C
HOUSENUMBER3
J06 COMP1,
TEMP POWER
77
INCLUDE RIGHT T(J
_TURN ON U ILITIES OR OC PY B RIGHT
� , d� ';rS
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:
44-760 Liberty Avenue, Lot 30, Monticello -Heritage, La Quinta, California
CEILINGS:
TYPE: BLOW MANUFACTURER: CERTAINTEED THICKNESS: R-38
WALLS:
TYPE: BATTS MANUFACTURER: CERTAINTEED THICKNESS: R-13
GENERAL CONTRACTOR: CENTURY CROWELL COMMUNITIES LICENSE #
1
BY: TITLE:
PARAGON SCHMID BUILDING PRODUCTS, A MASCO COMPANY LICENSE # 632072
B TITLE: ADMINISTRATIVE ASSISTANT DATE: 12/12/2002
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