0108-036 (SFD)LICENSED CONTRACTOR DECLARATION
1:�ereby 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
10131 /01
Date S' f' 4' y� �r Signature of Contractor
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:
CarrierPolicy No.
k1f�%1s13IN &A01.8 TNo. 1MC-5440619••0,3
(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: VvL.,�. •. ,. Applicant
Vr✓r�,.
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 axesult 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)` Date f� a'•�
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 01,W-036 TRACT
A J'M $142MM 32 24197>2
JOB SITE /
ADDRESS
APN
4"16 LXHIM.CY AWTNUIR.
to" ?2_M6
OWNER
CONTRACTOR / DESIGNER / EN (NEER
152,55 30, 0D" 91T''!FX r, M. 021535.30,
"V n' ➢TRFX7s nT1R 07,10110M1�iAt�i:
b:�1' 10 CA 92408,
&M UNAWL)IMM CG& 321.09
2120
USE OF PERMIT
S"`�IGJ-17,FAMY DW91.12,10
SM, PIAN 4C, L0 TV - M -MIT %3f, ES I10,T 11++IC'I•.WA S38 OCK
fR g i.) '(ii'►i., C'.A OR, S ai d'S:WAY ti{�.f�C.,A14 C14EVIK FEE
.C1°kyl�l�C)�`o.to1'3'#
�Ri��lr}f3t;:' ON FOR Iu&`�F..�s�lCE OF SJ$Sixla;= Mf it4 's I'118:°
'!`F?.AICT CON'ST1tdJf"i.ION 2.,400,00 b�y
i�C�b1.�:I�F.A.`HO 02.00 NY
Q`s'R.A,M'CAR1TORT 604.00 SF
�:�Sj�T.UNATMD Coffr ar +C ons—mucum
A42,9V3M,
�$y:ILGi.19�ltr�Y �8hf7`.+ a7 L�3.V.�.. 4Y:�RMa� •,
COITST1RUCTION FRE 101-000-4)8-000 $'00100.
%fr.NN CHECK ,FEE 101.000.4391.318 065.28
NFICHAWICAL Me 101-000.421.90V $6660
� ZXS•RICALVEL? 101^'00 210.000 WC52`
MWO11;d'C MIS 101,.000-4194100 $142100
51'Ron fM k11O'Ftf,} 1 ME-1?ESIV 101-000-241-00((} S14.,39
MALM ;# FU 1 1.019000-423.000 S20100
DEVELOPER IMPACT "Z
I �n IM, AL C0'��IS-014 f 4 ' �' CH—Ocy.
X3 3 P
Zoo
AUG -3 2001 T-.,,, SCI'; ren DUE HOW
CITY Off LA1 CL! JTA
,
FRANCE DEPT
RECEIPT
DATE
BY
DAT /FINA D
INSPECTOR
�fc
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footingsj�
_
Underground Ducts
DuctsSlab
-�
Grade
OlUd
Return Air
Steel
Combustion Air
Roof Deck
g/�
Exhaust Fans
O.K. to Wrap
_
0/
F.A.U.
Framing /�i�� _p/
Compressor
InsulationI Z�– fJ1
Vents
Fireplace P.L.
9
Gri'Is
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines ,
Party Wall Firewall
Exterior LathO
Y
Drywall - Int. Lath
Final
_
�1' 70 q-0 2
Final
POOLS - SPAS
BLOCKWALL APPROVALS
steel
Set Backs
J
Electric Bond
Footings
Main Drain
Bond Beam
3�� _ ,;
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
® J
!/
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
��, , �� –p/S
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral ,2
/
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.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
11--.---'vw'1r�.-1 -..Vw---✓ i----."WlIII
INSULATION CERTIFICATE
This Is to certify that insulation has been Installed in conformance with the current energy
regulation, California Administrative Code, rite 24, State of Callfemia, in the building located at:
44-816 Liberty Avenue, Lot 32, Monticello -Heritage, La Quanta, California
CEILINGS:
TYPE: BLOW MANUFACTURER: CERTAINTEED THICKNESS: R-38
WALLS:
TYPE: BATTS MANUFACTURER: CERTAINTEED THICKNESS: R-13
GENE C T CTOR: CENTURY CROWELL COMMUNITIES LICENSE # l l kl
BY: TITLE: 6�_P`r S
PARAGON SCHMID BUILDING PRODUCTS, A MASCO COMPANY LICENSE # 632072
B . TITLE: ADMINISTRATIVE ASSISTANT DATE: 12/12/2002
JRN-6-2003 12:07 FROM:MONTZCELLO 7603609389 TO:97777011
41,
�4
T Ci. _ ..�OF LA-QUINTA
I BUILDI G, SAFETY DEPARTMENT
`^'urns
AUG 2001 77-7-7012IN R C 'ON. REQUEST LINE
777,7153
Owner'
UrftRY CIROMTLL
Contractor CEfTUR ' C&QMH_
PWMIt Number 0108-03�'
(5
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 44-81.5 L113ERTY AVENUE
SPD -PLAN 4C, LOT 32 - PERMIT DOES NOT INCLUDE
13LOCK< WALLSIPOOLS, SPA OR DRIVEWAY APPROACH
TYPE OF INSPECTION PATE INSP,
FOUNDATION A SETBACK
FOOTING STEEL
titAtN GROUNp S EM
'
GROUND PLUMBING
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL. ALL, A OVE HAS SEE: IGNE:D
CONCRETE SLAB ---
JOISTS d GIRDERS
ELECTRICAL GROUND WORK
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS & GAS TEST
HEATING 8 VENT • A/C
FIREPLACE
ROOF
BONA BEAM
O.K. TO WRAP
GROUT ❑ W 0 8'
FRAMING
INSULATION -
PRE -ROOF
COVER NO WORK UNTIL. ABOVE; HAS BEEN SIGNED -
DRYWALL INTERIOR
7—
EXTERIOR
EXTERIOR LATH -
POOL PRE PLASTER
POOL FENCE d GATE
SEWER SEPTIC TANK
ELECTRICAL
PLUMBING '
FINAL GAS TEST
HEATING - A/C
HOUSE NUMBERS