0108-037 (SFD)LICENSED CONTRACTOR DECLARATION
tl 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 41 t Signature of Contractor'"
�' t" �✓ C,:.% ( f' / r - Vis- ,kv...r • 6,..
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 ISignature 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.
( •) 1 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 I Policy No.
00101W EAOUINS,
(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. f om
Date: e)- r--/- > Applican4 k"° ,"`t
`� E�'" % J �' 'x m•(�a.•v>,.: w•sr
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of -.the Labor Code, interest and attorney's fees.
IMPORTANT .Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application, becomes null and void if
work is not commenced within 180 days from date of issuance.cf such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) )`°/ `V a Dateezt"+r'
BUILDING PERMIT PERMIT#
DATE VALUATION LOT f TRACT
JOB SITE
APN
ADDRESS
-I.s�34�.,�'ih��f�; "!Ya��r.;�".1�'UIR";
604-072-MOWNER
CONTRACTOR /DESIGNER / EN (NEER
CEMi1 i :Y CROWED Cf iWh'UNMEN
CEMM Y CR(MMIL Clamw9rIM
1535 301 IT, >S`i'4� .,1.91.11E 0900
1533 ZXX "Dw UrK.61'e.L M 0200
RAX :1~iEANAi'�YWO CA 92409
'SAW BER"r,1 R40 C'A M
(909)381.600) Oi3 -4 1120
USE OF PERMIT
I U
SM PLAW'13Mbv, €.-(Ml Pif;;RMIT 1;1DIES SOT r1HMUDY, BLOCK
WA1.: AP004 PRA OR, DR5MSA`�'APPROACH 75% MAN CHECK FEY,
RRMIC:TiOR.. FX)R ;ISSU.€ IAC E OF S'A.Yt 9 PLAN TYPE
` kACT CONSTRUCTION 21215.1v BF
POII*ti171'1?AY 10 29.00 ISF
�l'w'7` 3°} i� � `€. �$£Off` �: '►�2;•i" 33?E�. �i
13.191020
.VAU' "VIES W07
CONRRUCTION ME 101- ,001.41;3.000 r,551aa
PUOMiLeCK FEE $160.11
MWh1A1`I,ICAI,:MS 151-600-421,000 "4100
ELF. aTRICAi,1s 101-000-420-000
P1.UM1 INO FFF 101.000-419.000
3120140 MOTION FII A RMIO _101-006-241 -000 $13.20
C-�sf1k�lc.SStlgqDIWO S 101,MO.42 3-.000 $.00
f20
W�FCCE�' a
YE t c p PSE
IMPACT
`,EJ beLL/i.�1 AND $ICSf.�. 1.A1.,UL`CK
Jr423 TIRR-PAW FM
$0.00
FEMU P`1CPIRS l`11fP; AiO?W
77,1)31
AUG — 3 2001��
CITY OF LA QU!NTA
ai t.nc nrnr
RECEIPT•._-_,_ :DATA' BY
DATE INAL D
INSPECTOR
' �to v
r�
i INSPECTION RECORD
OPERATION
DATE
DATE
INSPECTOR
BUILDING APPROVALS
Set Backs
Forms & Footings ___
,,� (�91 A_
Slab Grade/Al
Exhaust Fans
Steel
Roof Deck
F.A.U.
O.K. to Wrap
Compressor
Framing
Vents
Insulation
Grills
Fireplace P.L.
Fans & Controls
Fireplace T.O.
cnndp„�m i in,
Party Wall Insulation
Party Wall Firewall
Exterior Lath
_
Drywall - Int. Lath
Gas Piping
OPERATION
DATE
INSPECTOR
MECHANICAL APPROVALS
Underground Ducts
Ducts
steel
Return Air
Combustion Air
Exhaust Fans
Footings
F.A.U.
Main Drain
Compressor
—ate,
Vents
Grills
Equipment Location
Fans & Controls
cnndp„�m i in,
POOLS- SPAS
Final
Final
COMMENTS:
ELECTRICAL APPROVALS
Temp. Power Pole
Unde(ground Conduit
Rough Wiring I i � — /55.1 _ 9�
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Notice (Perm) �_
BLOCKWALL APPROVALS
steel
Set Backs
Electric Bond
Footings
Z
Main Drain
Bond Beam—
—ate,
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
8/Z3�
Heater Final
Water Piping
/ -,
QQ
Plumbing Final
Plumbing Top Out lZ—%� �4S
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral/�,
- — p J �%�%$
Pool Cover
Sewer Connection
Encapsulation
Final
Final
COMMENTS:
ELECTRICAL APPROVALS
Temp. Power Pole
Unde(ground Conduit
Rough Wiring I i � — /55.1 _ 9�
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Notice (Perm) �_
10,117/2013 01:07 FAX 0018/019
:r/uiJ:NJ.1.A'P%/I'J.•y%AIVItJJJLlMVJ/{'f.0J•Yr�IY///NrIIl:%/I//?IJA�:/J/.J/J/I.>.I'JIh/%//%J'J//�%//%////f,•i/II;dJl'/%/Yi%IJa:I//(/%/I%•/% //lJ% N: JJJJJ.%V/.J/,V;'wn J:f. �„
INAVImATION CCRTIFICATE
This is to Certify that insulation has been installed in conformance with the current energy
regulation, Califomia Adminictrative Code, "title 24, State of California, in the building located at:
44.844 Liberte Avenue, Lot 33, Monticello -Heritage, La Qulnta, California
CI_ILIN
TYPE: BLOW MANUFACTURER: Certainteed Thickness: R-38
WALLS:
TYPE: BATTS MANUFACTURER Certainteed Thickness: R-13
GENERAL CONT CTOR: CENTURY CROWELL COMMUNITITES LICENSE # 7��1
BY: // --
TITLE: ll'>vh S�-
PARAGON SCHMID BUILDING PRODUCTS, A MASCO COMPANY LICENSE # 632072
TITLE: ADMINISTRATIVE ASSISTANT DATE: 12!12/2002
• i s,
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JAN -6-2003 12:07 FROM.:MONTICELLO 7603609389 TO:97777011
I .�
CITY A (�t,IINTA
B,IIWG DEi)ARTMENT
-7012
INSPECrlON REQUEST LINE
CITY of L.A oulnra .7153
r Ilan E UEPi
Owrwr LL
ContractorqE TURY CROWELL
! Permit N tuber 0108-037 ,..�
POST ON JOB IN CoNspir.0008 Paa
` INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 'E
SFD-PLAN iiX LOT 33 - PERMIT DOES T OT INCLUDE
BLOCK WALLS(POOLS, SPA OR DRial%AY APPROAC$
I
TYPE OF INSPECTION OATS
INSP.
FOUNDATION A SETBACK
FOOTING STEEL
MAIN GROUND SYSTEM
i. GROUND PLUMBING A ism
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL AL B_QVE I
CONCRETE SLA13r7/'J1j�%
JOISTS A GIRDERS
ELECTRICAL GROUND WORK
1 DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN 81ONEC
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS A OAS TEST
i HEATING A VENT • A/C
FIREPLACE
ROOF
i BOND BEAM
O.K. TO WRAP
GROUT 0 4' 08,
FRAMING
i INSULATION ` '
PRE -ROOF
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNE
DRYWALL INTERIOR �.
i EXTERIOR LATH
SEWER SEPTIC TANK
• lIY�I.e
1i law-f4vs P APRW^ • i tilt Z
ABOVE APPROVALS DO NOT INCLUDE RIQ TO
TURN ON UTI ES OPING
Ga1 �/ s•.o�� 9�L&,L7rL_
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