0108-039 (SFD)LICENSED CONTRACTOR DECLARATION
I herby 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
WA. A.1101
Date s. r' "" Signature of Contractor + I {"� a•" l r- �' '.
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.
(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: r" 1 r Applicant
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 vgid.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) ~., fR "+ t^, > Date*%
BUILDING PERMIT PERMIT#
DATE VALUATION LOTTRACT
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ADDRESS
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604-07Z
OWNER
CONTRACTOR/DESIGNER/EN (NEER
C.'}"R ruR.Y Cao%WaL a; OMWI ti r ,r
OMP.y moVImpu. GC)`%"�•.�+3Y1kaTr=
1535 ISM VW M.R. r, 912 0200
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USE OF PERMIT t � t
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RMUC'FION>F01.1ISSUANCE OFSP:vIKP TY1'Ir,
TRACT CONSTRUIt" X1014 V21.5,00 SF
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PLAN 03EC°K P`RE 101...{lil -4I: 99 3i*4 $160.11
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MECHANICAL 1799 101
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CITY' VF L'€s QUITS
Fli: jrjl E DEPT
RECEIPT
DATE
BY ,/
DATE FINALEDINSPECTOR
Z1
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
Underground Conduit
DATE
INSPECTOR
V
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings s Z1iL
Slab Grade
8I I. ?_SI
G, /jj -
Underground Ducts
Ducts
Return Air
1z--5-
Steel
Roof Deck
7
Combustion Air
Exhaust Fans
O.K. to Wrap
/
F.A.U.
Framing
_�� sp� _
Compressor
Insulation d�=dam
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 �%.—:Z�2- z
BLOCKWALL APPROVALS'
steel
POoLS-.- SPAS
Set Backs
Electric Bond
_
Footings
Main Drain
Bond Beamer —
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Water Piping
Plumbing Top Out
2 JQ- �C
�y �S
Heater Final
Plumbing Final
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection -/,;7 _ev
Gas Piping f iZ. h' 415
Gas Test
I Encapsulation
I Final
ELECTRICAL
APPROVALS '
Temp. Power Pole
Underground Conduit
Rough Wiring l,Z
Low Voltage Wiring
Furfures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final 21 -�-Z
Utility Notice (Perm) 2--.2's" p
COMMENTS:
,6 e &,&—
G 10/17/2013 01:07 FAX
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 Calffomia, in the building located at-.
44.900 Liberty Avenue, Lot 35, Monticello -Heritage, La Dulnta, California
CEILINGS:
TYPE: BLOW MANUFACTURER: Ccrtainteed Thickness: R-38
WALLS:
TYPE: BATTS MANUFACTURER: Certainteed Thickness. R-13
Z019/019
GEN CONT CTOR: CENTURY CROWELL COMM UNITITES LICENSE # 7/y/��
BY: TITLE: 19-� 50
PARAGON SCHMID BUILDING PRODUCTS, A MASCO COMPANY LICENSE # 632072
Bim- TITLE: ADMINISTRATIVE ASSISTANT DATE: 12/12/2002