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LICENSED CONTRACTOR DECLARATION
I 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
PrufeSsionals Code, and my License is in full force and effect.
License)) q#q y p y�Lic. Class Exp. Date
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Date ,r,✓ Signature of Contractor y r / %'>✓ f r .,`.i
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.
"(u�) I have and will maintain workers' compensation insurance, as required by
Seciion 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
works' 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�
kate:- /* 4, i % Applicant }'�; 2 �. :4 :t,i12
2
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. j
�ignature (Owner/Agent) ✓ ( -; - -�� `' Date"
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 01.06-33%2. TRACT
Z41974
JOB SITE
APN
ADDRESS
719-` W T' 3"D,EMTORMWE
I r2' tYtBlX
OWNER
CONTRACTOR / DESIGNER / ENGINEER
d:'nIMMY 171111 gWK11 C(Xy , riff"S
lnfruy�.y (IT
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1.13 S 100, �p Bii,:Cel:.�'+:L', F i 0200
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15315 so, 817 kr.k..d1�+6:.d,4 L ro, �sIMI.
1S1A13' 1:3.'€ 1'AFv JR40 CA. 92408
SAN BER i.Ai'#.'t WO CA 9241'09
(909p, 81.60(77 C1110 2120
USE OF PERMIT
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3F?•) a P,OT &P?LAN CSAR -'PFJ'Xi0,' 1XTWj' N0T I XIX1la]? BLIOCK WALL
POOL DOMWAYAt?!'ROACH.
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3T.k'P CONSTRUCT1014 1,845.0-3 S
FOFC1PAf7311.i0 SF
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'113r :Wr"M 91"1MM<alRY
Cwt i� ritt fOi4 2+1 ? 101 ^000 -4 IM31.50
PLAN C HW. 19. FEE, 101 -MI -439-318 $590.51
M C1' ANICA&L IM 101-(X,0,421-000 U10100
1513011?.PC..All ney, 101-000-+420-000 $174.94
P1 4 Uhlb'31 H0FF,E 101.000-419a000 $149,00
aTMAX0 'AlOTION 117t- RF -31t) ;01-000-241-000 S11,20
ORADINOFE1101-000m4m«000 311.10 0
tJF FJZ1rol,.F',. !MP.3�kGT P+v1, �1,9f1"1.00
P'311.-3-TaP ALC°.CSAI `,t L1 > C>N CJS PLA—V MACK
X36 X23,15
J. WIS ME-V.l J laIX0
$0.00
RECEIPT
DATE
BY
DATE FINALED
INSPECTO
_Z5 —3
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings
�f
'v/
_
Underground Ducts -
Ducts
Slab Grade
Return Air
Steel
_ _
Combustion Air
_
Roof Deck.
3/�
Exhaust Fans
O.K. to Wrap
7/v
D C
F.A.U.
Framing
yam_
Compressor
Insulation
/Q
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Lath
_Exterior
a
- Int. Lath
_6-jDrywall
i�_
Final
Final
� — J 5-�
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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
�
���
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
_
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
$.�,
Pool Cover
Encapsulation
Gas Piping
Gas Test
_
Appliances
Final
COMMENTS:
Final
Utility Notice
L
(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)
ESI/FIVIE, Inc..
Structural Engineers Date July,2, 2001 By
1800 East 16th Street
Santa -Ana, California 92701
Company: CENTURY HOMES Project Name: MONTICELLO
Address 1535 South "D" Street"Heritage"
San Bernardino, CA 92408 'E S I F M E Job No.: 1000-2398-2
Contact: Burt cell (909)772-4621 Project Eng. R.R.W.
Phone (760) 200-1533 FAX: (760),200-4484 PH.: (714)835-2800/Fax 835-2819
Phone Conversation a Field Meet!g a Meefg-@.Clients An-Houie Meeting
MEETING OF AUG. .4th: with Framing.. Foreman Jimmy:,
MODEL PLAN 313 -Sales Office I Lot 12.:
GARAGE:. ADO 2x4. verticals to support hips. to. last flat -top -chord truss.
BONUS: ADD detail 23/SD2.
�Front Porch: ADD 2x6 blocking. and (2) A35 at end of 4x10 entry beam.
ENTRY: 4x12. FL. BM. may be deleted on future production. units%..;..,...
.0
.MODEL PLAN 5-
-ENTRY: ADD details 22/SD2 at each side. of Ehtry.
'BONUS: ADD 31 -inches- of SD1.2 at front wall. only. Shear 'walls. at end of. Bonus
and at oppositeside. of.-. garage, are considered enhancements.
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OF
COMPLETION OF THE ABOVE ITEMS WILL BRING STRUCTURES INTO COMPLIANC-1
WITH THE APPROVED SET OF CONSTRUCTION DOCUMENTS. -
file: - ML070201 . A4