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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
Professionals Code, and my License is in full force and effect.
*4 License # Lic. Class Exp. Date
7141 N B �y IV319.0
-- .
f9ate f =' ^'f Signature of Contractor}' �? d 'j / �" f
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 �nd 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 37.00,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.
ma I$HT1 t". • 4Cti�i6 03
(This section need not be completed if the permit valuation is for $100.00 or less).
( ') 1 -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
C�de, I shall forthwith "comply with those provisions'? Z yA
ate/.�
' ^,•',,/�,� Applicant L._.,f }, 1'<s`, /-' 1
'T 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 a
whose request and for whose benefit work is performed under or pursuant t
any permit issued as a result of this applicaton agrees to, & shall, indemnifl.
& 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 i
work is not commenced within 180 days from date of issuance of suc
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 i
correct. I agree to comply with all City, and State laws relating to the buildin
construction, and hereby authorize representatives of this City to enter upo
th bove-mentioned property for inspection purposes.
t
�ignature (Owner/Agent)- ' Date` K•' sf `
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 4 IW331 TRACT
qq� �cc��^ �L �qMy��9 [y q
JOB SITE
APN
ADDRESS ryy7 q`�y, p��y��y 7Q`��q
d.9- 76Y.i�J�6�Jle?.1bi./AIF.AY .ir tom. 4,.V=•
\XEY°i'�i.-L'•fY4y
OWNER
CONTRACTOR/DESIGNER/EN INEER
1535 so. RV MIXTU. SIM 00
1535 30. `V MR14Efi, 7M, -0200
SAN' BERNAR IKO CA 92408
ISSN BERNARDT+ O ("A WA109
(Po9 81.6orn Obit 2120
USE OF PERMIT
My y}. e
.713 • LOT 9 -ILAN 1 4EC _ PERMIT DOU'i+ OT INC:7.I]DE BLOCK WA .A.,
P001, OR biUVEWAY APPROACH.
TRACT twONSTRU4:TIaN 11,610 00 3F"
PORC14�A JO 62.00 SF
OARAGWC,ARPORT -604,00 S
�',D�t��`,� +::C;►�'7:' ;D�:�' C:f�S�T�a"�".�d;�'('::,€'➢;CDS
�«�'��:sS.'�i
P RR13± r F. Z WMM"fav
CONSTRUCTION F ION PER
tP_ 1 �;y)L•BEtCCICt .Y�yyEE �
.. 3 •'CgzgOy?tI^��31
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y�"p3!(i@�S
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.d'S1AT+ti HAMIJL:FA.1:18'diE 101- D00-42.1-000 3FAU7oI 7/
101-D00-42-000
RLWIF 21CALI, prZ, $ 01-Q$t14?"420.000 $153.33
PLUM' INO,i�r'. 101-030-419.000 $142.00
SSy�Hy`Rdi�'�p}ig�E���r�.qq�'lvy�OTY0111 VES a �. 8D 10 -000-241 -000
$1p3.�trf�`
f1q
�1JS�AIl� 40 P.RR 101 R'✓'.r1 -42,3-00® 'Ja0A
T?'t<.E'LOP9R, IMPACT F'3P; 84,4tX�.90
'
Int Sul -TOWN S MR. LTC1109 r'U.dD P AR C':'}.$ECK
V'3,833.83
JUN 2 5 2001 c .MAL PMWLr-r 1,,11M JYUX 2K)W
CITY OF LA OUINTA
FINANCE DEPT
RECEIPT
DATE
BY AT IN
INSP TOR
151
9
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
_
0
Underground Ducts
Forms & Footings
/
Ducts
/
Slab Grade
Steel
f3�6�
Retum Air
Combustion Air
Roof Deck
O.K. to Wrap
Framing
�/ ��
Exhaust Fans
F.A.U.
Compressor
-
-
B_ �G
Insulation
Fireplace P.L.
��
Vents
Grills
_
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lith
_
�/2
Drywall - Int. Lath
_
/L� —'—
Final
-
Iv.
Final
- 7 � ✓- -
_
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
Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
��, , l8 . ! �i�
Encapsulation
Gas Piping
Gas Test
_
✓ /�
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
_n
ELECTRICAL APPROVi�5
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
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`Utility Notice (Perm)
ESI/FME, Inc.
q Structural Engineers Date : July 2, 2001. By: R.R.W.
1800 East 16th Street
Santa Ana, Califomia 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.: 1000-2408-2
..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.EXI Feld Meet'g a Meet'g @Client's = In -House Meeting
MEETING. OF .JULY 31st with Frsmr ng. Foreman..lirr�my
MODEL PLAN 3B/ Lot 8
Living Room:. At front wall ADD (2). HTT22 for missing- HPA's
At detail 25/SD3. at front wall (shear abv. and blw. window) .
ENTRY:. ADD hangers as per manufacturer at Girder -to -Girder connection -
Also ADD detail 19/SD2 at .each side.
Garage: ADD (2) .2x4 trimmers . to: support Girder Trusses over Garage. .
MODEL PLAN_ 4C / Lot_9
Nook: At rear wall ADD SWI 1 at both walls with 251SD3 .
Garage:. At rear wall; ADD' (4) 2x4. braces in -lied detail: 17/S:D2
Optional Exercise Room: At rear wall ADD detail 8/SD2 over SW 10.
At front wall ADD . ply under. window,
c 5. =. z
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Up.1 1X01rn
Au 2Go
COMPLETION OF THE ABOVE ITEMS WILL BRING STRUCTURES. INTO COMPLI)
WITH THE APPROVED SET OF CONSTRUCTION DOCUMENTS.
A.