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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.
License # Lic. Class Exp. Date
'11,4188 B 043310
Date' ; Signature of Contractor m"' • , P ).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.
( ,) 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: Applicant ir' a i •` Irl,'
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.
�i
IMPORTANT Application is hereby made to the Director of Building and Safety
Gr, a permit subject to the conditions and restrictions set forth on his
r
application. Y
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. t
Signature (Owner/Agent) �LDate o 1:
. w ,
BUILDING PERMIT PERMIT#
DATE VALUATION LOT TRACT
JOB SITE - '7
ADDRESS .� Q
APN
&;, 79-900 DANDMIAM DOW,'
604-072406
OWNER
CONTRACTOR/DESIGNER/EN INEER
CY£'N1'iSRY CMOWET,L COMt~,Q'MUTLES
C° t'.i ia'I2". CRO' ELL CO =If.9
115315".M IV ETRITIT, SIM 0200
1535 NO. '"D6 UTIMIET, 'Mr. WIN
Fi 3 i £+'13f1l3O a& 92408
SA14 f i1aAIWI 'O CA 92408
(909j383 -6007 CBLff 2120
USE OF PERMIT
Sn)- PLAN 43, WTI- I.3'`,€�, RMi T 0003 NOT 1Ni:LL91Tit<• SWC K
TRACT CONSTtC3Jt'"?I N )40+0.003R+
Pd:tRCHIPATtO 62.00 V
0PA&csEMARPORT BfJ :U(y O
lOMW:T': ,� COST Oil CONSTPU CMON
x, 2 4„ . ,ECJ
1s ERM r TI`ER Mff.MANY
O,".(�')!�si'�"�afl)IO?'3'�C�;� �3�3� l X11 �%iOCin� 9 �• 00U � �'?�i�, 00
F4,HC'TfUC1AL FRS $144.58
P3,3,>`M1tiWO4 VEE, 01-000-419-000 $142,00
IDEV ?%JAa. E i IMPACT W, $1,907.00
d
C®3 ?°1 i C;� Odd �NT11'T. ? f C`E1t�,c:
$3,wI7.50
tf IMS PRE -PAM liPSN'S
�
MOD
�''''''' tom�,, (((� �y�� p� �g.• r��r�. +� p �+ )NOW
AUG. — 3 2001 , i .Ti3 �tt"Lk Rs.C�.'fa c7J �i.+BL S�ti7Y
p.. bra y �p
tyn�pis�r,50
I
CID 0;
RECEIPT
DATE
BY/°; ;•
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs,c)
�;
Underground Ducts
Forms & Footings
U/
Ducts
Slab Grade
_ T /� C
Return Air
Steel
Roof Deck
(- _
�/,d�
Combustion Air
Exhaust Fans
O.K. to Wrap
�,�/g^
F.A.U.
Framing
_
1p. -Q (
Compressor
Insulation
�� (f ( ��
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
1//- 7 Q(,'
Final
Final—/
— Z S
POOLS - SPAS
BLOCKWALL APPROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Waste Lines
C!�/3�- J C
Electric Final
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
ryc`J�_�}/
O.K. for Finish Plaster
Sewer Lateral
_
//''�"�' �/'
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
-
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduft
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub. Panels
Exterior Receptacles
G.F1
Smoke Detectors
Temp. Use of Power
Final
—_
Utility Notice (Perm)
�0�
10/17/2013 00:57 RAX
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 California, in the building located at:
79-800 Dandelion Drive, Lot 1, Monticello -Heritage, La Quinta, California
CEILINGS:
TYPE: BLOW MANUFACTURER: Certainteed Thickness: R-36
WALLS:
TYPE: 6ATTS MANUFACTURER: Certainteed Thickness: R-13
002/01
GENE CO CTOR: CENTURY CROWELL COMMUNITITES LICENSE # %W-1
BY: TITLE:
PARAGON SCHMID BUILDING PRODUCTS, A MASCO COMPANY LICENSE # 632072
B TITLE: ADMINISTRATIVE ASSISTANT DATE: 12/12/2002