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LICENSED CONTRACTOR DECLARATIONS '
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
r.31412�6 1� � i � � � 1 up, 1/0
Date,-- Signature of Contractor
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.
�>rii�.x;�`3� 1�0'�'� 3I'�N`. A"J.'�'pC-•��i?���f4�
(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, l shall forthwith comply with those,. provisions.•f'
Date: c;,*s`'; / f Applicant—
Warning:
k" � A' 11.1.f r_o .,f�'11
,. _
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 A" plication 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 �Yx.:x
whose request and for whose benefit work is performed under or pursuant fo
any permit issued as a result of this applicaton agrees to, & shall, indemnify' ,
& hold harmless the City of La Quinta, its officers, agents and employee.
2. Any permit issued as a result of this application becomes null and void ifs
work is not commenced within 180 days from date of issuance of such, i
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 Its
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 upor��
the above-mentioned property for inspection purposes.
fy 7 I
Signature (Owner/Agent) _r Datetr"•f tl J `
BUILDING PERMIT PERMIT#
DATE t VALUATION LOT �71,f°� (jQQ TRACT
i IDB. .ItsF 24127-2
JOB SITE
APN
ADDRESS 7Y� �q y� /l cp�vx �� y y� y� t e1
93-93) kM�s,CFJ1,eA`i+�i'.'F.6,�R 1F.'
t �7 p ��y
604-07�N`E1i,7Ey
OWNER
CONTRACTOR / DESIGNER / ENGINEER
C' 'AMY CR0ML L, COINWUN7 IRS
G1'1'�TM&Y ,0WE.1, COWAiTiMIES
15.15 301 ILI* gritW11 r; ITM #200
1535 so. D. "'umpry, a, #200
6 Xd MHARI 790 CA. .924,08
SAN BY—RM.4a DWO CA, 92409
-
(go5p8'1-6aw (A31191 2120
.USE OF PERMIT
.V0-. PLA,14 213x. LCIT36- PE,t2;lt9IT MES 1,107 mrou.i! nm, BwcK
WJkeUeWYPOOL, SPA OR DRIVE WAY APP€tO.CaCH ?S% FLAN CHWX ?R, '
fe,1 DUC TM FC?,R S;rbf.> IME OF Sf1:AP1.Z PLJ04 TYPE
TPLAC x t:tDNWIMUC'. UYN 1,30 ).00 SP
POi1f..`Hlb'M 10 49.0 wf'
OMt'AVIUb+J7NlSC-OR 420,04 OF
C:'C19- 11 lair` C.'O.N.VI�'0C1�.'0111
°li�C7ix�3170
'[y, g j' y �, �^! y!�}^� �X��'7,'pa;�,A:�1`IA1711E)
.. !lbRK 9.� 9idAsX 110bMAR 7C.
CONOTRUCT1014 RZ 101-000-418-000 $6,64.00
P1,AH CHFA 1~: FEZ 2 C?1.91rJ 2w�3�?-:1213 IM06
MWI'lrJ'A.L7 FRE - $604,40
F*111011'PUfM&L €VIFI $119.90
PLUMBINO F", S130100
S`2'1f.£)dvL4.tyiO`2RA4 n - RE-SIn 101-000-24.1-000 $141.4+6
013.«ADMO PEP, 101-000-423-000 $,20.00
'EWPYI C IMPACT .ME �Z,9ii7.r?U
l t] ITC A10N AND PILM MX
IMS MR-MIDEEM
$0.00
AUG - 3 2001 FMI )M.rr ".Y.S ±)U:N0W
IVNN9.62
CITY OF LA QUANTA
FiivlkNC[
RECEIPT
DATE
BYE
DATE FINALED
INSPECTOR
a.
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs �t/ DC
�/
Underground Ducts
Forms & Footings
Slab Grade/Z9�
_l7_ v (
Ducts
Retum Air
Steel_
Combustion Air
Roof Deck
lr7-� -d
Exhaust Fans
O.K. to Wrap
Q Dz_
F.A.U.
Framing'
Compressor
Insulaon ���f• _
t
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Z
Final
3 —/-
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 8/�� ,� G
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
l
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 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)
IN,SUL.ATION CERTIFICATE
This is to certify that insulation has been installed in conformance with the current energy
regulation, Califomia Administrative Code, Title 24, State of California, in the building boated at:
79.937 Dandelion Drive, Lot 38, Monticello-Herltage, La Qulnta, California
FILINGS:
TYPE: BLOW MANUFACTURER: CERTAINTEED THICKNESS: R-38
WAS;
TYPE: BATTS MANUFACTURER: CERTAINTEED THICKNESS: R-13
GENE CONT CTOR: CENTURY CROWELL COMMUNITIES LICENSE #7101,9k
BY: TITLE:
PARAGON SCHMID BUILDING PRODUCTS, A MASCO COMPANY LICENSE # 632072
B . _ TITLE: ADMINISTRATIVE ASSISTANT DATE: 12/12/2002