0108-011 (SFD)LICENSED CONTRACTOR DECLARATION
U) I hereby,affirm under penalty of perjury that I am licensed under provisions of
lid hapt6r 9 (commencing with Section 7000) of Division 3 of the Business and
C%J,Lu '4Pofessionals Code, and my License is in full force and effect.
--.License # Lic. Class Exp. Date
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Z Date' 17) Sig'nature'of Contractor" 9 - 1 -P
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i= C:) OWNER -BUILDER DECLARATION
UJ LU I hereby affirm.under penalty of perjury that I am exempt from the Contractor's.
CY) 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, -Bus * iness & Professionals Code).
1, is owner 6f the propd ' Irty, am exclusively contracting With licensed
,contractors to coAstruct,the project'(Sec. 7044, Business & Professionals
Code).
6 1 am exempt under Section. 'B&O.C. for this reason
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N Date Signature of Owner
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FL < WORKER'S COMPENSATION DECLARATION
o'M Z Thereby affirm underpenalty of.perjury one of the following declarations:
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- .; ( ) I have and will, maintaiii. a cekificate of consent to self -insure for workers'
UJ LL — compensation, .as provided for by Section '3700 of the Labor Code, for the
tj —J performance'of the work for which this permit is issued.
will maintain workers' compensation- insurance, as required by
Section 3700,of the Labor Code, for the performance of the work for which this
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'05. F -r permit'is issued. My. workers' compensation insurance. carrier & policy no. are:
7� Z, Policy No.
;, Carrier
co� :D oolm md. no,
< (This section need not be, completed if the permit valuation is for $100.00 or less). .
certify that in the performance of the work for which this permit is
Z,r Ice issued,
I shall, not employ. any person in any manner so as to become subject to the
worke�rs' compensation laws of California, and agree that if I should become
subjdct to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions:
Date: Applicant -`2*17`7 -
V
Warning:' F,ailbre'to secure Workers' Compensation coverage is unlawful and
-_shall subject an employe�r 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'.'apermit subject to the conditions. and restrictions . set . forth on hi's
application.,
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1. Each person Upon whose behalf this, application is made & each,pe - rson at
hose benefit work is performed under'or pursuant whose_requ6s,t and for W ur nt to,
j. 4ny.oermit issued as a result of this apolicaton. agreestd,, &,shall, indemnify
& hold harmless the City, of La Quinta, its officers, agents and employees.
2. as
Any permit issued result of this application becomes null and void if
work is -not commenced within 180 days from date of issuance of such
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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
• correct. I agree to comply with all C4, and State laws relating to the building
construction, and hereby authorizd representatives of this City to enter upon
'
the above-mentioned property for inspection purposes.
Signature (Owner/Agent)
6 A Date
_
BUILDING PERMITPERMIT#'
'
DATE VALUATION LOT' TRACT
24197.2
JOB SITE
AP
ADDRESS
7.9-913WILLWANY. NVOM"WAY -.7N
% -0724M
.OWNER
CONTRACTOR / DESIGNER / ENGINEER.
CENTURY COWN93M Me
CEROPIR Y CROVIE 1- COMMUNUM, S
so, "v, ;kTrp-ta, waL.,0,00
V MmEw, mz, nob
SM B ERNINRIMIK ) CA 92409
SAWBERHARDINO CA- 92408 -
(90g.)381,60(ri MIA 2120
USE OF PERMIT
ISMITOTIR FAMLY Dwinj INE -11
SIMS. PUN 2CROV, I.DT7- PfUrWIT W.WS NOT INCIA)DZ' H1,CICK
e k.-. e.,
4-
TRA(,'T (X-114-MUCTION 1.800,00 3F
F i0 Ko*H' WATIO 49.00 SF
".
420.00 OF
1115TMATED CWT 030 MINSTRUMON
CONSTRUCTION FRE 101 -000-41 MUD $fi"109*
PLAN GHWKr�Eg
P
YMMMANWALFEE 101-000-421-000 S160.00
ELZ1,TPJC-AL PT2,
1.01.000-0 9-W-0 %J X00
ORADINO VFW 301-OM423 000
DEVEWPER IMPACT FZZ
41- ..-IVFAL i00 INUMITOXAMI) PLAM LWMX
§08
$3,049.62
7=3 P10 -PAID I-NEV.
AUG 3.2001 ii� 11EYMEVVIKES DI TE NOW
LOUT
RECEIPT
DATE BY
FINALED
INSPECTOR
th.
INSPECTION RECORD
ray OPERATION
POOLS -SPAS
Steel
DATE
INSPECTOR
BUILDING APPROVALS
Set Backs
Forms & Footings
Slab Grade
p _
Approval to Cover
Steel
Roof Deck
O.K. to Wrap
�0�3_6 —ki
Framing
Insulation
Underground Electric
Fireplace P.L.
Final
Gas Piping
Fireplace T.O.
Gas Test
Electric Final
Waste Lines
Party Wall Insulation
_ _
Water Piping -
Plumbing Final
Party Wall Firewall
'
Shower Pans
Exterior Lath
y
Pool Cover
Drywall - Int. Lath
Encapsulation
Gas Piping
Gas Test 1 . X -7
OPERATION DATE INSPECTOR
MECHANICAL' APPROVALS
Underground Ducts
Ducts
Return Air
Combustion Air _/z
Exhaust Fans
F.A.U,
Compressor _
Vents _ _
Grills
Fans & Controls
Cnnrlanm}a t i— Z I,
Final
rasa, Ir7�T` - G- I `•-'11I!___1
BLOCKWALL APPROVALS
POOLS -SPAS
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
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test 1 . X -7
Final
COMMENTS:,/,5/,3 ok
Final —
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Low Voltage Wiring
Fixtures •-
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Notice (Perm)
10/17/2013 00:59 FAX r 005%019
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INSULATION CE ICATE
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:
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79-913 WIIlisrn Stone Way, Lot 7, Monticello�Heritage, La Quints, California r
TYPE: BLOW '.MANUFACTURER: Certainteed Thickness: R-38
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WALLS• f�
TYPE: BATT$ MANUFACTURER: Cettainteed ' Thickness: R-1.3 4
" GENE CONT CTOR: CENTURY CROWELL COMMUNITITES LICENSEfe
BY TITLE:_ �rPf-j S�-Bii
PARAGON SCHMID BUILDING PRODUCTS, A MASCO COMPANY _ LICENSE # 532072,
g TITLE: ADMINISTRATIVE ASSISTANT DATE: 12/17J2002'. s
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