0108-022 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby`9ffirm under penalty of perjury that I am licensed under provisions of
`6apter 8I(commencing with Section 7000) of Division 3 of the Business and,
Professionals Code, and my License is in full force and effect.
License # Lia Class . Exp: Date
374 f ��� 1;� •.,,,��-'�i �' fi� � `� �'. � �}l'x3' � I�i �.
Date = °� 01 Signature of Contractor'c
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).
( ;) 1, 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 I 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,provislons.-"Y
Date r::.J i_. Applicant
Warning: Failure to. secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
ofthe Labor Code, interest and attorney's fees.
IMPORTANT. Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Eachperson:upon whose behalf this application is made & each person at
whose request. and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
-& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit'issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation.of work for 180 days will subject permit to cancellation.
I certify that. I. have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned. property for inspection purposes.
r/1
Signature (Owner/Agent) + ` ' xy. Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT yp
TRACT
JOB SITE '"
APN
ADDRESS
79L-"4 WHAJAMSTONE WAY
OWNER'
CONTRACTOR / DESIGNER / EN (NEER
MIMUD-11 MOWELL comiyugrim
C,RIMIRY CkOWEU. CCa �ih t34v' k C d,
1$ 3*0.
353.5 t vDa MiSX 5 M. AZOO
T"AW'3��t"t2M, M0 CA 92408
SAN BEi NARTYWO
CA 91408
(909)381-60971
y
C '2120
USE OF PERMIT
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SM Pl.AN' "rt IUv, l OTAR• PVMMIT DOES NOT TINK1 UDY BLDCK
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MI�4�:7i COST M {NSTRxCMON
132191 20
S #3W5nyMA#_ArG
C(DMO'1 RUCTION FV, i, E91-oo o -4't e-000 PRIM
VIAN N CfdSs+a: K FENS. 101.1000439-3.1.73 $160.11
MINIM", MaLl k= 101-000-4-21-000 $0.00
MAXTRWAI L MY, 101-000-410-000 $13V53
P1.1:1°MB.tWO RM 101.000-419.000 $124,00
57110:t,9O O° JOH Mit, , k UJO 101-000-2 S;t -000 $13,29
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trllit,>,DI"0 0IMP, 1,01.-000.473.000 $20.00
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AUG - 3 2001:x. ' '.On_Wrra elm €pow
Cir/ OF LA OUIMI'A
EINIAKE DEP-l'
RECEIPT
DATE
BY!(, 'i
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings
Slab Grade
_ _ _
p%�7.�
S Dl
/
Underground Ducts
Ducts
Return Air
Steel
Roof Deck
O.K. to Wrap
Framing
Insulation
/� /j�/ s _ —
Y �a`/
/ ��
���
Combustion Air
Exhaust Fans
F.A.U.
Compressor
Vents
— —
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wali Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
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
Water Piping
�Q -7
�/�� /��
Heater Final
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_/�
Appliances
Final
COMMENTS:
310
0/1— 2 'A'
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 3� —�
Utility Notice (Perm) —S'— Z S
r. nne wslA•� S'A(N'A'/i'N^s/i.'Nir.iY.w:NM'w[wA.rups�r»"Mir.vr�rMw.vJ wHMVWM:viuW.Mi•'iva�•r.'ivn!Nir�v L'YIW.r.M.l'N:6t'N:Yi:.di)'MJYf."?'Y%�"VI!L'✓//FVN/s .l
. INSULATION CERTIFICATE
This is to certify that insulation has been installed in conformance with the current on argy
regulation, California Administrativs Code, Title 24, State of California, in the building located at:
I
f -19.934 William Stone Way, Lot 18, Monticello -heritage, La Quints, California
f CEILINGS;
TYPE: BLOW MANUFACTURER: CERTAINTEED THICKNESS: R-38 j
HALL'S: '
TYPE: BATTS MANUFACTURER: CERTAINTEED THICKNESS: W13
GSN CONT CTOR: CENTURY CROWELL CQMNIUNITIES LICENSE #
l;
BY: TITLE: SvAQQi,
PARAGON SCHMID BUILDING PRODUCTS, A MASCO COMPANY LICENSE # 632•)72
S TITLE: ADMINISTRATIVE ASSISTANT DATE: 12/12/2002
l=.nta iinerrntrew�r.u."vn�r�larw. r....wu'_'"`.�,y"Mr..r. .r.. �•.rnrr•_.�..�.�..�.�.�"�r�r�._.�.�.....�.�..."�.�.�".....". �. �. �.... _. _... _._..Y _._._ ._. _. ___. _. _. _.__-. �__.-. . ... ...... . .. _. .