0112-059 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter 91(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
40914 AB RIC 3,011)3
Date t " 1 ,rst: Signature of Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that ! 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:
4 () I have and will maintain a certificate of consent to self -insure for workers'
` cornpensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
;(4 1'1 ave 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, tI shall fortthwith comply with those pyo sl n,,ss. / c��
Date: r ¢ Applicant - = � •.
`4
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 'Ms,;.
application. f'
1. Each person upon whose behalf this application is made & each person a
whose.(equest'and for whose benefit work is performed under or pursuant G
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 voidVif
work is not commenced within 180 days from date of issuance of sPrt✓ch
permit, or cessatio,n_of work for 180 days will subject permit to cancella"r'n
I certify that l have read thi's application and state that the above informatiofi fts
correct. 1 agree. to.complywith all City; and State laws relating to the bulldl g
construction, and hereby authorize representaWes of this City to ente upon
'the above-mentioned property for inspecti n purposes. r.
Si nature (Owner/A ent) Dater
BUILDING PERMIT - PERMT#
DATE VALUATION LOT' TRACT
2 8 19 Wk
JOB SITE _
APN
ADDRESS.
'5591
7�i9� i� .
OWNER
CONTRACTOR / DESIGNER / EN (NEER N
C°t+%7a0M 110140� n 11M1LA :`i EWIM, DIM
U4 4 G`�i lCI=110,l
2'280 "WAMW CM ;',' WM RSO
2280 WARD POW C HIC':LE; X1::150
ICIIORCAA CA 141720
COR010, !CA 91720
(909)X79-4000 4"`1'UA 5761
USE OF PERMIT
•- ..
f-,f?f�«+1��4:f1py:`;i+l�µ,•y?,'�'+�,i1��7yC1i�Y� ♦y�. y C4,yr y y 7,�g p�,wYy dap 1
J/�,d,AttJ1yf Ippc2�e0dh�ln'�,i+�vy44C.I✓" FSl/ASt�n9LA++eI�..�{rcf,.fyJ�.i,�91.Ae.fp�+9a.R,+Stlfvi,'],LS.
[SK) *, d1P`'yayr1lC�G�I/+i5lt�tlini/iOE,,pS',NC
,L'O0U."PA OR DDR 9' �Tr�7N%S x�t'J!"a�`Jd'&CH, 7.5% RbL.L�1.�Ss�i IOYI ,1 O .rli�R W CHECK.
k'EE X40R A>!;!( U.V1PLR J88i9A' CE, Ore SAME :PUA0 TYP
C. 3F
CONSTRUCTION %142,RATIO
IiryF��'�l�r`A�M
�4s!A�
sle
1131 iAOEICARP(Xtr 688,00 8F
i
Rgs6,MKI�.n7#' CvObrlPtl�'� 141 �:'j NSKR C-170
a�64,2-94S.0
;PqP-}
All./"d[.iR I
(.°o)4sP'1"1t'C9iu"Y'i,cm 101-000-418-000 00.418.000 - S1,2110
PLAN CKW* F22 1011-000-439-318 $?A 9. 19.4
MECTTdA1'd.ICAL'FFF, 1 �x�JGn•421=i1s10 $ ,Sf9
F%Fi.CTIUCA1, F10, 1i?1. C(1i i' 3- tad? $178,73
Ta.UM BINIO tom: 101-000-419-000 $1991,73
S"TRONCI MOTION TYRT,' . RR: ID 101-000-241--000 $26.43
o0RA;i t k10.f T"a 10110C 0.423.000 $20190
YNFR.11,3TAUCTURE OME, ' -225-000-44.4 -342 S1,9(4110
APT IN P6!BIk, PLAW - USK 270-0013445-000 S16t�,'73
f 6s i. •^�
"
0.011M#C ION AND P'LAN CIMCK
$4,047,41
1 U 14 1a'.L RF k3
er
YDATEny
`AECEIPTit=+ IiiiE
f .i"", '
BY';/
F L
INSP OR
i
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs_
Forms & Footings
1,
Underground Ducts
Ducts
Slab Grade
-/tel es
Return Air
Steel
�dd
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
S .r{
F.A.U.
Framing
_ _
�-� - ��� _
Compressor
Insulation
�� lfj
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
_
(fir/—�b!L •�
Drywall -1W Lath
_
Final
Final
i/�
POOLS -SPAS
BLOCKWALL APPROVAL'
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
Waste Lines
��_y
Electric Final
Heater Final
Water Piping
_(jsj1%
Plumbing Final
Plumbing Top Out
-
I
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
_
��5�
Pool Cover
Encapsulation
1�d
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
' � 3/i9/off
�/�G �ja�oa✓
Final
/
Utility Notice (Gas)
ELECTRICAL APPROVALS ,
Temp. Power Pole
Underground Conduit
Rough Wiring✓�
,_
Low Nottage Wiring
_,
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F].
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
KI
i
CITY OF LA OUINTA
Fy O
BUILDING 8 SAFETY -DEPARTMENT
777-7012
INSPECTION REQUEST LINE,
-'777-7153
owns, CENTEX HOMES
VOIltrwtOf M
• t.
Permit Number 0112-0_`•9
POST ON J08 IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
J08 ADDRESS[ SG -259 WINGED FOOT
—,
SFU - LOT I PLAN 4CL- PERMIT DOES NOT
LNCLUDE •BLOCK WALLS, POOL, SPA, OR
DRIVEWAY APPROAC:
TYPE OF INSPECTION DA INSP.
FOUNDATION d SETBACK
FOOTING STEEL
MAIN GROUND SYSTEM
GROUND PLUMBING
PRE-GUNITE
DO NOT POUR CONCRETE UNTL ALL ABOVE HAS 9 N SIGNED .
CONCRETE SLAB
JOISTS 8 GIRDERS
ELXQTRCAL GROUND WORK
DO NOT PO R NCRETE UNTfL L ABOVE HAS BEEN SIGNS
ROUGH ELECTRIC
ROUGH PLUMBI - +
ROUGH GAS T T'7 / 0"
HEATING 8 VE -
FIREPLACE
ROOF
BOND BEAM
O.K. TO WRAP
3WU-To 4' O 8'
DaYWAIL INTERIOR
EXTERIOR LATH
POOL PRE PLASTER.
POOL FENCE & GATE
$EWER
FI 4ALB
ELECTRICAL
> PLUMBING
FINAL GAS TEST
HEATING - A/C .
HOUSE NUMBERS '
JOB COM PLETED_
TEMP POWER
wwwonaVACS 170 NODE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING
t Z0 39dd 1S3M dJd X31N39 .6098b9S09L. 8T:90 Z00Z/99/60
..Certificate
o_f Occupanc_ T F
_.
:=City- of La,.,Quinta.-..
Buildingand --SaMty'De artment pro>i
This Certificate issued pursuant to the requirements of Section 109 of the' Uniform Building Code,
certifying that, at the time of issuance, this structure was in compliance with the various ordinances
of the City regulating building construction or, use. For the following: .
BUILDING ADDRESS: 56-259 WINGED FOOT
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0112-059
t Occupancy Group: 'R-3 Type of Construction: VN - Land Use Zone: RL -
Owner of Building: CENTEX-HOMESAddress:. 2280 WARDLOW CIR STE 150
F
City: CORONA, CA.', 91720
By`. DANIEL P. CRAWFORD JR.
Date: 9/6/02.
s Building Official
POST IN A CONSPICUOUS PLACE _..
. �ccup
oO
�Cedifcatof ancy-
City oFLa_,,',Q,utnta -
Building and Safety Department
This Certificate issued pursuant to the requirements of Section 109 of,the Uniform Building Coale,
certifying that,' at the time of issuance, this structure was :in comp/lance with the various ordinances,
of the City regulating building construction or use. For the following:
BUILDING ADDRESS: ,56-259 WINGED FOOT
Use Classification: SINGLE FAMILY DWELLINGBldg. Permit No. 0112-059
Occupancy Group: . R-3 Type of Construction: VN Land Use Zone: RL
Owner of 'Building: CENTEX HOMES Address: 2280 WARDLOW CIA STE 150
City: CORONA, CA., 91720
By;. ,DANIEL P. CRAWFORD JR.
Date. .:9/6/02 - • r
Building Official .
*. POST IN A CONSPICUOUS PLACE 1
}