0108-027 (SFD)N W
C:)M
Cy Lf)W
fid' i
'O'^^Z~
W O O
LUa�
Z
LICENSED CONTRACTOR DECLARATION
Thereby 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
71 1 ka I043i 1/01
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).
O I am exempt under Section _ B&P.C. for thisl 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 work1or 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 001,I)ItH FAOLF INS, Policy No. AIDC -344068,03
(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 an`q 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: 'A; " ,' r Applicant F r f
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 costof 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 his
application.
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 applicator 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.
Signature (Owner/Agent) • I ' „j !-? Date
BUILDING PERMIT PERMIT#
TRACT
DATE VALUATION LOT TRACT
7197-d
JOB SITE -"
APN
ADDRESS
7c►-� .IVC< f�ti C`OIJWr
Sd ! 43'� i9fDtri
OWNER
CONTRACTOR/ DESIGNER/ EN INEEER
1 q �7�y /� 7�YL 1 / �/ �p p7 e� p��
C19 :l"a �VtS. 1..� �} 4•V 1:,7 �✓ VA7 d i'1�21�7?}��'S llLk�
7 ^i � {� ��1T 71 (y
Cn41111t, 1 CR 0* ^ E1.1, Le%,fldU.N IT .1•' 3
`D° MWMT, VM #200
'151:5 z3o. -I)- "'T :C+.m'0 aP., .420o
SANBF"MID190 iCA 51?A 08
,.Ai!7MMAIRI)I O CA 92,408
C,�J09)3F3i •E*4�7 ��.L� 21 ��
USE OF PERMIT
21SiIt3:C. 1b'.I? MR.,y 1C� � fT3I 1�hYCi
SYL16 PLAN 2A, LOT23 .,PERMIT DOME NOT Mt~l UDr, Ul.Di:'M
WA1.1,11:0001, SPA OR DRIVEWAY 11PPROAM 7S% PIaA,14 04fWI: FEF,
REI)1)CTION ty)R ISSUANCE OF St.ME PLAN TYPE
TRACT CONSTRUCTION l,Ri)6,gli ak
11rOkle7iiP'. il,10 sk'
0ATIACIM.A,RPORT 479,00 OF
ESMIA17.0 CORE OF C0119£RUM7 10K
0
r,:C)i4STRUC'TION 101-000418-:000 560199
PLAN ICHWK FEE 101-000-439-318 $139.06
MECHANICAL FEE 10)-000-421-000 9601 0
f£I.A' N'RIC AL PCH 101-000-420-000 V 39,90
PLUN ID910 FCC' 101.000-419-0(K() 9130.00
nXONCl do OT'IGN FRE • RESSI13 101.OW-241-000 $1.0.66
ORADINOIVK 101-(3(1ti-421. 100 00.00
i3EVE-LOPk.,1MFM $1,9U7.gt)
p1�1 C 'i�UC°FIC)10.t�!)'T,A�CF:CIJC'`!:i,Sl�'.F;7
IZZ),"i PRFPAM N1.t�:1`�
$0,00
I AUG - 3 2001 MR- M OYS P1� NOW
X10496-2
CITY OF LA UJINTA
FINAi E DEPT
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
D SPECTM RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BULDING
APPROVALS
MCt CHANR CAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
d
Ducts
_
�2-�Ds•�i/
Slab Grade
_ _
Return Air
Steel
Combustion Air
Roof Deck
(�
Exhaust Fans
O.K. to Wrap
_
4 ( �/
F.A.U.
Framing
Compressor
Insulation_..
—p !
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wail Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final L –
SL®CKWALL APPROVALS
Steel
POOLS - SPAS
Set Backs
Electric Bond
Footings
—�3 __
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUDAS0NG APPROVALS
Waste Lines ��6J ��
Gas Test
Electric Final
Heater Final
Water Piping
Af
Plumbing Final
Plumbing Top Out
_per• p�
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
j ��y _�
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final —Z
Utility Notice (Gas) _ S
ELEC71'=AL 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 y
Utility Notice (Perm) — r Z
COMMENTS:
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
79-884 Hancock. Court; Lot 23, Monticello -Heritage, La Quinta, California
CEILINGS:
TYPE: BLOW MANUFACTURER: Certainteed Thickness: R-38
WALLS:
TYPE: BATTS MANUFACTURER: Certainteed Thickness: RA3
GENERAL CONTRACTOR: CENTURY CROWELL COMMUNITITES LICENSE #
BY:: TITLE:
PARAGON SCHMID BUILDING. PRODUCTS, A MASCO COMPANY LICENSE # 632072
B, TITLE: ADMINISTRATIVE ASSISTANT DATE: 12/12/2002