0108-026 (SFD)C0
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LICENSED CONTRACTOR DECLARATION
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
7IM88 i()ft0, 11
Date `�' .s Signature of Contractor i'_;
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:
Cartier Policy No.
( 7I:�EN KACIL-9 INS, 3dWC-144068.03
(This section need not be completed if the permit valuation is for $100.00 or less).
( ) I certify that in the performanc&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 provisions.
Date: n�,. i;..,. ,�. Applicant-
Warning:
pplicant
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 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 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. f
Signature (Owner/Agent)I 'A L: 4 -1 f-' Date '
BUILDING PERMIT PERMIT#
DATE ! VALUATION LOT 01MC46 TRACT
2,2 Z41517-2
JOB SITE i
APN
ADDRESS
i .i3"C,0CT CMfef
CQb"Irl-tom
OWNER
CONTRACTOR / DESIGNER / EN INEER
1535 50, 83J° c7'.I.'RW.i.`, UTE, 4200
1555 80.0DO JERKUT, s7Tu, 020
SA1d`F3F"ARDWO CA 92408
WMtNARD NO CA '924138
MW 2120
USE OF PERMIT
MOLE hd4'Wl; Y 3:+V4 1 �1NO
SFEI-1'YjN14 XEIRm, L OT22 . PERAUT i O&S NrYT INC1,UT?I, 51[1}CK;
WALLS'i1*(XIII, BRA OK nR.lVWAY APPROAC H -M, % PLAO O CHt o,K 110e,
RKOUC'i 100 FOR IS211.A14 C E OF SAM PIAN 'TYPE
TRACT C'ONSTRUC:T1014 8,800.00 SP
Pt/fi`.LI•I.MATIO 49.00 B
CIARAG1?#CARP(AT 4201,110 SP
ES'i.?M&I" (77(3 67 OF
IM623. 711
PRR1 Ilr M WMHARY
C:O STft,UCT'ION M,?,� 101-000-419-000 3664,00
PL.At4 CHECK FXF 101_000_4139_M S I-It&06
HKIIA MICA,
If'1:F4 TRIC`�.AL Hr1yl a b i-OUiI 42C)-pEIf1 $1 I9so
PiAI ISI? D10 FRIF S 03011
EITfJONOl MOTION PZJ - REZID 103-000-241.000, 00-`!1'11.007. $10.06
OR AP)HO I &F. 101 4*0-423.000 $20,110
I&t+Tl941PER IMPArT ImoK
k',-'EC7�r .C 1 $. s7t":'I�rt}r.1 P11gD PLANt"EMIX
`�3,I 9.62-
LAUG- 3 2001 I FXIM PM -PAW) FF_Z
$0100
"1 M, X4do_C), FMS MAE NOW
CITY' i]F Cr 6UNTA
FMAKE DEPT
RECEIPT
DATE
BY'
DATE FINALED
INSPECTOR
I� SPECTIJN RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
SWLUNG APPROVALS
M ECHANiCALL APPROVALS
Set Backs
�l
Underground Ducts
Forms & Footings
Ducts
—990 -..V?
Slab Grade
_ _�
1
Return Air
Steel
Combustion Air
Roof Deck
1�'J
Exhaust Fans
O.K. to Wrap
_� _
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T:O.
Fans & Controls
Party Wall insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Find
= — 2
[COOLS e SPAS
SLOCKWALLfL APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
— 3 O_,—
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg, Test
Final
Gas Piping
PLUMB
NG APPROVALS
Gas Test
Electric Final
Waste Lines
$j _� ld l G.
Heater Final
Water Piping
!
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
— ? p�
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Z_
Utility Notice (Gas)
.. 2ur—
ELEC =AL APPROVALS
Temp. Power Pale
Underground Conduit
84
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)
This is to certify that insulstion has been Installed in conformance .with the, current energy
regulation, California Administrative Coda, Title 24, $toteid California, in the building located 'st:,
794M Hancock Court, Lot 22, Monticello -Heritage, La i lulnts, Caiifcmia
CEILINGS'
TYPE: BLOW MANUFACTURER:'CERTAINTEED THICKNESS: R-38
WALLS
TYPE: BATTS MANUFACTURER: CERTAINTEED THICKNESS: R-13
GENERAL CONT CTOR, CENTURY CROWELL COMMUNITIES LICENSE.,#: 71,
BY; TITLE: eo-g sy 7�Cv
PARAGON SCHMID BUILDING PRODUCTS, A'MASCO COMPANY LICENSE 9 632072
BY:: TITLE: ADMINISTRATIVE ASSISTANT DATE: 12/12/2002