0108-029 (SFD)fV W
O :3 M
r W
oZ�
O O
tD
ti
W LU
(L
Z
LICENSED CONTRACTOR DECLARATION
I hereby„affirm under penalty of perjury that I am licensed under provisions of
Ghapterl (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
7,1;188 FI, 1 f7�:3 I A) I
Date;-' i Signature of Contractor f 1 '
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).
() 1 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:
O 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:
Carver 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 provisions.
Date: 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
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 workis performed under or pursuant to
any permit issued as a result of this applicaton agrees toi & 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 notcommenced 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) til`r' = ,: _.i !f
. Date,
BUILDING PERMIT. PERMIT”
DATE VALUATION LOT 01WO79 TRACT
} fit C 1 2 24197.2
JOB SITE f _
APN
ADDRESS
79-91.2 HANL'cJCK COTM
&M-072-006
OWNER
CONTRACTOR/DESIGNER/ENGINEER
CFMIURY CR£JWIe,'[ L C:'r-Jlld3b MQT.IIY0
C"..'E:l+fUR Y (M OV+tO-L C (,AV1 f 1NrrJFS
155 5150. 0. "1)MM ;T K #200
153.-,30. -V STREOF, 'aTd'F flzoo
3A1',i.13'FA14A,FiDA40 C"A 92,408
Sr4N'B�t'�&i:Ai^FDINO C% ' 242
(900) S81- 5007 Milt 2111
USE OF PERMIT
atixJ'CFI"R flAbal ' T!WLx1 '.LMG
SFI)- N A14 4A, LO'T25 , PERMIT DOMNOT INOLU'DR, BLOC:
WA,LLiE/P00 ., 91",A OR DRIVEWAYAPPROACH 75% Pli Ck31XK FEE
I21rL)UC'PICM FOR IiSS U A14 r. OF SAME PLAN TYPE
14AII'T C(1a'lirtRUC"TION 1,6".00 $F
IPC➢F1MPATIO 6:3.60 Sig
6ARAMC.Pt'f2iP+AtT 60A.00 $F
N'SI ►i"'flllA,1'1+B OoUr OF C''Cp! SMUC.'770N
1$6,. sor)
'1•'1amu1f°f.ru, gummilkRy
CC3HXr?..UC 1aP1 FEE 101.000-418.000 aM11,00
PUM CHFZK kvF- 104.1-000-439-318 $16 .361
M•ECHAiPi11CAL FEE 1014A),-4211-000 S6630
r1,W,t`.7RJ(!AL FEE, 101 -OW -420-000 $144.68
P1:U! -01INGFEE 101-WO-419-OOID 2142i00
STYtUNQ MOTION FW? - RESID 101-000-241-000 $14.30
0P:AT).040 F9F.. 101 -000 -4 -23 -OW $20,00
OBVE1,C))'].'R.1MPAC'T FE 81y(Yl,4tit
AN1.) P1.. W G`1RCK.
$3r x.66
1=4 PRE-PiM 7109
$0,t3it
AUG - 3 2001 ' FEES Dur, Now
&3,249.66
CITY OF I.A GUINTA
( NANICE DEPT
RECEIPT
DATE
BY , ` �'
DATE.FINALED
INSPECTOR
i
LSPECTIU�•� RE��RD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
B4. LDONO
APPROVALS
MECHANICAL APPROVALS
Set BacksUnderground
Ducts
Forms & Footings
Ducts
4 We
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
/-p/
Compressor
Insulation
;R -/2-4P/
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath,.
D/
Dr#vall - Int. Lath
Final
Final
3- Z
- -
P®®LS e SPAS
HLOCKWALL
APPROVALS
Steel
Set Backs
Electric Bond
Footings
_
� �'
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLURfdWNG APPROVALS
Gas Test
Electric Final
Waste Lin esG/
U-� C
Heater Final
Water Piping
jr
(
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connections
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Nctice (Gas)�B
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
-
Utility Notice (Perm)
2
10/17/2013 01:04 FAX
i.reVrir=iw�rsWrrNYi^»YnicvMflYJIIpY.MntM1.a�is�v/.YJWIrr �t/N./Yfi!/NAf/!.V//'f7tl.LVIAR(N'lr�M'N�NYY////IYSY//.Y///.I/F7A19WitI�/NiUYnv.N vM+�9�/Y/YAI
INSULATION QRTIFICATE
This is to ceitify'that:Insulatlon has,,beeatnstalled in conformance y4th'the current energy
K
regulation, California Adminietretiva Code. Title 24, State of Cal brnia, in the building located at
79-592 Hancock Court. Lot 28, Monticallo44oritage, La Quints, California
CEILINGS:
TYPE: BLOW MANUFACTURER Cert inteed Thickness: R-38
WAS:
K TYPE: BATTS MANUFACTURER: Certainteed Thickness: RAS
U
GENERALCONTR&CTOk CENTURY CROWELL,COMMUNITITE8 LICENSE # 7/!V"-/ K
TITLE:
d.40, SC0ce
s
PARAGON SCHMID BUILDING PRODUCTS,,A MASCO COMPANY LICENSE #182072
TITLE:.ADMINISTRATIVE.ASSISTANT DATE. 1V.12/2002