0108-025 (SFD)H
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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
�J lr .l tsl f10.131/01
Date t '' I Signature of Contractor
PI'i'1►I_� �Zili-��TI��>!_1eT_�fT[ol�l
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).
O 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:
O I have -and will maintain a certificateof 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.
O 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. M_ y workers' compensation insurance carrier & policy no. are:
Carrier Policy No. ,
. 001/$32,04 EACL9 NwC-s"063.03
(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 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 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.
Signature (Owner/Agent)' f�' Date
BUILDING PERMIT PERMIT JI
DATE VALUATION LOT 0108-M TRACT
`
I 11,06,62-3.W 1211 24197-2
JOB SITE i -- -
APN
ADDRESS
W-91.7 >< ANC'OC-K C'010rr
60q-d;172•-w(i
OWNER
CONTRACTOR / DESIGNER / EN (NEER
r E*h�a'E((Y�y.T�rylyi y C'RC)t�s"11: L (�:yC�);. ,yap'€gIy3�ITYA
C'�h�"1;zy.;'�r4z�tyCYZ0�4j'��.�J.y:.1:,�CPc•:�aM�iapArr�tltdliW
J 535 q7 Q. ODD LI RUKT, U.I.C.`r. 02,0,r0
3 5. i Do. "Ir arpshr, rrm? 'Yl200
$ A14 WARDINCa C,�,AL 92408
ISAU 13M1+lAT<°Y'INO C'A 97A08
(90$)381,.6001 fIBLIO 21 AO
USE OF PERMIT
- n`•?wau 17"M At 3� I RT�#]�➢'O
NFU-, PIAN 2C)Y^ LOT 21- PMAMIT DOES HOT INCLUDE B1.OL;K
*WAIAVf'' XX,a SPA OR UXN t WA`1 APPPOACH 7514 PLIA W CHFOK PEP
itL&d. UC`I'ION PPI R. ISSUANC3lr OV SAME PLAN TYPE
TRACT CtyN;''s RUC;'TION
PORC;i• IPATIO 49.00 Sit
t A.#1.a�CI#?+'C>ARF'Olt`Y' 420,00 t
Tr:MUAJf' D COST OF i,C?N.SIMUCIMON
1Clts,�:I�.,3d1
I?•�C�� 3�i`� �iJlil�Y
101-000-118-M) 56600
P1,M1 CHWX "t € 01 18 $1138.06
MECHANICAL FRk? 101-000.421.000 160,00
ii"d.i%.C;7`1dICA1.Y EE 101-WO.420.000 $119.90
ptlukilfo flr9 FRE 101.000.419-000 51311104
STRONQ Ia QTID*N FE - RESI D 101 -000 -1411 -ft) $,10.0
O3tAD HO FFX 1,01-000-42:1.WO 520,00
VY1V]i?'bD11Z IMPACT UP, $1,"7.00
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tly; MD KAN C°:.fT410,�,.
LYS0 PRY -PAID M0
' AUG - -3 2001 6
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Flt<A'KE DFPr
RECEIPT
DATE
BY ;':
DATE FINALED
INSPECTOR
tttrg�
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
S UL®INO
APPROVALS
MECHAMCAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Aa
Slab Grade
f
Return Air
_
Steel
_
Combustion Air
Roof.Deck
Q
Exhaust Fans
_
O.K. to Wrap
F.A.U.
Framing
_ �J
Compressor
Insulation
f{ . y-- y
Vents
Fireplace P.L.
Grills
Fireplace, T.O.
Fans & Controls
Party Wall Insulation
Condensate -Lines
Party Wall Firewall
Exterior Lath
_
Drywall - Int. Lath
Final
Final
=
POOLS - SPAS
SLOCGZWAL
L APPROVALS
steel
Set Backs
Electric Bond
Footings
Bond Beam
2 . 13 -oZ X45
Main Drain
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLaDMBNG APPROVALS
Gas Test
Electric Final
Waste Lines
Water Piping
� �
_
Heater Final
Plumbing Final
Plumbing Top Out
Shower Pans
_��3�Q�
Equipment Enclosure
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final _ 2
Utility Notice (Gas)
EL ECTMCAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low. Voftage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Al
Final
Utility Notice (Perm)
j0/17/2013 01;03 FAX
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INSULATION CERTIFICATE
This is to certify that insulation has been installed in _conformance with the current energy
regulation, Calffomla Administrative Code. Tile.24, state of California, in the building located et;.
79.917 Hancock;Court, Lot,21, Monticello -Heritage, La;pinta, California
E E
TYPW MANUFACTURER: CerWnteed� Thickness: R-38
TY TTS MANUFACTURER; Certainteed Thickness: 003
GENE CO RACTOR CENTURY CROWELL COMMUNITITES LICENSE'# 7/,
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BY,
IM 012/019
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PARAGON SCHMID BUILDING PRODUCTS; A MASCO COMPANY LICENSE 0 832072
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TITLE: ADMINISTRATIVE ASSISTANT DATE: 121,1212002