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0108-030 (SFD)CO N LU Osco W dZl� 0' 0 LO ti ~a 0) Z LICENSED CONTRACTOR DECLARATION I herby 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 ?'141 jt� �'1 .`} .• 1 E'i/;11 df3l Date y" Signature of Contractor ? -' ` OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that,1 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 8. 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 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 forwhich this permit is issued. (} I have and will maintain workers' compensation insurance, as required .by Section3700 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. C9OLi�11: EA01.9 INS. l+ W11-544IM-a:3' (This section need not be completed. if the permit valuation is for $100.00 or less). O, 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_. , Dater Applicant ti _ i Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employerto 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, indemnity & 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) 4- t i I { Date BUILDING PERMIT PERMIT# DATE i VALUATION LOT MCC -Wo TRACT r 26 24197-2 JOB SITE I APN ADDRESS 7a,.!�-0 �'a�hi�`i)C'IL c'('auali�,i ff�a~•i•�`%�,•o�%Cj OWNER CONTRACTOR/DESIGNER/EN INEER CINTURY G'ROWEU'.. L'CS1+fiA LYNIfffa (ISIN11MY CROWE,III CrJ1►lCmisbal'S 1535 ;i2Q T" O'TMrI SM, 02cru 1535 M. 4V t -I MFET, Me #200 SA14Mi:l�".�•+lLDINO CA 92408 W18kRNARDINO CA 9MO8 (909)981-6007 CB1;0 ZA20 USE OF PERMIT IGU SM PLAN 2Ij1,1.4IT26 - PrUtMIT LOi.9140T R4CL UL)t! BIDICK W.AJU..W0M,'SPA OR D14MMAlt' APPROACHW% PLAN CHROK FEE REDILICTION FOR ISSUAHCli OF SAME PIAN TYPK TRACT CONSTRUCTION I'M1,013 S1+ POL2OHIPATi IO ' 40.08 Sid 0ARA+( EWAitPOR'8 420.00 OF ESTIMATM ICO:FC OT+' ("O'NarlRucnoft 106,62330 FER.W1<FEW, b"'(F.i ufI.A1: Y C'ONS RI.1 11013 = 1 03 - 0DO- 418.ON WIN P11d+N C;HYXX VVY, 101.••000439-318 $132.06 MMINN ICAL "B 101.000421-000 860.00 IIL;':t"T IC:AL FEE 1,01-00 0-420-000 $119.90 Pia.'ft�P+�l�3I ii 101.000.419-000 $130,00 S"1'h.OM 1, EY ICN PRE - RES'ID 101 -000.241 -OI i) $10.66 (1R1111IG5 PEE 101.0)00.423-M0 $20.00 1)AVI: 0ftvR IIMPAC 7 iii• Lit -M-09 AND P'i,AN +L.'PIEM I $:3,Eld3t, fii' I r< 1Y..3b1 PRE -PAID FM �Cy. CiO q U G — 3 2001 1t :jlT T? ns DUE NOW CITY OF LA.Qli!NTA FINAPl E DEK RECEIPT DATE BY' DATE FINALED INSPECTOR INSPEMAN 101 N EGOO R© OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR l ULCING APPROVALS MECHAMCAL APPROVALS Set Backs_ Underground Ducts _ Forms & Footings Ducts _ Slab Grade _ Return Air Steel_ Combustion Air Roof Deck Exhaust.Fans O.K. to Wrap -C F.A.U. Framing —p/ Compressor Insulation= f 7 -p ) 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 BLOCKWALL APPROVALS Steel Set Backs Electric Bond Footings / B _ Main Drain Bond Beam Approval to Cover Equipment Location. Underground Electric Underground Plbg. Test Final 7 -/��� Gas Piping PL UMONG APPROVALSGas Test Electric Final Waste Lines�_ Heater Final Water Piping Plumbing Final Plumbing Top Out ®_ Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection _ _ �� Encapsulation Gas Piping Gas Test Appliances Final COMMENTS: Final Utility Notice (Gas) ELECTMCAL 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) - pG INSULEJON CERTIFICATE. Th Is is to cattily that insulation has been installed In conformance withthe current energy regulation, Caiffornia AdminlstretWe Code, T11111e.24, state of California, in the building located at: 79.928:Hanoock Court, Lot'28, Mooticeilo•Heritage, La Quintin, California CEILINGS: TYPE: BLOW MANUFACTURER: CERTAINTEED THICKNESS: R•38 WA"TYPE:BATTS MANUFACTURER: CERTAINTEED THICKNESS: R-13 GENERAL -CONTRACTOR: CENTURY CROWELL COMMUNITIES LICENSE # 7l BY, TITLE: &4t0 _i2A PARAGON SCHMID BUILDING?PRODUCTS; XMASCO COMPANY LICE.NSE,# 632472 BY TITLE: ADMINISTRATIVE ASSISTANT DATE: 12112/2002