0101-336 (SFD)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 # L•ic. Class Exp. Date
Date of •• '_ Signature of Contractgr.,
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 R P(nfpssinnals Cod@).
(') I, as owner of the property, am exclusively contracting with licensed
contractors to construct the Ipioject (Sec. 7044, Business & Professionals
Code).
( ) I am exempt under Section_. , B&P.C. for this reason
Date Sionature of Owner
" U Q WORKER'S COMPENSATION DECLARATION
CL —
p Z
i2 I hereby affirm -under penalty;of perjury one of the following declarations:
Lo <O () 1 have and will rhaintaini a certificate of consent to self -insure for workers'
X W compensation, as provided.. fo`r by Section 3700 of the Labor Code, for the
Om -.Q performance of --the work for -which this permit is issued.
Q U (r)"'I have and will maintain workers' compensation insurance, as required by
O u Q Section 3700 of the Labor Code, for the performance of the work for which this
d rn H permit.is issued. My workers' compensation insurance carrier & policy no. are:
" Z Carrier Policy No.
(30LDEN XA0.1.,R WAC 14701401,
J
(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,
]'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.
, cam' t
- Date. �� Applicant -'-C rf••-
Warning: Failure to secure Workers' Compensation coverage isunlawful 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.l
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' P
any permit issued as a result of this applicaton agrees to, & shall, indemnify
&hold harmless the City of La Quinta, its officers, agents and ,empd del
2. Any permit issued as a result of this application becomes Wulf a10 Ai 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)` """"°" Date Mr02
a �
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 01iD -&' TRACT
139 -1
JOB SITE
APN
ADDRESS
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OWNER
CgOyNT+�R}AC`T+lOR//y3DESIGNER/ EN
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W.A,J iP00JUSPA. OR <APPROACH 13RIVEWA'9,''35% nLJ%N CHECK tips;
REMftw' IUN FO.R ZJd"lltA'Ily3. Z 1331JANC E OF S.A..UZ P .61 1 171%
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T -IM i`.Mr SUMMARY
C"tJNS!'R:JG"1 ON FRE 103-000-418-000 9954.50
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APLAH
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101-000-419,000 $111,7400
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LAU
W'ALPXRWrFEZ8'0UF. NOWti
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs _
Forms & Footings �
Slab Grade
Steel
Underground Ducts
Ducts
Return Air
Combustion Air
Roof Deck
O.K. to Wrap_
_ _
_��
Exhaust Fans
F.A.U.
Framing
Insulation
Fireplace P.L.
_� ��y
i
Compressor
Vents
Grills
Fireplace T.O.
Fans & Controls
Party Wail Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
�- µ AtaAN-w-,
Final
BLOCKWALL APPROVALS
Final
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final I
I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Z,-(� C�
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Sewer Connection
S /
`�� G
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
"•
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures �_ / SWE
Main Service9 6�
Sub Panels
Exterior Receptacles
G. F.I. _
Smoke Detectors
Temp. Use of Power
Fina
U..11rty Notice (Perm)
SEP -17-2001 10:52 WESTERN INSULATION. 909 688 8786 P.17.,16 .
ESTE INSi)'LA�'ION, L.Pe H `
4211 Lath= Street, Riverside, Califon -da 92501 }
Tel. (909) 686-8760 Fax (909) 686-8786 -
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:
TRACT`/ PHASE: SANTIAGO @ LA QUINTA DEL ORO #23971-1/P"SE•1 .
LOT #: 39
SITE ADDRESS: 44-265 VIA CORONADO, LA QUINTA, CA -
-- -- ----- ,.-----------_ -
EXTERIOR WALL-, -•
MANUFACTURER: JOHNS MANVILLE 'THICKNESS: 35/8" R -VALUE: R-13
k CEILINGS: BATTS :BLOWNIBERGL—A5'Sl
MANUFACTURER: JOHNS MANVILLE THICKNESS:, 16 1i4 " F -VALUE: R-38
ICINGS: BATTS BLOW
MANUFACTURER: JOHNS MANVILLE THICKNESS: 13 " F -VALUE: 8-38
GENERAL CONTRACTOR: CENTURY AMERICAN DEVELOPMENt CORP.
BY:
TITLE:
DATE:
- INSULATION CONTRACTOR: WESTERN INSULATION', L.P.
LICENSE NUMBER: 794484
BY: -- r
TITLE: PRO TION MANAGER
DATE S EMBER 17, 2001 ; '
Certificate of Occupancy �&
CIit of La QU'in'ta
Building and Safety Department �fi�oFTti°
This Certificate issued pursuant to the requirements of Section 109 of the Uniform Building Code,
certifying that, at the time of issuance, this structure was in compliance with the various .ordinances
of the City regulating building construction or use. For the following:
K
BUILDING ADDRESS: 44-265 VIA CORONADO
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0;101-336
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL
Owner of Building: CENTURY AMERICAN DEV. CORP Address: 557487 SOUTHERN HILLS
City: LA QUINTA, CA., 92253
&By: DANIEL P. CRAWORD JR.
Date: 9/20/01
Building Official
POST IN A CONSPICUOUS PLACE
.rim ` • • -