0101-337 (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 # Lic. Class Exp. Date
478689 11 MAIM(
Date °—�t"�;r Signature of Contractor"°'"t��'^"'"
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:
Carrier � Policy No. @gee Ypy�y Af((!p
�.f{�Y.JSJI:+I(! J;D1B+`i1.I.PV � Y ��CF d'Nt/V �"G47•
(This section need not be completed if the permit valuation is for $100.00 or less).
- () I certify that in the perforrriance`of the work for which this permit is issued,
-1 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 tlfo�se provisions.
Date: I "*,r. • csf Applicant
If
Warning: Failure to secure Workers' Compensation coverage sunlawful and
shall subject an employer to criminal penalties and civil fines up(to'$10eobo, in
addition to the cost of compensation, damages as provided form'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,E
application. J.
1. Each person upon whose behalf this application is made & each pegs
plat
whose request and for whose benefit work is performed under or purslMnJ toy k
any permit issued as a result of this applicaton agreesJo, & 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 Arid=void if
work is not commenced within 180 days from date of Issuance oi, 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) Datei 11- a
BUILDING PERMIT PERMIT #
DATE VALUATION LOT 010.1• - TRACT
JOB SITE
APN
ADDRESS
OWNER
CONTRACTOR/DESIGNER/ENGINEER
LA �)UWA Ck x2.253
LA,QL1:1NTA C°A. 92251.1
(760)5U M12. MIX 5407
: _
USE OF PERMIT
SM. - LOT 40 PLA -14 V, - PiLB;MX OS NOT iM1..f DE k11. CK
WALLIP001 PA OR A3'1'Fa.C'tAM DRI EWA'`C ISIA PLAN CHECK MIF.
it'��36f�T4fr?� I�3i� '�91R1f<.T3PL,tt F`s�uEsx�YdCO: C?I� �uA�ttt� 1pt•��7d '!"Y. P.i? .
TRACT CONSTRUCTION74x.59,00 1
PORCHIPA,' 10 SF
OARAOFUCARPORT @F)
�`.�.i I C011M 0.10 CONIMUMOY4
e d °e.9 Qtr
P.726ffffr M I lM.ES NY
f ON0,TRUCTIO)II 3dA�Ci�O S«LSIttUU SS6;'I.,<..t'
GHC.r.ME 101-302-A39-•31€
.PLAN
21-000 @iiSCt3.O}f�
MECHANICAL FRE .01-//00«4i7Sey V_
,
MEC'8'1,'3CAL ME, 301_000-412011000 X143.0
PLUMONG 101-000-419-000
S's'.RON1 a Mt3 «•1OX RESID 101-000-241-000 $16.317
C¢E{ADIINOFrig ;: 01.000-423.000 $20.00
a���'�i.f�#?ak�, 5��►4:��`�'Zn�?.t? �ay�+a�7.Gii
'
'A
l•�. } ;fP J', AL (':z7M�'1'1 UC:"h•Cr:✓<`f AN9'3••����?���:qq,�Lyyl+y�fGeL'��`1
$3,199y8�.26
y���:d�'�r�: {{� '�yy
,6eR.G�R7 $RG'-PAIl.�.C'�d:1S
$0.010
,.
TOM ?MgpY KP_'15 ME. AlY
s
$3,391_ ci
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i;
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
'J�'?J, _
Underground Ducts
Forms & Footings
��_
Ducts
Slab Grade
Return Air
Steel
z�%y�
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
I w T—�}
F.A.U.
Framing
�_3D d�
Compressor
Insulation V�—��Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wail Firewall
Exterior Lath
Drywall -Int. Lath
Final
_
Final
POOLS - SPAS
BLOCKWALL APPROVAL
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
_
Z I �p
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)
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)
SEP-17-2001. 09:19' WESTERN INSULATION 909 686 8786 P.03iO3
WESTERN INSULATION, .
SULATION LP • .
- . _ ,
4211 Latham Stl=t, P-'VC6ide, California 92501 _
Tcl. (909) 686-8760 FOX (909) 686-8786 .
r
INSULA,TIDN 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/PHASE 1
LOT #: 40
SITE ADDRESS-.---
DDRESS---- 44--260 VIA_CORONADO--•LA-GUINTA,_CA - -
.......... . - - - - - - . - _
-
E TERI R•WALLS:
MANUFACTURER: JOHNS MANVILLE '; THICKNESS: 3 R-VALUE: R-13
{
CEILINGS: BATTS BLOWN FIBERGLASS
MANUFACTURER: JOHNS MANVILLE THICKNESS: 16 1/4 R-VALUE; R-38
CEI NGS: , ' S --_ BLOW
MANUFACTURER: JOHNS MANVILLE THICKNESS: 13 " R- VALUE : R-38
GENERAL CONTR T R: CENTURY AMERICAN DEVELOPMENT CORP. ;
BY:
TITLE:
DATE:
MULATION C NT AC R WESTERN INSULATION, L.P. -
LICENSE NUMBER: 794484
BY:
TITLE. P D TION MANAGER
DATE SE EMBER 17, 2001
�� `. ..• Dai- 33� ..
TOTAL P.03
Certificate of 'Occupancy*
City' of La Quinta.
Building and Safety Department
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:
BUILDING ADDRESS: 44-260 VIA CORONADO
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: .010.1'-337
Occupancy Group: R-3 Type of Construction: VN Land Use Zone- RL
" Owner of Building:' , CENTURY AMERICAN DEV. CORP Address: 55-487 SOUTHERN HILLS
f City: LA QUINTA, CA., 92253
,By: S DANIEL -P CRAWFORD JR.
Date:. 9/14/01 _
Building Official
r
POST IN A CONSPICUOUS PLACE
1