0101-338 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Ci"apter 9 (commencing with Section 7000) of Division 3 of the Business and
Professionals Code, and my License is in full force and effect. .
License # Lia Class
Exp.
Date t a t t Signature of Contractor
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),
( ) 1, 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 oi-ie 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:
Carver• c tS q Policy No. p�q
-�iOr6i�%fiNP '.41P'S;W
(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 workerscompensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those(provisions.
Date:•`• tiu !l Applicant iir
. 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 foriin Section 3706
of the Labor Code, interest and attornev's fees. t..c
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.i
1. Each person upon whose behalf this application is made & each pers�o t
whose request and for whose benefit work is performed under or•purs�arto
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 -it
work is not commenced within 180 days from date of issuancea,of such
permit, or cessation of work for 180 days will subject permitlb,cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, anis 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) " `"" Dater'21
BUILDING PERMIT PERMIT#
DATE VALUATION LOT �1}�,-.�J' TRACT
JOB SITE r
APN
ADDRESS -
44-290 CORONADO
a�-a��a�
OWNER -
CONTRACTOR/DESIGNER/EN INEER
r
CWxURY AMSUCM TSEMO3 WAT, 00
o",.€-"1~a"l;'t.7Rt Cal.
55-497,0011TIMR1.4 HU -3
55-487 S0XrT13MTHU.,LV
1A QifiiRM %A 92253
LA Q�.TIMA CA 99v21. 5.3 -
(760)564-505512
I ICF OF: PER 4IT -
a
e 1FA1`..'..id:�.:cLr:,a�1�1
YiM ., %gyp` 41 P1at3N 281 • PERM DOLS NOT INC L0rig BWCK
W;Af..1..a'P0WAScPA 0K APPIROAC H LiFaff WAY.76V) £'LAN CH ftE?
"MIXTION I`1ORU "f tPLF. ISSUAi:7C;iZ OF SAME P1 e' X Ty -n
TRACT CONSTRUCTION Z m,00 8F
a PDRIMrifPR!` O ",13.00 a?
,%NIMAXTA) Coss 01? (1,10 ISPIRUC TI(M
�•f5 a 1 +� . > 1�
FIRWr NIM SUMMARY
C��'>�1�'�3�G"•�'1C+�3 z ;, 1 G1 u'A�1��4• � t�pU00 s8�3.�D
py'�.iqG:dii"SC !? 1f}�-C-1 tiJ-31iv' �:1i1?,fYo
WXHANIC:AL , 101-000-423-000
TUXL"TRIC.+A,-1. nIt 101-000-42"00
PLi3M:ti3 O M 301.000-419-000
STROHO TU OT11G' RE 1 7 I491 ->3C -? 1. 61L1fJ �t 6,37
CtrkF?.i1�tC#'t ;w�� R. 101:-(119-�;#3�f1K1i3G,tT1�
r.
r
3 i
i�
Z5fk' X' � ���`.��,j�yy•��''-�
''! -ffpyU_n00,911RU01f ap pW�.) y$ A*+u.(A
Ina PRE-FILID T`rIM
$0,00
M
t
RECEIPT
DATEq I
�t1w
B Y,
1 1 l�
DATE FINALED
INSPECTOR
:'~'1
P,
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Underground Ducts
Set Backs 7i\�1v ���
Forms &Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
O.K. to Wrap
Framing
y_��`
I�A
2
Exhaust Fans
F.A.U.
Compressor
Insulation
Fireplace P.L.
�_� p J
��
Vents
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
_
Drywall - Int. Lath
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
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
21�
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
tp
(3p
Pool Cover
Sewer Connection
_ _I�
ewv6c
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)
ifiOccL anc _ .Cert cafe of
• En
71
Cit of.La' Quin1W
ta �
Bulldihgl..and Sa'f6tyDopclrtment + ��"oF.
ThisCertificate 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 fo/%wing:
BUILDING ADDRESS:' 44-290 VIA CORONADO
Use Classification: SINGLE FAMILY DWELLING - ` . Bldg, Permit No.: 0101-338
Occupancy Group: R-3, U-1 y Type of Construction: 'VN Land Use Zone: AM
cJ S
Owner of Building: CENTURY. AMERICAN- Address: . 55-487 SOUTHERN HILLS -
DEVELOPMENT
'City: LA QUINTA CA 92253 '
} By: GARY HARTMAN
;zZ7
r `
Date: OCTOBER 22, 2001
Building Official v