0101-335 (SFD)LICENSED CONTRACTOR DECLARATION
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
476699 B
Date i Signature of Contractor" � 'A-
I
•
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
fproject (Sec. 7044, .Business &' Professionals
Code).
() I am exempt under Section B&P.C. for tFiis 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.
.'( ),.A -have arid will maintain workers' compensation insurance, as required by
S ction 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.
(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: 1 y1. g.jlApplicant :414
Warning: Failure to secure Workers' Compensation coverage i,s�unlawful and
shall subject an employer to criminal penalties and civil fines uptto�$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. y
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 persb`� at
whose request and for whose benefit work is performed under or puns agclof #_
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 fo 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)Data '?- L lei
BUILDING PERMIT ?ERMT#
DATE VALUATION LOTI..:�-3 TRACT
38 1 •.I
JOB SITE
APN
ADDRESS' 4WZ95 WA CORONADO
W4-211-017
OWNER
CONTRACTOR/DESIGNER/ENGINEER
O.WUR34"AWTICA DE- A^LOPUMIT, Cali.
ZIP. OR',p. : URY.lhi��..�'UCsNDE,+'�MOP.�.��� r, 17,O..
.5 5 -44 Rif B&OTHE;04 W23'
55-487 30tMq.M4,TMJX
LA Q'WgrA. CA 92,253
LA qWZ A CA 9275:6
-
(760)S&I.6612 ClWi 5487
USE OF PERMIT
SPI) . LOY ad PLAN SI .TZ s PEI2PdI T DOES 'tB yr 114CLdiM, .BLOCK;
�-W.�+d,I.�Ot�4.:A'uI',f# 0�.��•�I�C�.c�Cii I"rIiIV�?�Ni'.�4.�`:'�rr�, PLA1� f'3�I?CY. f�.H'�
REDUCTION FOR MULTIPLE IS5113 .14CI✓ OF SAMY PL A' -M TYPE
TRACT tvONVO7'RUCTI£313 3,229.00 BF
PORCIJ1B•6AT,10 63.00 SIS
(AMOr:�cARPORT (M I313107120
cobIr 531sT �f,.`�I.I .F.I�2ui"'1�.�014
-gg �v 'n y+�y �y�� �gyyl�,8�{,�� q..�;'yS111k��i;1E'.P.;.1)
S?9bY5.W.16.i.Y. ,43 J E AA GJJ.YJ.lP3•.YL.DV...i9
COMuTRUC1 RYN M 101-000.418 000
PL.F' W c I cfc.mr, 101 -WO -439-318
MCHANICAL FFZ 101-00OA21n000 SSS, SG
H11L 1r1%1JC 1%L FEE 101-000-420-000
PI.i31.d11It=15 FTE -Z 101.000.4.19.000 S1700
;'!`ar.t7lblC# VC?`I'K* Ift- • %`.I'SID, 101-000-$41 "000
0116DI'NtB F&M f f:: 104.-f1W9 42.3.000
h 4r I.51J?FS% a,tu]Pr f MR. �J,40l.f)0
p,� c� ryry q
LA �
iT TOTAI, Ct33ASTR'UC:'�'3CyN1.• WD MAIR C":�9:fMIC
a"W PRE—PAID i%F {ani
Zoo
r. 4�
3 'U?Y,4 ,PEW T SEW VVE.$ NOW
' 61.4
RECEIPT
DATEBY
I i
DATE FINALED
INSPECTOR
",*)I '"C I r l
()t
t
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs—=
Underground Ducts
Forms & Footings
iL�
Ducts
Slab Grade
Return Air
Steel
Roof Deck (2_ ��.4��
Combustion Air
Exhaust Fans
O.K. to Wrap_
��
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
// j
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wail Firewall
Exterior Lath/_
Drywall - Int. Lath
r
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
je
Heater,Finai
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Laterales
�+f�
Pool Cover
Sewer Connection
�(2� ('�'�
Encapsulation
Gas Piping
Gas Test
AppliancesId
_
/&*y 9/tea_
050-0
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.02iO3 „
y
I L. P
• WESTERN INSULATION .
4211 Letham Street, Rivcrsldc, Ca1dornia92501
Tel. (909) 686-8760 Fax (909) 686-8786
IN$ULA'TION CERTIFICATE
r S TO CERTIFY THAT INSULATION HAS BEEN INSTALLED IM CONFORMANCE WITH
THIS I `CALIFORNIA ADMINISTRATIVE CODE, TITLE 24,
• • THE CURRENT ENERGY REGULATION,
STATE OF CALIFORNIA,• IN THE BUILDING LOCATED AT;
TRACT /PHASE.' SANTIAGO @ LA O,UINTA DEL ORO/PHASE 1
LOT #: 38
a SITE ADDRESS: 44-295 VIA CORONADO� LA-QUINTA, CA - - - _ - - - - -
EX ERIOR WA LS:
MANUFACTURER: JOHNS MANVILLE THICKNESS: 3 5/B.
R-VALUE: 8-13
CEILI GS: _ BATTS BLOWN FIB=
' r MANUFACTURER: JOHNS MANVILLE THICKNESS:- 161/4 " R-VALUE: R-38
. . _
�BATTS1.- BLOW ,
CEI NG ,
;MANUFACTURER: JOHNS MANVILLE THICKNESS: 13 ` R-VALUE: R-38
ENERAL CONT A T R: CENTURY AMERICAN DEVELOPMENT CORP.
BY:
TITLE:
DATE:
INSULATION CONT. C O :' WESTERN INSULATIO-4, L.P. ,
LICENSE NUMBER: 794484
-BY:
TITLE: PR CTION MANAGER ,
DATE , S EMBER 17, 2001 _
x
• � �• • .. • �/I�i� 338
ertificate ofOccupancy-Y{ �
T
City of LaQuinta
Building and Safety DepartmentOfti
This "Certificate issued pursuant jo 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: ; 44-295 VIA CORONADO
Use Classification:SINGLE FAMILY DWELLING Bldg.,Permit No.: , 0101-335
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL
_ - . _G-wner of :Buildin CENTURY:AMERICAN,DEV.=CORP. - �--Address. —55 -487 -SOUTHERN --HILLS-
City: LA QUINTA, CA., 92253
40
By: DANIEL_P. CRAWFORD JR.'
A, 0.1
'Date: 9/17/01 -
Building .0ificial
/17/01'Building,Official
POST IN A CONSPICUOUS PLACE t