0101-331 (SFD)r LICENSED CONTRACTOR DECLARATION
1 hereby affirm under penalty of perjury that I am licensed under provisions of
Chapier 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
4786819 T� VJJ
Date - 7; Fy' Signature of Contractor
i
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I a n 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 tinder 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.
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.
00111)10.4 114011K . fid'(' SOWN
(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. F'
Date: i . 1 ' '' f Applicant !�r
V
Warning: Failure to secure Workers' Compensation coverage is unlawful and
.shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.,
IMPORTANT Application is hereby made to the Director of Building and Safe!YAN1
for a permit subject to the conditions and restrictions. set forth on
application. % d
1. Each person upon whose behalf this application is made & each perso at
whose request and for whose benefit work is performed under or pursdantto
any permit issued as a result of this applicaton agrees to;:& shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void, if
work is not commenced within 180 days from date -of kissuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) _. j�: t)s Date J
t
BUILDING PERMIT PERMIT#
DATE VALUATION LOT ���;..j TRACT
33 a 397Ia1
JOB SITE
APN
ADDRESS'p8
5-99 {�me�qq 1f Y 11
45(M-211-431
OWNER
CONTRACTOR/DESIGNER/ENGINEER
C.W 3R.)r,A KPJ.(!,Pr.>1.1 DENK.rC1P,AENC, C -O.
Z -P. CENTURY URit A1. _' 10AN DR°a-ELD.'� ...00r, Cok
w a-40 �?trnm. -_ ��3.=1.k
5 ^�} '7 �� � 3' T3 . t
I't, Q1.TtsI+P'.6A CA 92253
1.;A. Qt.Iil~3",if, Cdr 92253
(760)RA-5612M S 548'1
USE OF PERMIT
3f00 4.6 0T >';3 :FPL,: 3C a P13Fl MI T VMS NOT WP,I.JDE '81,OCK
WALTsit'e'XX4 PA,O'R.swC''I'.awkMCHOgWT,'IFSAV.7$KU.PLAI+3'L'•HEC"•KffE
I2.%7.31X'I ION POR IMt,:fT.,.`k IP12f ISSUA.110E OF 1,311.Sy(3 r I.A M TYPE
TRP.(,. J CO 1'J /'AV.'N'CTI ON 12111220.00 SF
PORCHIP?ATIO 63.00 Sfr'
C`AR:AOMARP R
0F CONY ATCdT`.�0M
i.WA si
PF'RMUkt IV, SUMMAY
Ci5MT!'A;47C`d'.a..iA..FEE 101.0,00—$18=000 MOP.
PI—AH CWWX PM 101-f1t10-.4,"K,1-318 $19$."
W—Cr'11A;I+CXC,. L FRE 101-000-421-000 X5,30
H1-, XTR'IC°AL 1,122 4 31-Lrt Q •2�1-d14?I# $1 %�, d e
Sa1,UMBRIOFRE, 101.000-419.000
ll
S'f'i�ONO K011 r. FTE A 1i:1?SIrl 101-000-241-000
C,w,:ixwo "ME "� 101-000-423-000 $l%t,W
f{ PXF 10A.:..0 nE, 31 Fa .AO
¢9 fl)
IpIR-TOTAL�`C.9I�i UCTC) Fl9+YTr`��Y�>�i�.y ,pAa3i�4C.` 1�1Ss�C.y��!�
°1'i2.
s, 3�7.ara�
(M$3,537.6
�q�cs
.. 4 ;4nL'r67a7,f„Z'4L`r�,ff"d�:x.��i'�5�•.S:.n7
$0,00
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
M
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
`
Underground Ducts
Forms & Footings
l V
Ducts
Slab Grade
3
Return Air
Steel
Combustion Air
Roof Deck
O.K. to Wrap
_5.
_�7
Exhaust Fans
F.A.U.
Framing
Insulation
_ /��
- _l�t/Q/
Compressor
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
0.1
Exterior Lath
Drywall - Int. Lath
ZZ611 ar �i G
�L�2 N P�l.��sq
y � �Z c,Q•(•-fid-
'
Final
/D �iQj
Final
/
POOLS -SPAS
BLOCKWALL APPROVALS
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
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)
,v
NOV-01-2001 16:08 J WESTERN INSULATION" 909 686 8786 'P.15i16-
ESTER: ' IN ULATION, .Le P.
4211 Latham Strcet, Riverside, California 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 /PHASE, 1
LOT #: 33
SITE ADDRESS: 78-510 VIA SEVILLA. LA QUINTA, CA,
.. - - - - - - - - - - - - - - - - - - - - - - - - - - -.- - - Y - - - - - - - - - - - - - - - - -----------
--EXTERIOR
- - - - - - -
-- EXTERIOR WALLS:
MANUFACTURER: 'JOHNS MANVILLE THICKNESS: 3 5/8 " R -VALUE: R-13
CEILINGS: BATT5 BL01hIN FIBER +" '
MANUFACTURER: JOHNS MANVILLE THICKNESS: 16 1/4 " R -VALUE: R-38 '
CEILINGS: BAITS _• BLOW
MANUFACTURER. ` JOHNS MANVILLE THICKNESS: 13 " 'R -VALUE:. R-38
GENERAL CONTRACTOR: CENTURY AMERICAN DEVELOPMENT CORP.
BY:
TITLE:
DATE:
r
_ INSULATION_CONTRACTOR: WESTERN INSULATION, L.P.'
LICENSE NUMBE • 7944
BY: r,
TITLE: PRODd6TION MANAGER
- � DATE 7EMBER 17, 2001 � -• . y
Certificate qf Occupancy
CityQuintaof La..
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: 78-510 VIA SEVILLA
Use Classification: SPD Bldg. Permit No.: 0101-331
Occupancy Group: R3 Type of Construction: VN Land Use Zone: RL
Owner of Building: CENTURY AMERICAN DEV CORP Address: '55-487 SOUTHERN HILLS
City: LA QUINTA CA 92253
..�+ By: KIRK KIRKLAND t.
Date: 10-3-01
Building Official
POST IN A CONSPICUOUS PLACE