9704-029 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
C*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 y,,,, . Exp. Date
Date r' ,A!'�� Signature of Contractoofr -^'' -'
OWNER -BUILDER DEC
I hereby affirm under penalty of perjury that�l exempt from the Contractor's
License Law for the following reason: �v
( ) 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.
ZENI.Tff INS. CO, 7A1,2066902
(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.wor ers' compensation prgvis6e of Section 3700 of the Labor,
Code, I st�ralrth ith:cpmply with those provision"s.
Warnirfg: Failure to secure Workers' Co�mpensafion coverage is unlawful and
shall subject an employer to criminal penaUes and civil fines up to $100,000, in
addition to the cost of compensation, 5pryfages 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 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'
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 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 representatiyes of this City to enter upon
the above-mentioned property for inspection purposes:
Signature (OwnerhAgent)% Date �`
PERMIT # CONTROL#9#
"Z1� Ilk,
BUILDING PERMIToT
DATE , �I TRACT "1��� g 157
X17! f ;6� .474.:.i1 .
ADDRESS 19120 �1V I�.�I.t�li A ll�fllIVE JOB
APN 604-343-032
OWNER
CONTRACTOR / DESIGNER / ENGINEER
C".9sl.i"f►#,':R.4+,i;;aN41 fl .�x"1'�
l!!7"!CJ't:1TxP7tc�°d!':i,LOMtitiNt'tLk'a
15,15 ::'1:)" ,yj`J
5a5 SO 11Ir iy, STV. #200
4. N'IIE- NA.itD NO CIA 92-408
SAN i3:F RNA.ltl: M0 CA 9240
USE OF PERMIT
al+%1- ,1�kRA41 f i +:)'ia510Y..a 1lVG�i. iQh., I GGA( i4. Wl1i.f., f"L Jk .
GIIA WY, PLANT x;L(°, FIL"1:Ni C1.11U.1-s' 1 i•d a:3tl t3Ut" 15 BY ;5',oPC*
LTJ.Tft'I,h 110% G:a1+ NA:M- Kr1N `fi'PK
I,? ,0.00 W?
'Af{A1C'risi(uE1lCk'i ikf !' 417.00 SW
RSTIAW ED COST OF CONSTUCICUON
98,474.14)
P.(,AN C1,W3M F01 61.33.29
M. , NS'i.1ti CG""I'tUid ME $45150)
...—�iG,i!•:i::�i�vw'I�;��F, f;El�, 1C��fi�-4Z�-#1t3;� . �s��,'_�1
If„ii!'12i( AI..I•"1`I: ifi!)t7-si2il-()C>tJ `j.I3.(1:5
Pf itmBING 1_ EIF, 101• -ow -inn -131)1) $148,00
?i"I'C�h1i7 ►1,iC37`3f.�'J )"t?E; lC��:i ll;:+ ” t () � �i�Q..�1.r�� ,1 ��? $'� �5
�i\c�,17�.tVcr)=%.F• ffii.C%4�-�#8.�`t)1)1� d%if.T.t'N�
NrFzley`r17U(:'i�t3l l�, i f: 22-5-000-443-342 $•, 3s.�,
.r
S1
l,: � � P�.E�F>11:1'� l�t"ES
$000
PID
0 8 1997 TO s'M�a:. �;��:.RAA1 r F {e�% 013.1, NOW
"3,3:wm .
APR
®�
.,-Ty
RECEIPT
DATE
Bi, r.
DATE.FINALED
INSPECTOR
INSPECTION RECORD
1 OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
Compressor
Insulation //
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping 7
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
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)
COMMENTS:
R i,. August 5 1997
F ,,CENTURY'HOMES
Century. -Crowell Communities
�. 1535 South.,,D,, St.,'Suite 200
,Sa.n•Bernirdino, CA 92408
Attention: Mr. -Mike BoggsN
SiJBJECT STRUCTURAL .CT-' DEL RAY AT
as , LA' QUINTA NOR TE; .LA QCtITA: CALIFQRI\jI�\ �� -� •`'.
v ,
fi+4 Dear 1VIr. Boggs
Based on your request, and•the,requirement of the City o1' La Quinta Building &'Safety
Department'
per requirements of the Uniform Buildiria Code'(UBC). 1994 Edition,,I
;.
have` conducted an `inspection on the job site/Trac[ No. 26.1.88. Del ReV. at'La Quinta. No=te;'.'
on ,Wednesday, July '.
•i•', . .•r'v .- _ �: `. , ' , , .. - -. fit_ , - -1
The .inspection *was limited tothe.lots Number 51;`52.*and-53_ respectively: The` purpose of
.;this inspect' was to see if the suvcntral'-requirements of these bu'►Idings were .compiled } '
,.
. , according tolhe relevant building codes :and approved plans, and` calculations : `The "
requirements include shear wall nailing,structural connections, and shear transfer details,:
* . ^ Pstrap,-anchor`,bolt''8iie,,spacing and hold downs. " f�
Some deficiencies were noted ;i hick were brought to YOUT attention.
x A.follow.up inspcction-of'thc site•w•as'also.conducted and`prewiouely observed structural
.,
,• r - deficiencies have:been corrected oto conform' with the approved` plans and specifications.
Please feel free to contact me if -you have inv concerns or.questions regarding the above '
information, - Once-agairi,� thank ;you -for -giving me the opp'orrunity to work with you � • T
x y { ,s
Sincerely,
� • `� QSS�l�lj,'�i4d . ., ,'' ' , � . • � .. � • •, `' • '� , r' +• .Y'' t )V
g/5 �
�7 l;y,i'E roc, Y7�}d
X163 VI
n 10
y,:! 'land sociates
15175 Chapala Dr. Riverside': tK"92507' Tel i9'09)784-2424 Fax: (909).784-0706 * r.' .
- , ,. y .. r