9907-119 (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
1478689 13 r O2l29/2t
Date )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).
( ) 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.
(� 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 001,))1d.F„AGLE Policy No. WC 547701400
(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" rovision,g.. -_..,,_.. *
Date: a OApplicant
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 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, 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 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 representatives of this City to enter upon
the above-mentioned property for,inspection purposes.
Signature (Owner/Agent) —S" Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT''TRACT
$291,2.23.20 - _ 05 I`2860�R
JOB SITE
APN
ADDRESS ...s("80 IU.VMRA
761--09"40
OWNER
CONTRACTOR / DESIGNER / ENGINEER
SOLl'n11.�N F111s uc
R..C. H01813S dba SOUrF,WRN TTH T„ 3, T_LC
1430 E CEWMAN AVE I 100
55.960 PG14 BLV))
ORANC3E CA. 92886
LAQ1.i.t' rA CA 92-M
(714)633M7260 C13TX 5487
F.
USE OF PERMIT
SatsO J, FAWLYDWF.i1.Itd'C3
SFD - IAT 6 PLAN 3AR PERMIT DOES NOT INCLUDE BLOCK. WALL OR
POOL.75% P.G I CHECK REDUCTION.APPUIED FOR MULTIPIX �!,UPMITT.AL
CUSTOM CONS'T'RUCTION 3,465.00 8F
PORCHIPATIO 936.00 SF
Q.ARAc3I/t`„AR'.PORT 723.00 SP
XST1KW11KD COSI OF CONNTTIRYC;TXON
291,223.10
MAW FEE suh04ARY
CONSTRUCTION FEE 101.000-418.000 31,:11.50
PLAN CHECK FEE 101-000-439-318 $269.07
MECHANICAL FEE 101-000-421-000 $113.00
LLUCTRICAL PRE 101-000-420-000 $193.A
PLUMBING FEE 101.000-419.000 $243.00
3TRONO MOTION FEE - RESID 101 -000-241-000 $29,13
ORADINO PRE 101.000-423.000 $20.00
17L"VUO,PER IMPACTFEZ $1,907.00
ART IN PUBLIC PJACES - RMIL 701-000.255.000 $228.06
SUB -TOTAL. coy-- 31'RlyarTOAT.AM PLAN CHE?OX
$4,318.99
LmS PRE-PtIM)0 0
$0,00
TO'.rAL PF-RAffT FENS DUE NOW
$4,3.10.99
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
- BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel I
Combustion Air
Roof Deck Cj7
Exhaust Fans
OX to Wrap
F.A.U.
Framing
Compressor
Insulation // pd >7
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 1:57 -
BLOCKWALL APPROVALS
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
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 d
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Law Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
MAR -06-2001 14:55 WESTERN INSULATION 909 686 8786 P.07i09
R-ESTERN INSULATION 9 FITC.
4211 Lathann Sweet, 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: #28603-2/ PHASE 4
LOT #: 6
SITE ADDRESS: X80-480 RIVIERA. 'LA QUINTA; CA .
------------------------------------------------------------------
EXTERIOR WALLS:
MANUFACTURER: JOHNS MANVILLE THICKNESS: 5.5 " A -VALUE: R-21
CEILINGS: BATTS BLO
MANUFACTURER GREENSTONE THICKNESS: 16 1/4 " R -VALUE: R-38
CEILINGS: CATTS BLOW
MANUFACTURER JOHNS MANVILLE THICKNESS: 10.3 " R -VALUE: R-38
GENERAL CONTRACTOR: R.C. HOBBS COMPANY
BY:
TITLE:
DATE:
INSULATION CONTRACTOR: WESTERN INSULATION, INC.
LICENSE NUMBER: 481278
BY:
TITLE: PR D CTION TANAGER
DATE MARCH 6, 2001