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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
#_42 �" G-3 �. /'1 f katteSignature of Contractor—
OWNER-BUILDER
onractor 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.
( ) 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.
r,TAI'1l Ft�ND 10- 1 R 3 4
(This section need not be completed if the permit valuation isofor $100.00 or less).
() I certify that in the performance of themork•for whi&(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 should become
subject to t e workers'co'mpensation pr visions-of�Section 3700 of the Labor
Code sh I o thFcomply with•those provisions. 71/N
Dte: Applicant
Warning: , ail re to secure WorkerstLCompensatiori overag Is u lawful and
shall subject an employer to criminal penalties and civil fines p to 100,000, in
addition to the cost of compensation, damages as provided fol5•i 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
correct. I agree to comply with4l•City, and
construction, and hereby; authorize repreSE
the above-mentioned propertv for inspectior
nature
f"the above information is .
vs relating to the building
5f this City to enter upon
Date
BUILDING PERMIT PERMIT";16-}5
DATE %10 1t"VALUATION 514.9#t:.4i0 LOT TRACT
JOB SITE
ADDRESS 45-400 A.SHE+'(?OD COUIC
APN
OWNER
CONTRACTOR / DESIGNER /ENGINEER
3OHN ERIO^1N,
t;tT-rCAN POOL CONSTRUCTION
45400 ASI-.{7d'ooD Coi31Zr
73960 HIG.t-IWA'l' I1 I
LA QUINTA. CA 92253
PALM DESERT CA. 92255-1%
{75D;)1:10.2588 C133: # U04
USE OF PERMIT V i
POOL ANEW OR SPA
POOL &SPA C,1dLY - ALARMSrl ARRIE S SMALL D1 , IN PLACE, A.'T' �!
4'.12J:-P1.A.'TVE-R MSPEC f10N
POOL W41)/OR SPA l f 500.130 Ls
A
&STIPWA. `, D COST OF Cay�NSPRIiC"I ION
A.4" ±:84.109
PLAN Q&Ctom F -h.9 101-000-4-49-3t8 $10.30
Cir>wv��9?tlt-.,4't"f'►7.TC"EBF `:a !i)!-�Cx}�,2t��'.-.(1()tf �,#�2,i'tf►
NIL,C14\NIL",.r'11., F E13 -- PC) 0.1, 101 -000.421 -No �uA.4t1
Ellw1 lOCAr, r _ .POQL 101 -WO -420 -OW
i'i,lifAWNG F1111 _.i'e0L 101-tW-41.9-000 2'r.t►t�
41,JII 7 rffA1, C 0le!S Ci(i1Crl10N ,A;NID P.1,AN C1 U.C'.K.
r361 V
LESS TRi
TOTAL K, RMIT FFZ8 DUE NOW
i•
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RECEIPT
DATE
BY
DFS INALE
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
Combustion Air
Roof Deck
Exhaust Fans
OX 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 UY
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
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:
..........
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APR- 9-99 FRI 3:53 PM WESTERN INSULATION FAX N0, 16195302997
WESTERN INSULATION, INC.
4211 Latham Street, Riverside, California 92501
Tel. (909) 686-8760 Pax (909) 686-8786
INS ' C.Y TIFICATE
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:
PHASE: DESERT PRIDE
TRACT: 23995-1
LOT: 27
SITE ADDRESS: 45-400 ASHWOOD COURT, LA QUINTA, CA
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EXTERIOR WALLS:
MANUFACTURED: Johns-Manv1/le THICKNESS: 3 5/8" R -VALUE: R-13
CEILINGS: BATTS BLOW
MANUFACTURER: Greenstone Ind. THI NESS: 8.1" R -VALUE: R-30
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GENERAL CONTRAC i Vli:` 1Ncb HOMES CORP.
LICENSE NUMBER:
BY:
TITLE;
DATE,
INSULATION CONTRACTOR: WESTERN INSULATION, INC.
LICENSE NUMBER: 481278
BY:
TITLE: PRODUCTION ANAGER
DATE APRIL 8, 1999
P. I1
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GENERAL CONTRAC i Vli:` 1Ncb HOMES CORP.
LICENSE NUMBER:
BY:
TITLE;
DATE,
INSULATION CONTRACTOR: WESTERN INSULATION, INC.
LICENSE NUMBER: 481278
BY:
TITLE: PRODUCTION ANAGER
DATE APRIL 8, 1999