0209-053 (SFD)LICENSED CONTRACTOR DECLARATION
.I•hereby affirm under penalty of perjury that I am licensed under provisions of
Chaptor 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
701039 BHICj� " Ii'14IAn
i'� AKb'�d%g6i
,,Date �kf Signature of Contractor rte"" -w
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.
(a )f 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 :1', ,,,tIlD Policy No. 00-1048813-D]
(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,,prroyisio s of Section'3700 of the Labor
Code, I shall forthwith comply withtho60iroftio6s.
,,Date: ✓` '+ }"
Applicant—e
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 of puFsuanf to
any permit issued as a result of this applicaton agrees to, & shall, indemnify ,
& hold harmless the City of La Quinta, its officers, agents an5',.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 i
permit, or cessation of work for 180 days will'subiect permit to cancellation. f
I certify that I have read this application and state that the'above informatio4s
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 inlspeclion purposes.
—Signature (Owner/Agent) '-'� ^'' ` Date
-BUILDING PERMIT P R
.
DATE i VALUATION �+�j�¢� ry ,p g LOT TRACT
Fr9d's•'�'
30,J4 tint0 3JOB
i��
t w q'"C1
SITE
ADD ESS '� - i I�. G� i�Cls arf�� ? e' . �+ aia��
APN 649-1W19
OWNER
CONTRACTOR / DESIGNER / ENGINEER
9968 &1•IDIM11 z'r.. "ITUME 102
78--401 F TUGHWAY 1-11
;AN 13I.CO CA 92131
LA Q 7,114TEA C.A.9225),;
60,)771.33363 C—DLi, 49'1 Z
-
USE OF PERMIT
OU T :A�t/ ILY DW:0;LLI£G
Sir,) _ ➢:, )T 63 PIAN 4.A, 'VERII A T DOO NOT 1KCf.,UD't• 81.0CIC
WAW, P0014 1P.4 OR,DRANEW.61YAX1'ROACH
TkACT comsilrit/ma)ON %S
Pop-CifJRM110 666.00 S
f +AR 14GJCAi'tl'f+R°3 I16.00 SIF
IMMIAM COST OF CtaNSIIRU17L'IDIX
CONSTRUCTION FRE 101.000-418.000 Sips.00
PS..NN CHECK FEE $01,61
ME;t°1F'tANICnAL FEE 101-000-421-000 00 $86.0 i
ZI=TRACAL fet1- 101-000-420-000 $183.W
ra;Lta}V5BING FEE 101.Orifi-4l9-00 ► 31911,00
STR,ra�frt ldJ.is°I'1 1*f f7. w? n �® J Q9-flt31—:� 1-la00 $23.0
CR.A.D1411 FEE 191-M-423.000 31fi.00
iDZVI'.d,,C)i'H IMPACT 4?E1.'
AR'f -DO POOL -IC PLACED -1<ESK 270-000,445-000 ,
K-3.-2"MAL Cf3Nl7YR.TY109Alti D PL,FiN LIRE-gIC
$4,9L-101
MEM PRE-PAMFEM
$01100
a�
.!,'TOTAL F0GW`r(EE8 DITE NOW
RECEIPT w
DATE— / — >:
BY ! j
DATE FINALED
INSPECTO
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
' BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
SS `
Ducts
Slab Grade
—e-
Return Air
Steel
— S
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
_may-
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 —�j
Final
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
Sewer Connection
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final —
Utility Notice (Gas)
ELECTRICAL APPROVALS
Tem Power. Pole
Undergipund Conduit
RoughWring
Low Voltage Wiring
Fbdures '
Main Service _
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
APR -01-2003 15:28 WESTERN INSIJLATION 909 686 8786 P.02/19
1
wwwESTED-mN I;llbuN SULATION, L.P.
4211 Latham Street, Rivorsido, California 92501
Tel. (949) 6136-8760 Fax (909) 685.8786
INSULATION CERTIFICATE
THIS IS TO CERTIFY THAT INSULATION HAS SEEN INSTALLED IN CONFORMANCE WITH
THE CURRENT ENERGY REGULATION, CALIFORNIA ADMINISTRATIVE CODE, TITLE 24,
SPATE OF CALIFORNIA, IN THE BUILDING LOCATED AT:
TRACT/PHASE: TALANTE / PHASE 4
LOT #: 63
SITE ADDRESS: 49-777 RAN 'HO SAN FRANCISQUITO - LA QUINTA, CA.
---------------------------------------------
IEXTERJOR MLLS; SA TTS
MANUFACTURER: JOHNS MANVILLE THICKNESS: 31/24 R- VALUE: R-16
CEIL� BA TTS
MANUFACTURER: JOHNS M AFV/LLE THICKNESS: 13" R- VALUE: R-38
d�PNT Gi�F ; TRANSWEE T HOUSING
�4
TITLE:
DATE:
BY: L
TITLE: PRODUCT 0 M
DATE: ARRIL 1, 00 '
WESTERN INSULATION, L.P.
r