0209-057 (SFD)LICENSED CONTRACTOR DECLARATION
I hAreby 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
17011739 13 UTIC '1.)1303
ate`d `•'r' 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.0 ,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
Saction 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 STAT FUND Policy No. 000-1643813.01
(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 th��pq.4isions.
,Date:Applicant��'�
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 whqse 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
t.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) Date l `� �•�'`
BUILDING PERMIT PERMIT#
DATE VALUATIONa'��,.°�! §i.+ LOT 1% TRACT
64
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ADDRESS ,z,,,�8�.5 RANCHO SAN TRANC-USQUI-0
APN 6494MO-15
OWNERM
CONTRACTOR / DESIGNERN NEER
1yJV % Sl1
4Y1Ae
AR1WS tf-;0ryTJGL7i1q yNC
9968 IMMW 171, Millis 102
78.401 F mauaw.,pa '11 I
SANDIEGO CA 921'31
LA QUW[A CA. 9225 4
%'760)7'71.3362 MTi. 4972
USE OF PERMIT
WD -1,.01 '1`I PLAN 4B. PERMI .° 009 "r HLOC K
WhLL% POOL, SPA, OR, i7P.IVFWAYAP:PROA,CH
j
TB (, COMT13UCTION V81.09 St+"
PURCH/RATIO Y%.00 S2r
a�. / A �Pc .�•c WOO 31•"
°RpmM m ffummiy
'CONSTRUCTION.Mi, 101 -000-418-000 "26095. so
.'
PLAN CHPXIC P?,Y, 101 000-439-318 QbF+l3 9i
WC13.-01IL'.A1. FEIR 101.000.4.21.000 ��G.Cltl
I;,:i?CT12aC" L Mt 101.000-420.0.00
P1dUMBINIQIft 101aOW-419-000
ST€tONO MO1'IMI ;„iUt R&SID 101-000.241-000 32193
GRADING ME% 101 -00,13-42 3,,000 313.611
L?1 VE OPPr•1'2, jMPA.CT t -r? $�405.1_n
AWC W YUBLIC> P AC"FA9 - RUIC 270 -WO -445-000 V.3.84
l: ESS PRE.pP.ATDY.
$0.00
_
At
fill
RECEIPT
BATE J' �,.
BY `�
DATE FINALED
INSPECT
t4
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
e
Underground Ducts
Forms & Footings
- c -OZ
Ducts _
Slab Grade
- c5z
Return Air 4�
Steel
Combustion Air
Roof Deck
2_ - y
Exhaust Fans
O.K. to Wrap
-
F.A.U.
Framing
Compressor
Insulation
-
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wali Insulation
Condensate Lines
Party Wali Firewall
Exterior Lath
Drywall - Int. Lath
_3
Final -�
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 ��
La Z
Heater Final
Water Piping
I Cy V
Plumbing Final
Plumbing Top Out_p
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
Furfures
Mairi'Service
Sub Panels
Exterior Receptacles `
G.F.I.
Smoke Detectors
Temp. Use of Power.
Final
Utility Notice (Perm) -
COMMENTS:
APP -01-2003 1-5'31 WESTERN INSULATION
909 686 8786 P.06/19
®fi Tl �TIJI Am 10N, L P.
4211 L&M= Sinet, Riverside, California 92501
TeL (909) 611"760 Fax{9og� 686 >3786
INSULAI"ION 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: TALANTE I PHASE 4
LOT #: 17
SITE ADDRESS: 49-618 RANCHO SAN FRANCISQUITO - LA QUINTA, CA,
EXTERIOR WALLS: SATrS
MANUFACTURER: JOHNS MANVILLE THICKNESS: 3 112" R- VALUE: R-15
CEILINGS: SATTS
MANUFACTURER: JOHNS MANVILLE ' THICKNESS: 13" R- VALUE: R-38
G-�ML®N TOES: TRANSWEST HOUSING
TITLE:
DATE: ,
8 ION CT2& WESTERN INSULATION, L.P.
LICENSE NUMBER: AW. 84.1
BY,
TITLE: PRODUCT 10# MWA-5 E14
DATE: APRIL 1, 7 . 3