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0209-059 (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 -0010.39 EMC 1/31/03 Date A• 0 <' 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. 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 STATE MD Policy No. DOJ -1.6+182113 -fit (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 provisions.� -' Applicant- Warning: pplicant 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 tKe 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 issuedtas 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 representatives of this City to enter upon the above-mentioned property for<inspdction purposes. ",<� ` , " Signature (Owner/Agent)(24 r"�%+" 7f lfe Date zV,,sF•.27 BUILDING PERMIT PERMIT# DATE VALUATION '612 LOT 15 TRACT 28464 J06 S)TE ADDRESS 4W 8 �li lr � . SAN o�ULLAN APN (494M,015 OWNER CONTRACTOR/DESIGNER/EN (NEER IYM LA Q'DTNTA, 3 Q TRAU8 VIL- -1C HOUMN 19C 99618 IM3MT OT., Sti.PM,102 18401 F 1,1'IOFIWAY 111 8 N' DIEGO CA 9`2131 Lr'3 Qin.►":i1.�t'1"A. CA, 92233 Q40)?7I `.33 Y B CIALA '/FVM USE OF PERMIT OT -E FAM—ly MIKILM SM - LOT 15, PLAN a. M. PZRMIT DOMS Noy' 1INC).LIDF, BLOCKW.+�IrI.. C^` % PML, VPA� OR Dt�dIVFWAY KPPRO.A,.CH'. -Y5% REF)UC TIOW TO PLh,'iv FORM LTA ME IuaiS.d NC1�, OF 1AME PLA34 TPXv TRACT CO:NSTRUCTIO1J;1a�6.�t'1i E! PORCH/PATIO 403.00 S c3ARA' OIUCA4,Ri ORT WM Sg 19MAIM ' AIM C0117r 0.r CC1MF. i7M111014 is_*16 2.,6'C PXAM., AW SLIMA" $y Curt0T,R11C*n014 n1m. 3011-00U-418-000 8949.140 M" t"t!•ECK ISE 1 f?j -000-09-318 $194.68 MECHANICAL ME J01-000-421-000 $86.00 FILECT ir-AL . VIR 1' 01-000.4 0.OIDO V%169 PIAIMBING1Ii 101-000-419-000 5179.25 5TRIIIA0 Mt:37ION FRE • 6iESM 101-000-24.1-f';0 $19,36 OkAACliAit;b P43 101,000.423-000 $14,00 LiL'"J"i.'r.L.G•PSR.IMPACT Mg- V0,405.0 k i ?t TJD-TOTAL CO'N' IJCvONS AND PLAWMEO 1J=1 PRE. -PAW 1-1W. Sokol 1"MrIff'r XnKV0 DEM, NOW RECEIPT DATEBY " DATE FINALED INSPECT! INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings - 2 - © 2. - Ducts Slab Grade - Return Air Steel p -2 L -4-2- Combustion Air Roof Deck J / „ Exhaust Fans O.K. to Wrap /_57_5 F.A.U. Framing — -- Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans 8 Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath - Z 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 Plbg. Test Final Gas Piping PLUMBING APPROVALSGas Test Electric Final Waste Lines 6 p- 2 - Heater Final Water Piping Plumbing Top Out D_ � 1 TZ Plumbing Final Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection =�1� 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) -� 7� COMMENTS: APR -01-2003 1$132 WESTERN INSUL.ATICN 909 686 8786 P.08i19 .WESTEIRN INSULATION, ION, L.P. 4211 Latham Sweet, Riverside, CWfforn' 92501 Tel. i09) 6136-8760 .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 THEBU LOCATED AT: TRACT/PHASE: TALANTE ! PHASE 4 LOT #: 15 SITE ADDRESS: 49.850 RANCHO SAN JULIAN -- LA QUINTA, CA. EXTER198 LLS: BAT73 MANUFACTURER: JOHNS MAAVILLE THICKNESS: 3 1!2" R- VALUE: R-15 CL_ _Ei INCe3: BAITS (MANUFACTURER: JOHNS -MANVILLE THICKNESS: 13" R- VALUE. R-38 ASWEST HOUSING ESTERN INSULATION, L.P.