0209-060 (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
701039 13 3:1x10 y `. e I M1los
Date Signature of Contractor: ,T
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.
1.0 1 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 11'fAT1 p3F14'f) Policy No. 000.1649813-01
(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•; 1 shall forthwith comply with those-of.Wisions. .
Vie: /1 %''..J~ -r.^.' 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 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 f
whose request and for whose benefit work is performed under or pursuant to
"zany 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 Statejaws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property forinspection,purposes.
'Signature (Owner/Agent) " �'"'� Dates to
BUILDING PERMIT PERMT#
DATE VALUATION LOT TRACT
$21347240 14 2
JOB SITE
ADDRESS aZ�$».1 AtC� ti aa�iL�
APNF�i
OWNER
CONTRACTOR / DESIGNER / ENGINEER
P -.M LA l^y1Ti104l A,, 2.. f'
MAWS W:OU ROMM MC
99681-13,13 ".I.T M"., W= 102
?S-40] f'' I'I±if3HWAY 1111
INAM;3'.11EC"0 CA 921.31
LA QUANTA, CA 92253
f�1r�
(160)771 -DO '.i1tl YdJ '4i 12
USE OF PERMIT, ,
g t' {y eggq q y yy7p9
iC�V6�:lid+d��i�.t�+.ti'S�YVP�.7...icEitl 4,7•
SFD ., tA7T 14, PLAN 3f3..P12RA41T DDIE i NOT INCLUDE BLOCK
WALLA P001, 0PA OR :3?.RISIKM.P>:'i APPRfJAM 75% MDUCTION TO
K.A14 t,HFP1C KEE PDI; ,VU i 1PL,w'' IS'a4JA.WCZ OF StA:HE PI -1W '$YI'E
IMACT 4."COSTRUC TION 3,.osr40 SP
PORC.FI!'PATIO 576,00 S
CIARAGEICARPORT 66100 Sr
EIRIDWrED CONT Of' %C?N9](3MM`iON
23:3,672-
z1W WHVE RUMMARY
CONSTRUCTION FFS 101-000-418-000 �9i133� 0
PLAN C'Ii€., X FEK 101-000.4.39-318 8214.07
MRCHM XIALPutF 101.000.42.1-000 M.56
EI,.ECTRIC,A.?, M0, 101-.000-,420.000 $171,47
PLUA1118M 0FFIR 101.000-419,000 $151,11
STRG2NO MOTTO IFfUt - >?ESID 301 -000 -?AI -000 $21.37
i1RAOING PIN. 101.000.433.000 S I Sr00
)L?Xf'VI;I,OPiR I'MlsA(r YEE ' $2,405.00
ART 11d PUBLIC PUAC Mi MUM V -070.445.000 8�9.I8
r'
i
r
SUB -TOT T, �.C53� ii�`1014 A - LAV +�i°I LK
_ LESS TIRE•:FAIP n, WKS
$0.00
��.._r F . A J P=Wr YETS .LYOX NOW
4 J &3.04
------
p;
�r rw.:3r• 5 j,
TT^�
REOBP�""" `DATE
BY '�
DATE FINALED
INSP R
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Z —O —
Ducts
Slab Grade
0-a
Return Air
—
Steel
Combustion Air
Roof Deck
—
Exhaust Fans
O.K. to Wrap
_
F.A.U.
Framing
_
Compressor
Insulation
-/y 3
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
_ 7,
Final — a
BLOCKWALL APPROVALS
steel
POOLS - SPAS
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final I
I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
1 _
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
_ S
Final
Final —
Utility Notice (Gas) � C,/�
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles 1 M-15
G.F.I.
Smoke Detectors
Temp. Use of Power
Final .—
Utility Notice (Perm) -�
COMMENTS:
APR-01-2003 15!32 WESTERN INSULATION 909 686 8786 P.09/19
WEST4 RN INSULATION, L. Pe
4211 IaWam Sweet, lbversids, California 92501
Tel, (909) 6136-8760 F= (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 CALWORNK IN THE BUILDING LOCATED AT:
TRACT/PHASE: TALANTE / PHASE 4
LOT #: 14
SITE ADDRESS: 4"10 RANCHO SAN JULIAN - LA QUINTA, CA.
EXTERIOR 11VELLLS: BAITS
MANUFACTURER: JOHNS MANVILLE THICKN!_SS: 3112" R- VALUE: R-15
CEILINGS: BATTS
MANUFACTURER: JOHNS MANVILLE THICKNESS, 13" R- VALUE: R-38
WEST HOUSING
MN INSULATION, L.P.