0209-065 (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. Dat1e�
701039 B BIC d � 11311103
,f
,-Dae /0-/5'4x' Signature of Contractor vI
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.
Mi- 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 F 14D Policy No. 0ft814644,1341
(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,,.l shall forthwith comply with�those p�:ov sioonnss
s.
ate
,D: l'lyt e 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 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 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
X.the above-mentioned property fop,,inspection purposes.
.Signature (Owner/Agent) Date A
BUILDING PERMIT PERMIT#
DATE VALUATION y [ y y LOT TRACT 9 �f tt'�C 9�,fi� aU�U 9 2896.JOB
SITE:
ADDRESS°�A�9bnc�s�6+Yti
APN
t
OWNER
CONTRACTOR / DESIGNER / EN (NEER \,
PM 1A Qir.wrj: , uz
Tf tANS, WFZr 140TJ Sul 13 INC
9"s MWZT ST., SUM? 102
78-4-01 F 1UGHWAY' ] 11
SAND 2130 CA (92131
LAQTI s 0.. CA 922-5
C160)771-336'3 c:'S'.0 € 4.972
USE OF PERMIT
MN'012? FAMUN' LtWELU NG
S1�i7 � ?.C1T fft FLaA•1� �1�}L PLiitUllff' l''l01suS' i�L�"d' I7JC1..U1+113.E,fDC.I�
WALLA P()01:,, SPA. Oft DRIV9 r`>;'Y APPROACH. 75%� W) DUCTION TO PLAN
+M;iiFZr. ME VOR f Al11. TIPL-r, 15S11.)IJ 04CLO, OF SA'M. Z PLA,'N T" i P
`1'F.4rT CONSTRUCTION 3,ZA00 SP
PORCH/PAT IO 40 2.00 SY
f#r9, ldC3�lC 1�C2! 657.00 S
EfTEMIMD COSIT OF C;CdJ. 911R'Cl'M:: 0H
A9e3M2-no
CONS'S'RUCNONYER 101-006-418-00D I:Ms0
pjLMj
tdEM%LAICAL lF"fM 101-000-473-000 W.00
101.000.00�iC1tiGIL WE JS£.6�'
3'Lt1MF4i "o FEE 101.000-419-000 %11A11%
S`f`1df;;tNO isfdOT10N F'`VZ, ; ID 101400-241-000 $19.36
f l `.h�'jtdCi1� ? Iitl-000.4 •.00 fi13:(tf►
DZVL?I 0P.?R- MPACT YZ �,4t95,G�Lt
a
' STMI-Tovu, Co?RMIRTY&ICrB AND PLAN 0;10mc
$4,032-48
� I i
i.L MESViJR.ti VO,Y'C
t! 4,03e&AU
15 29302 2'
C: f
RECEIPT
DATE
BY
DAT FINALED
INSPECT
INSPECTION RECORD
4 OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
D 39- o7-
Ducts
Slab Grade
Return Air
Steel
_ 3/ -p2-
Combustion Air
Roof Deck
p —
Exhaust Fans
O.K. to Wrap
_ Z _
F.A.U.
Framing
_ 2 _
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
-z- �-
Drywall - Int. Lath
/ S
Final
Final
— 5` 3
POOLS - SPAS
BLOCKWALL
APPROVALS
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
JA
Waste Lines ��Gr a
Gas Test
Electric Final
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
COMMENTS:
Final
Utility Notice (Gas) Oki
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring _ Z•
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
APR -01-2003 15.35 WESTERN INSULATION 909 686 8786 P.14/19
ww
Wj2,o.oqfziRNINSULATION* 9 L.P.
4211 Latham Street, %vera(de• California 92501
Tel. .(909)'6336-8760 Fax (909) 886-8766
iNsuLAif ON CERTIFIICATE
THIS IS TO CERTIFY THAT INSULATION HAS BEEN INSTALLED IN CONFORMANCE WITH
THE CURRENT ENERGY REGULA110N, CALIFORNIA ADMINISTRATIVE CODE, TITLE 24,
STATE SOF CALIFORNIA, IN THE BUILDING•LOCATED.AT:
TRACT/PHASE: TALANTE / PHASE 4
LOT A 8
SITE ADDRESS: 49-745 RAWW:HO SAN JULIAN LA QUINTA, CA.
V=BI08 WALLS: BATTS
MANUFACTURER: JOHNS -MAPIVILLE THICKNESS: 3 1/2" R- VALUE: R- IS
MIMSi BATTS
MANUFACTURER: JOHNS MAMVILLF_ THICKNESS; 13" R- VALUE: R-38
GINE ON . C OR. TRANSWEST HOUSING
TITL' E;
DATA:
_WESTERN INSULATION, L,P,
TITLE: PRODUCTIO
DATE: APRIL 1 „200
- Certificate of Occupancy.
U ry i�IGI��
Ulm
G OF'TYBuildin& Safety De m n t
g y part e
This Certificate is issued pursuant to the requirements of Section 109 of the California Building
Code, certifying that, at the time of issuance, this structure was in compliance with the
provisions of the Building. Code and the various ordinances of the City regulating building
construction and/or use.
BUILDING ADDRESS: 45-745 RANCHO -SAN JULIAN
Use classification: SINGLE FAMILY DWELLING Building Permit No.: 0209-065
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL
a
Owner of Building: TRANS WEST HOUSING INC Address: 78-401 F HIGHWAY 111
City, ST, ZIP: LA QUINTA CA 92253
By: GARY SHOWALTER
Date: 8-05-03
• Building Official
POST IN A CONSPICUOUS PLACE
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