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0209-062 (SFD)LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of 4,^g��h,i,pter 9 (commencing with Section 7000) of Division 3 of the Business and F•it)teSSlonalS Code, and my License is in full force and effect. License # Lic. Class Exp. Date 7010311 JB MC ;/� � 1131/03 ,Date 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). ` , r ( ) 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 pert rmance of the work for which this permit is issued. t��}!() I have and will maintain workers' compensation insurance, as required by Slection 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 ISTAT8 Ft91 D Policy No. 000.164"13-01 (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 thosefp,6v 69. Date: r j�%'r1'�f" � ,y .Applicant -'<' --*' av P 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 pure0ant 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 the above-mentioned property for innspection purposes. Signature (Owner/Agent) r� Date /0'I�'tre)'� -BUILDING PERMIT PERMIT# DATE VALUATION LOT TRACT $I93At2.80 12 28961 JOB SITE ADDRESS 49 -?39 RE�.�IM'0 s9f�•�I -TWA N APN 64t�'-100-E 15 OWNER CONTRACTOR/DESIGNER/EN (NEER PM LES Qti'.tkf�'rA, :T1 P, 1RAMwIa', r HOU&MG .114C 9968 11I59RT 91, RMT, I Q2 713.401 F MG11WAY 111 St=mob CA 92331 I. k QC 14TA CA 92253 (769)771-3363 CL" 49'7.2 USE OF PERMIT C3UFAMILY DWl '.WO SFr) -WT 12, PLAN 20, PE.R.i+UT I3OU NOT INCLUDE RRC K WALL0, P004 ZPA OR DRIV.11WAY APPROAG K 75% REDU"I' IO'N TO ,IN AN CHECK FEY. FOR MXJLTIPLZ ISSUA14Ct OF SAUZ PLAN 1101 TRACT CORSTR iC`1a1614 3,230.00 SF Pt'.3RCWPATIO 40000 Sip ? GARAS.Iiz.ICARPORT 651,00 sip ' -F EmMl7c0 C091' OIs" Cf3AMTUC'110- .(t 14.TOliC3':i'f`>:."$U R1PiWARV C40311 RUCTION FEF 9969,50- PLXt4 CHECK IEL: 1 CJ1-t1eTi#=� 3 �- � 18 $159.69 MEC.i-I"ICALii E 101-000.421-000 WAD cr>z��:�►.c,�=1�;; � 1��-Qaci�zo�cr,� �I��:�� , .P1Ii1MBINGI ITF 101-000.419-000 EI79125 STRON0 PV OT70314 FFE, - ila. 91D 101-000-W -000 $19.36 G RADINOFIjE 101-000.423-000 $14100 x)E'4atELC+i'ER IMPACT FEZ $4405.00 0 • PLAR CHECK, `rC A 3 'RTIC� .4197.0AN •: ____ _ �� s- LMS PRED,11AIDY—M ,� $0.00 flni PETMV 14711. ©rT 1 . P RECEIPT BY / 1 DATE FINALED INSPECTOR !DATE INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Q%—B 2 Ducts Slab Grade Return Air SteelCombustion _ Air Roof Deck © Exhaust Fans O. K. to Wrap —/ — 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 - Final 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 Gas Test Electric Final Waste Lines©-- _ Z%- Heater Final Water Piping J Plumbing Final Plumbing Top Out / Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection 3 Encapsulation Gas Piping Gas Test Appliances Final COMMENTS: 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) APR -01-2003 1533 WESTERN INSULATION 909 686 8786 P.11i19 N'SULATION, L.P. 421.1 Latham Sweet, Riverside, California 92501 Tel. {909} 6413-6760 Fax (909)A686-8786 - INSULATION'CERTIFICATE THIS IS TO CERTIFY THAT INSULATION HAS SEEN .INSTALLED IN CONFORMANCE WITH THE CURRENT ENERGY REGULATION, CALIFORNIA ADMINISTRATIVE CODE, TITLE 24, STATE OF CALIFORNIA, IN THE BUILDING LOCATED AT: TRACT/PHASE: TAI -ANTE / PHASE 4 LOT #: 12 SITE ADDRESS: 49-730 RANCHO SAN JULIAN - LA QUINTA CA. EXTERIOR WALLS: BATTS MANUFACTURER: JOHNS MAAfVIUE THICKNESS: 3 1/2" R -VALUE: R-15 CEILING,;, BAITS MANUFACTURER: JOHNS MANVILLE THICKNESS: 13" R- VALUE: R-38 NSWEST HOUSING ESTERN INSULATION, L.P, 1