0209-064 (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
Profes%onals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
�>
?010.39
F31iE; h� X J31 fU3
�Da`te;`) • '�'> ~ Signature of Contractor—
OWNER-BUILDER
ontractor,
OWNER-BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) 1, 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.
(f) I have and will . maintain workers'lcompensation 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:.
Cartier STATE 1±LMD Policy No. 00•464f.M3-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 Prov` ons�of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions.
Date: 1411,.XApplicant
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 ort.his
application.
:-t
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
the above-mentioned property for. inspecti purposes.
I -Signature (Owner/Agent) _, � " "" `�� Date Jiti • �+ �'"r�='
11 � r r ,,
BUILDINGPERMIT PERMIT#
DATE VALUATION M29p 7AO LOT 10 TRACT 2$964
„�'
GiJOB
SITE
ADDRESS x'69•, 70 RANO O SAN �.rQ:C,:iM
APN .649-M-015
OWNER.
CONTRACTOR// DESIGNER IEN1NEER
BOdd,LAQlM.NYC
TRn71481WL�Sg7OUSvO INCC
': 9155 :1M31 IT E :1.1 R)IT- 1.11 102
78-4.01 F R1.GHWAY ;1 l
,24AR1' DIM CA. 92131
1'AQL3'.tNMA, CA 92253
(760)771-3363 CT—L-0 4972
USE OF PERMIT
SF0 - 1.0T 14, PLAW 4C.R f PERMIT Oi)ES �dOT INCLUDM;~4LOCK
�h►",ti JA P004 SPA. Oil DIO'tlE5WA:Y,RR,PPIWACH, 7WiRADUC;
INSPECTION RECORD
OPERATION
DATE 1
INSPECTOR
OPERATION
DATE
INSPECTOR
- BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
p
Ducts
Slab Grade
_
—8�
Return Air
Steel
p
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
/—
F.A.U.
_
Framing
_a —
Compressor
Insulation
Fireplace P.L.
Vents
Grills
_
Fireplace T.O.
/�—/
��/
Fans & Controls
Party Wall Insulation
l/
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
of
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
I I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste LinesZEE
2 —2
Heater Final
Water Piping
Plumbing Top Out
3 _
Plumbing Final
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)
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 15:34 WESTERN INSULATION
909 666 e786 P.13/19
W '"" 6 T E I mm' N I1NTJL ATION, L*Po
4211 Latham Street, %vaside, Calkozula 92501
Tel, (909) 636.8760 Fag (909) 686-8786
INSU" IOR CERTIFICiTE
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:
TRACTIPHASE: TALANTE / PHASE 4
LOT A 10
SITE ADDRESS: 49.705 RANCHO SAN JULIAN- LA QUINTA, CA,
EXTERIOR WALLS: BAITS
MANUFACTURER: JOHNS MAWILLE . THICKNESS: 3 1/2'.' R- VALUE: R-15
CEILI�i®9: BATTS
MANUFACTURER: JOHNS MANVILLE THICKNESS: 13" R- VALUE: R-38
WEST HOUSING
-RN INSULATION, L.P.
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