0209-063 (SFD)1; LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapt6r'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
701059 BN C ��i� �� v lf3llf3a
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).
( ) 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.
(y,) 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'IYND • Policy No. DIDD-164881.4-03
(This section need not be completed if the permit valuation is for $100.00 or less).
(J 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 provissions.
Date: f " Applicant i
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 vod f_t
work is not commenceii 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 iV
correct. I agree to comply with all City, and State laws relating to the buildin
construction, and hereby authorize representatives of this City to enter upo
the above-mentioned property fo.r•ins�pecttiion purposes.
Signature (Owner/Agent) Date
BUILDINGPERMIT PERMT#
DATE VALUATION LOT 11TRACT 28964
t2,,1.,,,672_50
JOB SITE
ADDRESS 49 490 ACMOSANAfLIAa
APN
OWNER
CONTRACTOR/DESIGNER/EN 1NEER
P :tom. QUW.A, I.I-,C
TTt.AS4t` ' ",i`Iiti)L 11 CPaC°
990 .1 1'°,.>�T M% UCY!TE 302
, X3.,401 F W.011W.€ Y l l I
S"AX,I:t31�s"GO CA, 923 3l
I.jAQf:!INTA CA. 92253
USE OF PERMIT
MIM
SM . LOT 11, PLAN 3D, P.?ftiV;1T Of: Ee; NOT INCI.UDV, uU:Ic1. &aLr.:�
F'I?.?c FOR. ?i UT.:TfME ISSx.IANC1L, OF 3XVIE PLAN TYPE
'i'F ACT CONSTRUCTION 3M,4100 SF
P0..PXH17,F r,10 S',>r6,00 SF
0AILMI lCARPORT 662,00 S'F
��'I ;`I�) C(�r?, r lull, V` 111SI ' IC`'�''-t� 11,
/ i �1 / ��j
INERNU 107-
Ct NSTRUC'T19A F ISK 101 ^t 00.4 1 MOD V.03& ca
PLAN C:@i,F�K. 3TFX 101- (KJ -439-:318 .014.67
MECHANICAL ME IM -000-47.1-0100 $415O
kLEC<"TR'IGAI. F?S 11", 141-000-4.20-000 $171-t-7
P1A)MDING PC,F. 101-000-419-000 31.91123
GRADING f-7,9 1 O1.,OZO-423r000 $15106
'DEi=)P1• P1 JUIPA.Ci' FZ1. $A403.00
ART W PUBLIC JzLAC YS : R0,11`270-000-445-000
i
Ot�'.�,-`,i"c'1fi:AT -come 101- IT l IECK.
$4,183 ('k'i•
7 IelsSS 'PREI-PAiDFFM
$0 00
fejt' `� ��F.'i k i}, •,tti x ^.
RECEIPT -
DATE `
FD
BY f
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
/— —
Return Air
Steel
Q,. a 2
Combustion Air
Roof Deck
p
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
_
_
Compressor
Insulation
—3
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
3
Drywall - Int. Lath
Final 1 2— 3
Final 3
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
I I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines �'�
�.
Heater Final
Water Piping
Plumbing Top Out
Plumbing Final
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
%j
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring X7,3- 3
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles _
G.F.I.
Smoke Detectors
Temp. Use of Power
Final _ 3
Utility Notice (Perm) �'
COMMENTS:
APR-01-2003 15:34. WESTERN INSULATION 909 68b 8786 P.12/19
Es JL
4211 Latham Sleet, Mversfde, CaMomia 92501
Tel.. (909) 6116-8760, Fax -(909) 686.8786
INSULATION CKRTIFICATIC
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:
TRACT/PHASE: TALANTE I PHASE 4
LOT #: 17
SITE ADDRESS: 49-690 RANCHO SAN JULIAN - LA QUINTA, CA,
EXTEJ(T RIOR V % S: BAlT'S
MANUFACTURER;, JOHNS lAANV/U.E' THICKNE=SS: 3 1/2" R- VALUE: R-1.5
C BA7TS
MANUFACTURER: JOHNS MAAIVILLE THICKNE88: 13" R• VALUE; R-38
ASSN ST HOUSING
ESTERN INSULATION, L.P.