0209-067 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chap yr 9 (commencing with Section 7000) of Division 3 of the Business and
y Professionals Code, and my License is in full force and effect.
License # Lic. Class N Exp. Date
„�.
Date A) �+ ' 'y 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 properfy, 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.
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 W policy no. are:
Carrier SitA.TE MD Policy No. 00_164"D-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' compensationro-is.ions of Section 3700 of the Labor
.goy
Code, I shall forthwith comply with those rislons.
Date: /�✓'%'t' 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 ' c:
whose request and for whose benefit work is performed under or pursuant f
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 forr'nns�pvection,purposes.
g ature (Owner/Agent) Date
BUILDING PERMIT PERMIT#
0.109•,06'1
DATE VALUATION LOT 4 TRACT 29964
JOB SITE ADDRESS J. ".�s�. RANC~'.t�;O i#!%�.NTA MUZI �'r°w��TA
APN 649-400-015
OWNER
CONTRACTOR / DESIGNER / EN (NEER
PM LA (�rT.=A, LLC
11ZANS WESM HO IG 114C
%?(,� lmlwa'W, i-,Tvm In
78.401 :tr RaMMAY 'I 11
SAN =00 CA 92131
3-.A QTT04TA CA 9.2253
USE OF PERMIT
WOULRAMYLYMM.LANO
n) • for 4, PLAN AD. PERMIT DOES NOT INCIAIDIP? BLOCK
WA;i,IA J1001, RPA OR DRURKWAY APPIt,OAS"MSIX FtLIDUCei'CaRI TO PLAN
CHECK "M FOP, iMUUJ1PL-9 MSUANCE OF SAME PPI TYPE
TRACT CONPSTRUCTKM wI ;'x,00 :4r'
PO,RC IVIPATIO 526.00 ar
0:laAAMCARPORT 643,00.8F
EiT: k CM'S OF C OMNI R1p'MOX
191,936.20
(:c7A;VIRUCTICIN FEE 101-000-418-000 $061.50
PLIAAt C:Hir-K FEE 101-000-439-3 18 $199.45
MK1CMTQ(°Al: P'R'E 101 •000m421 pWO $92.5
if t:tIti.:'I',&IC A..t.e 11,99" ; 101 -000-420-OW $WAX
IPLUMPIN03 P3.:.E 101-000-419-000%- 5191,25
aT1oOW0 MOT1014 M,` RESID 161-000.241-000 $19.19
(RADFRO MSE 101.000.423<000 $15.00
I)ZV_V.LDP8,R IMPACT YE•E 15?�Ob.Ofl
x.
W
SUB -TOTAL CO AND I:'I,�N CEMOC
$4,041.31
XIM
ITA.L P;..•"RII�F..IET �,[+:.��' DUE HOW
—74
0%r1 T
RECEIPT V""--YA?.DQTE'-•y•-,�
' l
aY , // /
DAT NALED
INSPECT
'
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
_ - 2
Return Air
Steel
Combustion Air
Roof Deck
— 3
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
2 -
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
—
Drywall - Int. Lath
jV
Final
5 - - G
Final
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
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
_APX5d�0.1
Heater Final
Water Piping
_
Plumbing Final
Plumbing Top Out
—c')
Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
f _ — � �
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
Final
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) .f-
COMMENTS:
APR --01-2003 15:36 41ESTERN INSULATION 909 686 8786 P.16i19
ESTI 'N LATIC"N, Lo P.
421.1 Latham. S•reet,livcrside, Califomipa 92501
ToL (909) 6815,8760 Sit (909) 880.8786
INSULATION CERTIMCATE
THIS IS TO -CERTIFY THAT INSULA.T1WHASS 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 # 4"
SITE ADDRESS: 79-555 RANOHO SANTA MARGARITA - LA.QUINTA, CA_
EXTERIOR WALLS: BATTS
MANUFACTURER: JOHNS MANVILLE THICKNESS: 3 112" R- VALUE: R-15
SA TTS
MANUFACTURER: JOHNS MANVILLE THICKNESS: 13" R- VALUE: R-38
GENE- - -- ON; - Mlt'. TRANSWEST HOUSING
BY:
TITLE: PRODU(
DATE: APRIL 1,
WESTERN. INSULATION, L.P.
0
i