0209-066 (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. Date
7010301 B FITC fes' 1 / 11103
Date ) '4'r,, 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.
( ) 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 STA rt, I+"tj'ND Policy No. WO -1.001341
(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 those, rdvislbns.
Date f? Applicant—
Warning:
pplicant Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to .
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property fordnspecgtion purposes.
Signature (Owner/Agent) Date A
BUILDING PERMIT PERMIT#
DATE VALUATION t115*0%2" LOT 5 TRACT 289'6JOB �
ADDRESS 'N -,`i5 �'a�t.I�TC,HO S�i:I�3fAi AIAR�:A'FxJ Ai APN 6491 -.i.Lit"15
OWNER CONTRACTOR / DESIGNER / EN (NEER
PM Imo. QLTM:t'A„ i..;iX TitMs �Tv"�'m-14011miC t"igc
9961$ TUB" Z r ST., SCAIM? 102 78.4.17 }7 gMMAT 111
M; DJEC-* CA 92131 .t..ckQLTNTAi CA SIM
(7623)771-3365 MIA 4972
USE OF PERMIT
M1,1012. FAMLY T3' ? [- FNG
314) -LOTS, PU". XL P:L.t NIT DOMNOTMCLUDE BLOCK
WALL% P001, SPA. OR DRPIEW.AV APPRO ACC. % 1'.E97UC T IOM TO K
CHECK ?.%I,' FOR NIIti TIPILZ ISSUA NCZ OF &Afft PI JAM ME
TRACT CONSTRUCTION 3,2:10.00 311;
FC;It.0 �3iI�.A9`1:Gt 4if�.W? 4f/'
0A.RAMCARPORT 65-7,00 OF
5�3i{11:S1i�L6; 9U:3t'
C.ONSTPLt3CTIO7 IMP
101-000418.000 SM50
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101-000.4°39.318 n195�.£t3
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101.000.421.000
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101-000420-000
P!ai.Il I1 "o FE9 101-000-419-000 S179.23
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OCT L J U 2
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RECEIPT .
DATE
BY ' '
DATE F NALED
INSPECT
'A
s.
�
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
_ ®
Ducts
Slab Grade
_ 'j r 2—
Return Air —
Steel
- m
Combustion Air
Roof Deck
—
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
-- p
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 Q
Final _ =,6-�
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
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
—� _B� t -
Heater Final
Water Piping
Plumbing Top Out
=�
Plumbing Final
Equipment Enclosure
Shower Pans
%
O.K. for Finish Plaster
Sewer Lateral
,/
Pool Cover
Sewer Connection
e��i�
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)
COMMENTS:
APR-01-2003 1535 WESTERN INSULATION 909 686 8786 P.15i19
WESTERN I. iJLA: ION v LJP,
4211 Latham Stmet. Mvcrsidc, California 92301
Tel. (909) 836-8780 Fax (909) 680-8780
I1vSULN.110N CERTIFICATE
THIS IS TO CERTIFY THAT INSUI.Ai f ION 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 / PHASE 4
LOT M 6
SITE ADDRESS: 79-535 RANCHO SANTA MARGARITA - LA QUINTA, CA.
EXTIERIOR WALLS: aA TTS
MANUFACTURER: JOHNS MAtJOLLE THICKNESS: 3 1/2" R- VALUE: R-15
CEILINGS: BATTS
MANUFACTURER: JOHNS MAWILLE THICKNESS: 13" R-.VALUE: R-38
SWEST HOUSING
!TERM INSULATION, L,P.