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0005-013 (RPL)�,..+ LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of I— Chapter 9 -(commencing with Section 7000) of Division 3 of the Business and 04 W ° Professionals Code, and my License is in full force and effect. O =) M License.# Lic. Class Exp. Date r- LLJ cc c C27 / Y o Z r— Date Signature of Contractor- -� °- Z0 0.O J CD OWNER -BUILDER DECLARATION W W r I hereby affirm under penalty of perjury that I am exempt from the Contractor's ~ N License Law for the following reason: Z_ ( ) 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 LO N Date Signature of Owner O N d z WORKER'S COMPENSATION DECLARATION oZ I hereby affirm under penalty of perjury one of the following declarations: LID F2 0 () 1 have and will maintain a certificate of consent to self -insure for workers' X W Y= compensation, as provided for by Section 3700 of the Labor Code, for the O J Q performance of the work for which this permit is issued. m Q I have and will maintain workers' compensation insurance, as required by O (-)Q . Section 3700 of the Labor Code, for the performance of the work for which this rn P- permit is issued. My, workers' compensation insurance carrier & policy no. are: ,c Z CartierPolicy No. co Z) STATi:,k'WiN©. 100142�0Q r`' d J (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 fortwith comply with those provisions. .. ; Date:;r•A'pplicant Warning: Failure to secure Workers' Compensation coverage Is nlawful and shall subject an employer to criminal penalties and,avil 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.forinspecti,cn purposes. Signature (Owner/Agent) Date'_- z. re BUILDING PERMIT PERMIT# DATE VALUATION LOT OM ­013 TRACT (*/32/19C $1510W.00 JOB SITE APN ADDRESS 7r9�-3201'1TJ*MS - Y OWNER CONTRACTOR/DESIGNER/ENGINEER KSL LAND CORPOkKMM DIN, BALM W1ZW1 ffF8 79320 CUR115 81965 MOD ITfAM VIKW LA14B LAQMTTP, CA 92253 L.AQUWfA C"A, 92253 (760)�98w1766 CBL.4 1888 USE OF PERMIT POOL AN7?IOR VA POOL, & SPA ONLY,,ALARAiS/13Ar wzs si'1.4M,, HE IN PLACE AT& PRY, PLASTER J'CISP)ECT1014 PO01, A:W4DJOR. 5RA _ 15.000.00 1w n"rJMXfED COST OF C0MMTTC;1ION 15W000.00 PLAN CHECK FEE 101.000.439.318 SS05.30 CONST1?.1iCTION P%E 101-000-419-000 �t67.OQ MEXH.ANIGAL 1ME • - POOL 101.000-421.000 524.00 El.,P_.CTR10t.L F'ir2 -• P001. 101-000-420-000 $45.00 PLU1a11312 O FRE POOL 101.000.419.000 ,.f - t- C4Tr 9' LIB4'O'1::,AL 0ONWDRTTJ'M1014AN"'�+. PL"IR-M x X 1,,3.30 1.33?eUPtlD ERB. .� stnQ TarnvyT40A � 1irs.Tlde�rJ� RECEIPT DATE BY�JI/ f DATE FINALED INSPECTOR t/ r .• A INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS - MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade Return Air Steel Combustion 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 BLOCKWALL APPROVALS Steel POOLS - SPAS Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test I f_ Final Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection 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: 04/30/2000 22:09 7603988935 A RE -INSPECTION FEE OF $30 MULL BE CHARGED IF THE APPROVED ![W AND 10B CARD ARE NOT ON lK. SITE -FOR A -SCHEDULED SECTION. .NO EXCEPTIONSI LAZZARINI CITY OF �A (QUINTA BUILDING & SAFETY DEPT APPROVED �. cEpR CON�TQ� �r�rii,. PAGE 03 Tate Residence Date: 4129/00 79320 Citrus (Lot 18) Design by: La Quints, CA 92253 Date Palm Ent WESTERN INSULATION, INC. 4211 Latham Street, Riverside, California 92501 Tel. (909) 686-8760 Fax (909) 686-8786 INSULATION CERTIFICATE 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: CITRUS - TRACT # 24890-7 LOT# 18 SITE ADDRESS: 79-320 CITRUS --------------- -------------------------------------------------- EXTERIOR WALLS MANUFACTURER: Johns -Manville THICKNESS: 3 5/8" R -VALUE: R-13 CEILINGS: QB ATTS BLOW MANUFACTURER: Johns -Manville THICKNESS: 13" R -VALUE: R-38 CEILINGS: BATTS BLOW MANUFACTURER: Greenstone THICKNESS: 10.3" R -VALUE: R-38 ------------------------------------------------------------------ GENERAL CONTRACTOR: SHEFFIELD HOMES. LICENSE NUMBER: BY: TITLE: DATE: INSULATION CONTRACTOR: WESTERN INSULATION, INC. LICENSE Nl 1BER: 481278 BY: TITLE: PRODUC ION MANA DATE April , 2000 cJ ,Q '� .