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LICENSED CONTRACTOR DECLARATION
I hereby affirrr,under penalty of perjury that I am licensed under provisions of
Chap* 9 (cencing 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
Date G� 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:
( ) 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).
( ) 1, 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-insGre 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 /� ♦y» 1 Policy No.
(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 irr 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 provisi1.ons;
Date: �" �� -�--�. 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 for inspection purposes.
Signature (Owner/Agent) a /�� �•�/ Date �-
BUILDING PERMIT PERMIT#
�4,zyf 84
AT VALUATION LOT TRACT
sl;c� .397.dn � � -23995-19
AN 0 5 2000JOB
SITE
ADDRESS 45-.735 i:.lsi�ui3i1OOK LAINE
APN '04-040-016
OWNER
CONTRACTOR/DESIGNER/ENGINEER
CENT tl)".Y' CRCAVC-111 CC,MMUI`dl'i'lES
C-TIM'I`E,MY CR,('WELL CCtft MUN1' I S
1.535 SG. "G" a i'r�F ..i', S`i13. k200
1535 SO. "0' STREET, E r . #2100
SA.N 13 RN.A.R701NO C.A. 92408
SAN €3ERNAR.0010 CA. 92408
(909A 1-000°7 Moo 71210
.
USE OF PERMIT
iNuLE i'.�i�is:1.,!' uwSLL1N��
r
3i -'D -.L0 531;i -AN - P1 tUMIT DOES MDT 1114Ci.pw BLOCK WALL OR
751/61°3.AN CklE,t=1122EOUC'•'T'.ION r' PP.Llli6k'(31t PL1C.1L'f.'l1rI'a
T.r%JA TOY S"r'alicTIOi" A,aiivAO S
r3AE3r�i3L�J�;t1itT°UfC`i' 42000 SF
D C0.3T 0 C01N1,STrZUC� ION
169397.60
C�Tt7c, T�,T A 7��WfIAlAXE.
l� gy, y �* FE
��Y+i..i1t�Hi tr^. ER, SV1W�.IYiAR A
r. -
WNs'! RUC110N FEES 101-000-418-000
P1,Aty t14- `Ck V6F it11.(i1j114d 4-3 13 1��,7n
r , _ .
X.F1i4 HAN:IC-Al" Fa� 2 0;1-000-142A -0,0 $41.00
` c
:i.l~l:UTCAL .0 EE 1.01,000-420-000 $ 119.91)
P1.t1h(13IM F.E.E 191-( k3� 1l-Q0J
5'T72t"tNC}IFFF..-''KFS, 1P i F4l(!(0lj�1
GRAINN110 F1 E 101.000-- 63-000
DE- Via vP1:12.1.Ivil,AC T FEL
Att 1' 1'N PIJBLSC Pi. A(�ES - RES[r., 701-1100-255-000
'91 TIR-`17OM0. CONS'P"€ai'1'CTiOM AN!,,Pp;ANN ('141:(,'.9.
4R
LES„ Pr L_.RiiD PE13"
$0,00
PIMOT FREUS DUE NOW
RECEIPT
DATE
BY / J
DATE FINALED
INSPECTOR
/
011111M
INSPECTION RECORD
OPERATION
DATE.
INSPECTOR
OPERATION
DATE
INSPECTOR
Ar
BUILDING
APPROVALS
fi - MECHANICAL APPROVALS
Set Backs
:a :Underground Ducts
Forms &Footings
Ducts, ...
Slab Grade
1- 2Z
-Return Air
Steel
I :70-7w 0
• Combustion Air
Roof Deck
- -O Q C
:;Exhaust Fans -
OX to Wrap
F.A.U.
Framing
.,
Compressor
Insulation
(�-Zc3,�d
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
(, .7-(& - GO
Drywall - Int- Lath
(� .
Final 11
Final
_
��?�
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
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
t�'i 7
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 Q
Final
Utility Notice (Perm)
OCT -16-2000 15:01 WESTERN INSULATION
909 686 8786 P.03/21
TE N INSULATION 9
INC*
4211 I ww= Street, MVereide, CaUjor 92301
TeL (909) 686-8760 pm (909) 686-8786
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: MARSELLA II -23995.8 PHASE 2
LOT # 53
SITE ADDRESS 45-735 COLD13ROOK LANE, LA Q- - - - - CA - - - - • - .
EXT OR WAU&
MANUFACTURER: GREENSTONE THICKNESS: 8.1 " R -VALUE: R-30
IUNGS:, BATTS BLOW
MANUFACTURER: JOHNS MANVILLE THICKNESS. 11" R -VALUE: R-30
CE1L BATT BLOW
MANUFACTURER: JOHN"ANVILLE THICKNESS: 3 5/8" R -VALUE: R-13
®ENEEAL Q-01 IN002' ' - -CENTURY HOMES
LICENSE NUMBER:
BY:
TITLE:
DATE:
INSULATION Co �nT.'ESTERN INSULATION, INC.
LICENSE NUMBER: 48127
BY:
TITLE: OFFICE MANAGER
DATE OCTOBER 18, 2000