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LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
k5apter 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
B i0i3li120(
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.
( ) 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/w IN
��c� Policy No.
La
(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 provisions.
Date: 1 . r Applicant I ►'(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 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) !'k—om• t)_6 Date
PERMIT #
BUILDING PERMIT
991112-00
DfifAN O 5 2000 VALUATION ���`��y�.f� LOT �5 TRACT ?3995,8
JOB SITE
ADDRESS 4.5-715 i:iaLDAIscO+OK i.ARE
APN X11 +�->fy'ai!'t-al b
OWNER
CONTRACTOR / DESIGNER / ENGINEER
r� arr(!i?irCr3r�ts Gi i Cr0a,4'A4rT001-N'EC
Alr1\1 1% 111, let l.3lllV 1/. I.
ht:�t�,trnSSn''�r'0Vr�TROI�rc:11 r•r'r���.>ir�tPr`1EC
—1,j''.`lI\A l bre i..�r V�J/� 1:�,rrV 1.! 11
1533 SCJ- "inn MEf: i.', S'1 E. #200
SAN BERNARDINO CA 9241115
SAN BERNARI INO CA 9241%
4,909M1_(OH G T,tf fT1110
USE OF PERMIT
SlNGLin A'AMLk T;IWELLiNG
1
Si -D -LOT 55 d>L V44.T&-- TIE L DOES) NOT INEMUDE BLOCK WALL OR.
TIUC 1' ,. ONSTRUC' ION Z200slo "T'
('ok i-TIPATTO - 210 � F
(iAtAsfl7CAtdi'c�it'1' 635.008V
.ya��.+51FI PUU.'lr.7d"O..a;NS OFl.`+JN� TR�r.TI.J.•I4Y1'Y
132119.3.60
�t �; gqp a
F' �+8rr 67i�.LV3 iY6�ii ,W7
CX) NS'I'RUCf1. 0 N Fk:E 101 -WG -Oil{ -000$155.00
P(- q,j f r14jiH!1 FFF 101 -W-439-311 fR
;� a^.dS13NiCAi. i fsi~ 101-000-4211-0010
-
11Ld.0 -1 P tCAL FIX 101-000-4410-000 $13$.20
P1,UM' N0 F.fX, 101-000-419.0110
V't ONC, il.•-101'T.Y.0 HI?, M MR.SAIV1 801 -MO -241-000 $f 1.22
rp
I .RADRIG 1704 1.01-000.4.23-000 $20,03-
.#:)Ls\,1;i OPER .s VAI: t srE SI,5 37.t1i1
-' i 1
Awr fN 1'[!}3.L 6 PLAGi?S - RES1C 701-000-255-000 S;W.50
t
SUR-TC'I1 A 1. CONSTRUCTION AND MAN CY11 CK.
9;3,1 �R 30
LESS Pu-PLSID FEES
s0.00
TOTAL PL�IIt \tIT to F,RS'DIJE Nt 0 r
$3,72,11.30
RECEIPT
DATE
BY J
DATEFINALED
INSPECTOR
��
INSPECTION RECORD
^� OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
`Underground Ducts
Forms & Footings
0 " ow
Ducts
Slab Grade
12--L-2-00 la
Return Air
Steel
- l0 .
Combustion Air
Roof Deck
.gypjet
Exhaust Fans .
O.K. to Wrap
F.A.U.
Framing
tg , r -5 .-c,
Compressor
Insulation
-t.3 _
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
U . Z(. • OI j kQ
Drywall - Int. Lath
Final
Final o w
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location,
Underground Electrio ,.
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
Sewer Connection
_ Z
CQ
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final ®?Jb
Utility Notice (Gas) b �G
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Law Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power —5
Final .o ;
Utility Notice (Perm) '
COMMENTS:
OCT -16-2000 15!06 WESTERN INSULATION 909 696 8786 P,13i21
WESTERN I1 SULATI� ', IrTC.
4211 Latlu= StMt, Riverside, C8 MMja 92501
Tel, (909) 686.67W Fax (9091686-8786
INS ULATU C RTIFICATE
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 1 PHASE: MARBELLA 11 -23995-8 PHASE 2
LOT # : 55
SITE ADDRESS 46-715 COLDBROOK AVE, LA QUINTA, CA
EME iIOR WALLS:
MANUFACTURER: GREENSTONE THICKNESS: 10.3 " R -VALUE: R-38
C@ GS• BATTS BLO
MANUFACTURER: JOHNS MAN THICKNESS: 13" R -VALUE: R-38
� j A1TS BLOW '
MANUFACTURER: JOHNS M 1..E THICKNESS: 35/8" R -VALUE: R-13
GE IERAL CONIBACTOR: CENTURY HOMES
LICENSE NUMBER:
BY:
TITLE:
DATE:
111SI&A1I0n T A R: WESTERN INSULATION, INC.
LICENSE -NUMBER: 48127
BY:
TITLE: OFFICE MANAGE
DATE OCTOBER 16, 2000