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�t'`-'} LICENSED CONTRACTOR DECLARATION
I hu -%y 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
i id i "' h i "'3lri0f
Date �- �- �� Signature of Contractor -71111 A
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:
CarrierY�, Policy No.
%'Jne�
OU.3N N f.:A.�.�LE INS.
(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: 7 r- Applicant �. �!"�. a�!r�! 7 /fl,s
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) 11 .1 A Y -f V'a't + / ! Date 1 -' 7 1l
BUILDING PERMIT PERMIT
991Z -1191
Q N O y 2000 VALUATION LOT TRACT 2;�5 8
JOB SITE
ADDRESS 45-70i C:{3LDA ROOK LANE
APN bf e-+ i4i�0�i6
OWNER
CONTRACTOR/DESIGNER/ENGINEER
YCR01.:1E,LA. COINSIIMIU`.n,T.T.
CIR.IT1114CRO1E C'MMU`1I'.S
3333 SO. "D" S'!'i EET, a''rE. 400
1535 SO. HD" SI'.ltEU, S-1 E. #2100
SAN BERN.AkDINO CA 92408
S,AN URNAIWINO <:.'s1 92408
t909)'1R1-f�t1R7 C13L# 2120
USE OF PERMIT
SING E ?=AM L DWTLL1NG
v
SEMS-LOT-56PLANIX - PI k&fiT i M-'1 NOT I1vCiiit?E DLOCK vJALL OR
11QUL. 7Yt" w PLAN L'tlCCK F,UXil;)UV1(Xd APPL.1110 FOR N;01tfIX3
SUBM111 AL
is Ar"r CCINSITR TION ',",u+"io.00 SF
1'011c,kl/ Xf10 f : `� 32.027 V,
UMW-JFJ AKFi K,T 4211.2)0 SF
r
a ESTIMATED &`ED COST CDL CC3NS•L RUCTIC)"N
106,397.60
0NS'1Rt.Je'. iON FBI: 101-000-41£2-000 SGd4.UU
'
M�! r''
i XXIIANICAL. FIM 101,-000-422.1-000 !•+;.1`rf3
ti"
�
1:E.1rClItUCA,I. F H E iOl-4tQti-460-t7iiu at ty.hr
:fT' � �,
PLI.i:hilONG FEY 1O.f-000-419-4)f)0I-
'f
ST R ()NO it O't'TOV f: f-_ �f�.F.CI'� � l .f)fi41-��1-1�(lf) $ [21,624
"°� ,�� S I•.
Q'IZA.MN i F1111 10.1-000-423-0017 $20.00
r:0 --A
bF-VilOPER JMPAt: l' 1"M
ART 1N P0,13LCC i?I,s�r..°�.'S - ld_SW 70)-0)-255-000 $15.99
,M' JR-TgI'A f , COMS"ML,tMION AND PLAN CIA C;:K
%3,059 49
;;F,SS PR -13NVD FE .
U
•4O'ICAC.. &'1:;DiMIX F E 1;S :i.DlIC. NOW
$-li,fli9.�4i
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
''
Underground Ducts
Forms& Footings—Z1
—
Ducts
Slab Grade
Equipment Location
Return Air
Steel
^L --L -
Combustion Air
Roof Deck
-
Exhaust Fans
O.K. to Wrap
4k -c0
F.A.U.
Framing
4. i3 Q0
Compressor
Insulation
(o 'U'Dp
Vents
Fireplace P.L.
Plumbing Final
Grills
Fireplace T.O.
Equipment Enclosure
Fans & Controls
Party Wall Insulation
O.K. for Finish Plaster
Condensate Lines
Party Wall Firewall
Pool Cover
Sewer Connection
Exterior Lath
to --L (o - 00
Gas Piping
Drvwall - Int. Lath
r. --cep, _(4A IL
Gas Test
Final
COMMENTS:
Final
a\(fo
rinai
Final
BLOCKWALL APPROVALS
POOLS - SPAS
steel
Set Backs
Temp. Power Pole
Electric Bond
Footings
Main Drain
Bond Beam
Low Voltage Wiring
Approval to Cover
Fixtures
Equipment Location
Sub Panels
Underground Electric
Exterior Receptacles
Underground Plbg. Test
Final
Smoke Detectors
Gas Piping
PLUMBING
APPROVALS
Gas Test
Electric Final
Waste Lines
s.- t2 -o0
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
CA
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Final
COMMENTS:
Final
a\(fo
Utility Notice (Gas)
o C
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)
L
dl i
OCT -16-2000 15:01 WESTERN INSULATION
909 686 8786 P.02i21
W 0"A IN'SiJLATION 9
INC.
4211 Latham street, Riverside, C"f n s 9260 i
TtL (909) 686.8760 FOX (909) 68Er8786
Eff aE"AT
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: MARBELLA II -23956.5 PHASE 2
LOT # 56
SITE ADDRESS 45-705 COLDBROOK LANE, LA aUINTA, CA
QaEglog WA S:
MANUFACTURER: GREENSTONE THTC SS: 8.1 " R -VALUE: R-30
CEILINGS: BATT$ SLOW
MANUFACTURER: JOHNS MANVILLE THICKNESS: 11" R -VALUE: R-30
CEI GS: BATTS BLOW
MANUFACTURER: JOHN ANVILLE THICKNESS: 3 5/8' R -VALUE: R-13
GENERAL CON'MGToa - CENTURY HOMES
LICENSE NUMBER:.
BY:
TITLE:
DATE:
S T IVTACT WESTERN INSULATION, INC.
LICENSE NUMBER: 481278
BY:
TITLE: OFFICE MANAGER
DATE OCTOBER 16, 2000
I