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N LICENSED CONTRACTOR DECLARATION
4ereby 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
71.H86 B 10i31/20(
Date Signature of Contractor i N/4,171 = 6
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:
Carriertt1� 4 Policy No. } F t 1! n
t14J1.0LITIN L:iVi.c.t TL^l �4. }4 YY i. .i'"tV ty'U2
(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: t 4.31 Applicant W f I .d
v V
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes. EE
Signature (Owner/Agent) A Date 1
PERMIT #
BUILDING PERMIT
QA _E �000 VALUATION ��� 1".6,0 LOT .57 TRACT
AN Y
�
ADDRESS 455-635 �.O.LDBROOK .ANE JOB SITE
APN 604-040-016
.OWNER
CONTRACTOR/DESIGNER/ENGINEER
!°'-!1AP!''f 71)iy i"'"Oilti!'J;i P ra"ta.rna•r r'ar!'-rn:
14..4J1i lAVt V .I i It A
tr, Nrm ro v riy-sAyri Tf-lnhl Ok n MTM-(A:v
.
1IIA .. ir14.W♦1 I. A4t,%,%a,44n`14-JI V A, I. AI.a.J
153 + SO. rOa STREET, STE ii200
1535 SO. IV' 6'VKtiET, STT. 'M
S_AN t3E'R-NA ANO CA 01408
&*kN .BLRNAFLD1N0 Cj1. 92408
(9091,
M CM X 2120
USE OF PERMIT
S.I.N6LE..FAMILY' OvJ> L.L£NC3
-
SY D-C.OT57 1 LAN4C:- ia>:•,12.M(T DOTIS 14071 .iNC'`I;LIDE B4,tjc1': Ai .T, fi11
f'00,, 75% PLAN! CTWa C:K !Z&)i1CTILUN AltK.J�U'FU.X. Yb1U.i.,'1'!.'r'i„t: 1
'� 4.Ct�7� Afl4 R1 Cry 1p .4 f.
its r l G�.14l.pTl.\,1A4Til!lY SF
,-, .,c.'N0.00
lY0lRl-:4lIkPX1-16 / : ind,06
CitUQl�d dCtliiNt)($ > ” ',. 0S.00
iD COST OFT OTISTxaiU ION'
1321193.60
a'i R. LIMIT FEE SUMMARY�
� 1
C.'ONSTttIIG".t'1014FEF_' 101-000-419-300 5755.00
PI, ANf;'%tf~�,"(.C.R't 0()I.-(1(tff�Q�a-;i1R
ANZ471ANIC tV, FEB 101.-000-4121_000 $51M
3 ��
f. � •r
Ef:Et"'T'KICi�i.Irl;f: .1041.000-420-000 $18.24)
ti'(.i';1�t333"I�IC11�.�: 1.(11-00{7-aly-U00 �13t3.50
"`} �-- I
TROMI 0-7d 14
I'{
01-C-M000G31Sitf'1 S $20,Qt0
.��
!)BgLs PJRt uL.iwAC P F :'i,yilfi,vt,
LQ
Arra' 114 PUBLIC.PLAC1±S-1t.ESID 70!-000-255-000 W.50
LESS .PR'Gt'MO FU S
$0,00
.i"��✓I CP �J .i'S`,r �+tlYli".i �I�C.iIw� F.Al)c�l�llJ'!Y
�Jt4�3�..J�
RECEIPT
DATE
BY /r
DATE FINALED
INSPECTOR
U
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
'OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
' '
Underground Ducts
Forms & Footings
:;-2Z -pp ttd
Ducts
Slab Grade
1 -LV 42V
Return Air
Steel
2 -22 -(Du t
Combustion Air
Roof Deck
Exhaust Fans Y
O.K. to Wrap
la -tom
F.A.U.
Framing
LU . .
Compressor
Insulation
`7'_ L -d
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
q : QQ
Drywall - Int. Lath
(A --50 �O
Final o�
BLOCKWALL APPROVALS
Final
POOLS - SPAS
Steel x
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
L -tt _ nx3
Heater Final
Water Piping
Plumbing Final.
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
`2^
Pool Cover
Encapsulation
Gas Piping
Gas Test
(
,.
Appliance's
Final
Final
Utility Notice (Gas) .ov
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:
OCT -16-2000 1507 WESTERN INSULATION 909 686 8786 P,14%21
WmE TERN
I ►UI�A,TION INC 9
42111 AMA m Street, Riw nide, California 92501
Tal. (909) 685-8760 V= (909) OW -8786
lNgM ATI®Ni CERTIFI�AT
CERTIFY THAT INSULATION HAS BEEN INSTALLED IN CONFORMANCE WITH
THIS IS TO
THE CURRENT ENERGY REGULATION, CALIFORNIA ADMINISTRATIVE CODE, TITLE 24,
STATE OF CALIFORNIA,
IN THE BUILDING LOCATED AT:
TRACT 1 PHASE:
MARBELLA II -23995.8 PHASE 2
LOT #
SITE ADDRESS
67
45.685 COLDBROOK AVE, LA QUINTA, CA
MANUFACTURER:
OREENSTONE THl 10.3 " R -VALUE: R-38
Q&ILdNGS:
BATTS BLO
MANUFACTURER:
JOHNS MANVILLE NESS: 13" R -VALUE: R-38
eBATTS BLOW
MANUFACTURER:
JOHE THICKNESS: 3 518" R -VALUE: R-13
GENERAL CODITRACTOR:
CENTURY HOMES
LICENSE NUMBER:
BY:
TITLE:
DATE:
: WESTERN INSULATION, INC.
LICENSE NUMBER: 48127
BY:
TITLE: OFFICE MANAGER
DATE OCTOBER 16, 2000