9912-194 (SFD)LICENSED CONTRACTOR DECLARATION
_ 4,a 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
N W Professionals Code, and my License is in full force and effect.
O =) M License # Lic. Class Exp. Date
✓ �j f /R
Z Date �' Signature of Contractor f*' ���-t• I r' t-� L'j
IDOL
J U C) OWNER -BUILDER DECLARATION
HWW I hereby affirm under penalty of perjury that I am exempt from the Contractor's
U) 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.
C'`) () I am exempt under Section , B&P.C. for this reason
N Date Signature of Owner
ON
rn
z
WORKER'S COMPENSATION DECLARATION
C) CL
2 Z I hereby affirm under penalty of perjury one of the following declarations:
U-) H O () 1 have and will maintain a certificate of consent to self -insure for workers'
X W 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.
ED Q C) ( ) I have and will maintain workers' compensation insurance, as required by
O Section 3700 of the Labor Code, for the performance of the work for which this
d H permit is issued. My workers' compensation insurance carrier & policy no. -are:
? Z Carrier Policy No.
0 l('3L;: :�`.E,,GLI .1UNS. V4 %, 5>'s iivu-`tae,
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(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: � � ,, 4.h Applicant 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)-.�i' L a Date^ SCJ
AN 0 5 200BUILDING PERMIT PERMITN
9012- 194
M� �� VALUATION .f.'32,19� 6ll LOT TRACT 1 ,�v8
flVIADDRESS
JOB SITE
43-445 C10E.+0BRW'..K .L V%1E
OWNER
CONTRACTOR / DESIGNER / ENGINEER
q �jV (2 Y I 1 (t dJ�t'
fci'/'Ai'1UR i C ROVI{i'.4:,�_. 4ONI' IIJIM: i IS
Y1+F ♦ 1.
Leh try♦ p tt n��t �� •�t•�
�. C. f-.lUilii 1CROii�ELL l.ONIMIVali"MIS
153-1 SO. '.Do STREET. S"l'E #200
1535 SO, "D" 5T EE r, FVE. W. U0
S.tA1N BL,11 4AR INO C A 924U8
SAN BERNAWINO CA 924118
(909)1ii1-6(X)7 1120
USE OF PERMIT
t fNt,i X i AIN11L Y `L' jh/EI,UNQ
SFJ),J 0 TSa .PLAN 413- PE:AZT DOES -NOT INCLUDE BLOCK IWALL OR
P00-1. 7Yb PLAN C.RECA RI,-0UC;1710N APPLIk).ifol', MLi:1:'Y'1:Nf..;
SUBMfrrAk
TRiiCr COM A RUCTIOI*1 t7)i 42410.00 317
PCiit;MPAM 22.00 3E
QARA0WCJ%1L1'f:J)2'1' 635.00 *F
t.tvIAJf,ED C.aST Of" COSjl�or31719 !rl
CON S':RUCTION FFX, 101 -(ft -41H -0,}U 5735.00
pl,fl;N IRF Ff)j-(�f)-4y9-SPR AtS�,fCi
r+a
,. s5 t.SO
"lLC ivlik/C..i 1 1; 101.100-411400 °
- I
W l; lRICAL VEE 101-CA10-420-000
P LIN1E0KIJFFE 10),000-4114-000 �13ti.5U
' :• i
NTRONCi RFS") 1 U i-()fTf)2cil •0lf!(
fi"
(-,
A'BryU
L^�23 '010 1rRADING ,I-,� 0 al
101_000
f'* j _... .
UAiVEI.CA.e'01k t'1VLVAC:T POE
A1i'1` IN PUB1,1C PLAC S - 701-t}t -7`x:5-000
S;ai-'fYl`j'f�l' ("f1i`1Sf"[,iC''tlt;lt(f.AND pj,A.fvt'1��C,1c
LESS PRE -PAM FEES
10.00
T(Yclkl, P;r'MMIT k'.it.RS DUE tX()%y
$.5,261.52
RECEIPT
DATE /
BY� r
DATE FINALED
INSPECTOR
' INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
2 22= Oq 14L4
Ducts
Slab Grade
Return Air
Steel
'L -ZZ = 00
Combustion Air
Roof Deck
Exhaust Fans
OX to Wrap
--;go
F.A.U.
Framing
I('
Compressor
Insulation
to ;+
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
- /t • do
Final
Final '� �S.o
BLOCKWALL APPROVALS
POOLS - SPAS
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
L"2`t-f70
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
Sewer Lateral
O.K. for Finish Plaster
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final Q
Utility Notice (Gas) p '1jro
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 O
Utility Notice (Perm)
COMMENTS:
OCT -16-2000 1508 WESTERN INSULATION 909 686 8786 P.16i21
WES1
TERN INSULATIONS INC.
4211 LalbA SCracC RfverSidc. California 92601
Tel, (909) 686-8760 FM (909) 686-8786
ENSM.ATION 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: MARBELLA II –23896-8 PHASE 2
LOT # : 69
SITE ADDRESS 45.645 COLDBROOK AVE, LA QUINTA, CA
EXTERIOR WALL&
MANUFACTURER: GREENSTONE THICKNESS: 10.3 " fit -VALUE: R-38
INNS: BATTS BLOW
MANUFACTURER: JOHNS LE KNESS: 13" R -VALUE: R-38
I N9GS: BATT BLOW
MANUFACTURER: JO MANVILLE THICKNESS: 3 5/8" R -VALUE: R-13
GENERALyCQNiRAQTOR: - - . - .CENTURY HOMES
LICENSE NUMBER:
BY:
TITLE=:
DATE:
INSULATION CQ : WESTERN INSULATION, INC.
LICENSE NUMBER: 461278
BY:
-20-
TITLE: OFFICE MANAGER
DATE OCTOBER 16, 2000