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LICENSED CONTRACTOR DECLARATION
I hereby 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
t tiLS I lH ! l /70i
Date J" C-/W� Signature of Contracto - -19;-A f Ogg Ag Y
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:
Comer Policy No.
!'s11..1.i41Y .1=11��ai,: iLv� 1'a 91i1,
(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 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) `- � -` �� Date
BUILDING PERMIT PERMIT/t
"li-Ins
DATE VALUATION
�.�1.(�(+� LOT �7 TRACT
JAN 0 5 2000
ADDRESS �:7~II {F f,liLBUI.1i11GIl LANEJOB SITE APN l►li@-F�i{D-N44i
OWNER CONTRACTOR / DESIGNER / ENGINEER
f,4.--kr°4w `.,Kp0%%rvf,1i. ft I, k,vjo, iTit.t 1'CNI'll141 f 1-11)\r �ri.i, cl, 0.14llux,i
1.53SO. `W ofR,26.1',,TIIE 4200 1.53:.+5i.►. ^fir, SIRE , Sii;. viii' ,
NAN BE'KIdARDIN0 CA 92,108 SAN f ERNAf DINU CA. 91.108
(()1191-6007 (NON 7120
USE OF PERMIT
1.l iVeii..Is t'.��1.1 I,i" i) Vv �Li.tjV U
5.—FO-LOT4 1LAN 3rD- PM -11T DOES NOT IN..LUDC i3L%X3.w WALL G.R.
1000. 7Y PLAN CJHEC:.00 kE.T1VI.IC;'110N A1'1>i.1.EAD 1A_1.K IM-t16AV-111E
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4I.illi•/ 40iv,)artiVC1'i17;v 21 163.11)cO _.1'
0t,�RAG&;CK1ZPGftT 635.00 SF
N''u7TY R.4 a111V1h. 41 le%, r f9'SP elf )b,muT1li4ir-%*Vf%rt
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PFITU%fil "Cl R1111. iu-M-KA-AT
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101-000.410-1119*
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At<l' IN PUBLAC; l 1,AVC3-4 - R!"SW 701-0000 25N -(*U
$75.01
`f IPI-.T'(Y('Af. C-CINIS1141 fi°i'((,.)N LINO T -'I AN (`fft%:C'k,
't'tffitf, i'C;1rdCv1.1'S 1 CF -S 1MENOW
RECEIPT I DATE I BY /"j` ,' I DATE FINALED I INSPECTOR
�i/741.7 7 7
,$'Q 010
0.2,42427
'INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS y
MECHANICAL APPROVALS
Set Backs
OEG
UndergroundDucts
Forms & Footings
Ducts
Slab Grade
1-21=00 KLA
Return Air
Steel
_ t -pp hur
Combustion Air
Roof Deck
9 _U _c
Exhaust Fans
O.K. to Wrap
S
F.A.U.
Framing
Compressor
Insulation
-7 -�
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
V - Cl"- Liu .
Drywall - Int. Lath
Final
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
Z - r - 00
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final cey,
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
Final
Utility Notice (Perm)
OCT -16-2000 1506 WESTERN INSULATION 909 686 8786 P.12i21
WESTERN INSULATION9INC.
4211 Latham Street, Riverside, CaWOrl'" 92801
Tel. (909) 686-8760 Fax (409)680 -SM
p[SMATION CERTIFICATE
THIS 15 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 11 -23995.8 PHASE 2
LOT # ; 47
SITE ADDRESS 45-820 COLDBROOK AVE, LA LIUINTA, CA
----------------------------------------------- ------- --- -•--
EXT� LAR WALLS:
MANUFACTURER: GREENSTONE THICKNESS: 10.3 " R -VALUE: R-36
BATTS BLO
MANUFACTURER: JOHNS MANVILLE KNESS: 13" R -VALUE: R-38
CEILINGS: BATTS BLOW
MANUFACTURER; JOHNS MANVILLE THICKNESS: 3 518" R -VALUE: R-13
--------------------------------------
GENERAL CONTRACTOR CENTURY HOMES
LICENSE NUMBER:
BY:
TITLE;
DATE:
IN-Ql➢LATlnN CONTRACTOR: WESTERN INSULATION, INC.
LICENSE NUMBER: 48127
BY:
TITLE: OFFICE MANAGE
DATE OCTOBER 1$, 2000
r
From AEPC EKY
714-505-4207
�. 0 T
f 't5, 30,19M as; 57 ar Pai
12711 NEWPORT AVE., SVn G
rjSPN. CALIFORNIA 92780
714A,505+4207
®oa6
SUEa.
REMARKS.
DAM:
L4
ACTION.- � ��'e,
u�
PER REQUEST
FOR APPROVAL
FOR YOUR USE
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