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LICENSED CONTRACTOR DECLARATION
I h'��" `by 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
�i41isS ii 1u131i2G(
Date C Signature of Contractor M
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 COLDTIN UA.t.! ? INS; Policy No. :
(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: I r- —---Applicant
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, indemnity
& 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)?1 �.! �,n. Date ? `
BUILDING PERMIT PERMIT#
9912-114
DATE VALUATION S132,1.98-60 LOT 61 TRACT 23995-8
JOB SITE45,6 rte. COLDB� OOK A` &NE
ADDRESS
APN i1f1�!-ib�s6b �:iu
+ 60
OWNER
CONTRACTOR / DESIGNER / ENGINEER
C'::ii'1`t11?.Y (; n1:+>uC.L G; f.AiiJr:t'f'i S
r'Fr''J1:'Y CROWEll, Gt3�t1�1lTrii'.Y:I:4
1533 SO. f°L'" .5"1' U671, r -M- it200
1535 SO. rte° IS"CREET, 5.iis. 9200
SAN 4_EKNJW)1N0 CA. 92408
SAN t31:RNAlt INO CA 42408
(9119)381 ••aw 2120
USE OF PERMIT
SWCYLF., RAMILYDW13i LII,°1G
SPD -L0161 PLAN 4A - .,T1RA4t'1 i DOES OT istiu,a .i1' E BLOCK WALL OR
.t 00L. 751io KAN C W Ck i UDLIt 110 A!>YL13s1B.t'U,It MUL`1'1144t, .
5aL?f3�4iT'I'nI-
7'Ic.ACT CCaA,u',CRUCIIGN 21200.00 I3
Pti7f2C.ii PA T IO 22.t1U SF
tlt\iLEii3t�%C;A72!'tJ.St'[' GSS.iIU Sty
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�SkAL*11t., .\ DC Vf.S A 'V*'ti.� CION,J��tl D'ti!.' ��i.�a ll VT
� 'i�+ si,t►t�
a-fk D I
C:ONS,rRuerioN m, 101-000-418-000 513 �.cn1
PLAN (74FCK RFP 55.60
• ,
R4: C 1A;.TCA1.1'1"C 101-000"4x1.000 $53,50
La�uE�7 TZ% ALS 101 -OW -420-060
PLUt411%4:1.tVirFEE 10i-11131)-419-000 $138.50
�`• ,+! ,
r-
4'VMOVt MfTrrcIN VF1_ _?zt vtt) 10141IM-7 41
GRADING 11M.1f)1-000-•12$-0C;) �syf?,Crp
��
061V I,L31•'Er11TAfPAC1'i;Fr-,. si,go.(fu
Ate.`P IN K [ki1. IC PLAC IVS - WEI-AL 701-00W255-000 $80.50
�*.� =` •`
of )r�-t� 1'f�T. C,t�Ns rl"tiic [t`>N AN1'1 PI AN C 14F
�3,2m.l`d
LESS PRF -PAID FEES
$1 00
'.i'i3°fAll, PCQi,;iUT FEES' IMC NOW
b-i,Zt►�.!52
RECEIPT
DATE
BY/�" )
DATE FINALED
INSPECTOR
1 'r-t
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
%-tZ-bo
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
. t jL
Compressor
Insulation
Vents '
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate tines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
1 - Z,a _eO
Final
Final 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
Z -`L 2 -ep
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
Final
Utility Notice (Gas) b
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) 'Z
COMMENTS:
,,.
OCT -16-2000 15:09 WESTERN INSULATION 909 686 8786 P,18i21
IMTERN INSULATIONS INC.
4211 LWlmm street, aside, California 92501
Tel. (909) 686-8760 Fort (809) 686.8786
IXIM ATI®N CERTIFICATE
THIS IS TO CERTIFY THAT INSULATION HAS BEEN INSTALLED IN CONFORMANCE WITH
THE CURRENT ENERGY REGULATION, CALIFORNIA ADMINISTRATIVE CODE, TITLE 24,
STATE OF CAUFORNIA, IN THE BUILDING LOCATED AT:
TRACT / PHASE: MARSELLA 11 -23886-8 PHASE 2
LOT # ; 51
SITE ADDRESS 45-SONCOLDBROOK AVE, LA QUINTA, CA
E 181OR WALLS_
MANUFACTURER: GREENSTONE THICKNESS: 10.3 - R -VALUE: R-38
CEILINGS: BATTS FKNESS:
MANUFACTURER: JOHNS MANVILLE 13" R -VALUE: R-38
CEIUNGS: BA BLOW
MANUFACTURER: JOH ANVILLE THICKNESS: 3 318" R -VALUE: R-13
-
GENERAL CONTRACTOR:- CENTURY HOMES
LICENSE NUMBER:
BY:
TITLE:
DATE:
INSULABON C WESTERN INSULATION, INC.
LICENSE NUMBER: 48127
BY:
TITLE: OFFICE MANAGER
DATE OCTOBER 16, 2000