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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
i idi n ii i'"V20i
Date Signature of Contractor`�'��
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
r,
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 Policy No..
conA)%) V'i.SiiC'Lr f1� if'vu` q,w'Pik, 1:
�.. l.f. l:, ll,v�. - 4.. :J9 �.�:iN.
(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 provision
Date: Applicant ',r ? d,/-I•?r�--'
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.
rC t.��
Signature (Owner/Agent) ` / Y1 �� Date—L
BUILDING PERMIT PERMIT/
993 x-1234
JANO 5 2000 VALUATION 5104.397.61) LOT 46 TRACT 23995—Is
JOB SITE
ADDRESSlJ-f►t�liE�.ljl,t�0�3L1iS1.ir2�(jiL'+
APN
�I1f�1D-�A€i
OWNER '
CONTRACTOR / DESIGNER / ENGINEER
If, r'().1: -."..n:;':;:
1533 :� ..P.��. r�iGEr. STT. tr20o
1533 9O. '"17 MRFE1 11.4200
NAN.bf:kNA.KDJNU UA _42 4408
NANRERNAKIAN0 CA. 9240
f�it3�13R i-iif}(17 CIA] .# 2120
USE OF PERMIT
.i•7?4,OT46 PLA14 C - Pi3lts UT DOES 140T INCLODE- $l; iZ i,3ALL OR
3?t xUfa. 11.AN CHECK W-.UUCVION P,1'1'1.IED h'QR 144t11, 11PLE
;iilltf�til%�`!'�1�,YUit'J' fLt3.t1U Sty
i:i�.Y J.�ati It el. ��v�H �J d� �1�1•:�i��i Qi:.4fti'���`a..3ti
i'Si�?p���.�:i
VVIRIVirc FEE SUMMARY
C.:t:9N5'.i'�f;1t✓�'1.ON:F'�7i f�tl-Ut;ii-<dltr••d1i�U $6ad.lk3
�_,,,, �>.
P'f.AW C"CdF.r`;1C VPT, X117 70
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'd'i ►2l i?Jt Aii�?7'tr X1.11 r. F _ PRO $110 rui
101 -000-423.000
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t\}t"!' .its lal ilii:..lC .6�T>s1.Cf�r3 - .tekiSl.i; 701 -WO -255-00
tit -'Y'YI'A 1. r:"OMti"fP f IC 110NI Amn V!, AN f'NF(T"K
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'Fa,s:ll A I, t'E RMI.T ii E"EN 9)i 1 E .IVOW
S4.059.48
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION .RECORD
OPERATION
DATE
INSPECTOR'-:
OPERATION
DATE —T
INSPECTOR
BUILDING
APPROVALS
MECHANICAL"APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
-L —CO
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
Ke
F.A.U.
Framing
Insulation
Z ji-- co— ju--
7& - 1 &4
Compressor
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans &*Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final I
Final
BLOCKWALL APPROVALS
POOLS 'SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground PIbq. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Q
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas) lco, I
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) 21(to C 12 f6>L
COMMENTS:
OCT -16-2000 15:03 WESTERN INSULATION 909 6B6 8786 P.07i21
"imN INiT TIO�T, INS.
42 11 Lothfl- Street, Mvcmido, C11=mia 92501
W. (909) 6868760 Pax (909) 686-87$6
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 —23995.8 PHASE 2
LOT # 46'
SITE ADDRESS 45.600 COLDBROOK LANE, LA QUINTA, CA - _ - - - - - - - - -
-.. - - - - -
EXTFJgI "LEa
MANUFACTURER: GREENSTONE THICKNESS: 8.1 " R -VALUE: R-30
CE.� BATTS FICKNESS:
MANUFACTURER: JOHNS MANVILLE 11" R -VALUE: R-30
BATTS BLOW
MANUFACTURER: JOH MANVILLE THICKNESS: 3 5/8" R -VALUE: R-13
-
GENERAL CONTRACTOR: CENTURY HOMES
LICENSE NUMBER:
BY:
TITLE:
DATE:
INSULATION ON (i STERN INSULATION, INC.
LICENSE NUMBER: 481278
BY:
TITLE: OFFICE MANAGER
DATE OCTOBER 16, 2000