9912-183 (SFD)H
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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
7141 E03 B i 0/31;20i
200
Date ��f` 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:
( ) 1, 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 `! �+, �/+! g q4 yy ai 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.
Applicant
Date: I -� r / : 1 / ±.,�4
<< , �.
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 1 2 IEZ)
BUILDING PERMIT
JAN
U 5 2000 VALUATION SA3Ei„�S1.3(i LOT
JOB
SITE
ADDRESS 45-586 CO1° DB.> RO'1,11.° LAIE
OWNER
1.a�A rimoi/ i.. tov. a..0 coma iwlai i ..'s
3 =33 SO. "D" S 1 REL --r, S-17.13_ 4200
SAN 113-URI+T.Ait1:INO Cts 53,408
USE OF PERMIT
5E1vcILE t AMIL Y .DWT-LL,INO
PERMIT #
991z_183
45
APN
CONTRACTOR/DESIGNER/
TRACT 23995 -it
6 4-040-01.6
/,.1u �w .. ♦.Iw \f is Lr � ll. tJ ♦ ��..
i535 SO. 9)" M-REE'1', VE. 4200
SAN I3ERNAR1DMC) Cil !x2408
(9010,481-0 07 CBT,fi ZI70
SrD-LOT45 PLAN 3A- PE MIT DOES NOT INCLUD]i.BLOCK WALL OR
POOL.
TRACT iOiVST{`IW1110111 101
P RC IVO—ATIO 26.00 Si,
OARAC'01,'ARI:100' 635JAl St'
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ib(�'ie���f�!,q�(i�i_d]]`�lr/.EE ���T rb'�.Iit`�/ ARA
\.ibil' ISTR4C Y 109 Ft --L7
a j�9 y/�(� +U r� j/�
kV S�NV-41 00
Q �1 �y
$748 O
Pt.,n 3i;.H'fCa_K1(1I_0904Y9_13119
f C7NANICAL rM
101.-4X?'J-1122-000
zst(I:CTRiCAL 1-11-
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St:96.'�S
PLIJIMSINO FFE
IO1-NO-41,'.D-000
$137.25
tTFini.30 1V!0Tf0N 1:Fr,. - ft}?Sf 17
101-M-244 -VX)
$1 .(kl
G'R ADUNIG IF. 01
101-000 4123-000
S,2( 00
3'l�RVF.10PFJt:IMP.AC i'FEE
31,Sx17.A)0
rift'!' 1N PUBLIC PLACES - REa1C 701-(30)-251:.000
575.88
S1f-'t`X"Al., rtNS"1Rt.rC."TIt)N a;3r) PI -AN",
USS PRS -PAID PEES
RECEIPT IDATE
DATE FINALED I INSPECTOR
X0,00
$ 3.708.140
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION -
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Waste Lines
Underground Ducts
Forms & Footings
"L — i!
Ducts
Slab Grade
�, -'j, �'-tC�
Return Air
Steel
z -�
Combustion Air
Roof Deck
Gas Pioina [] FEZ _.✓
Exhaust Fans
O.K. to Wrap
_ ei'-®g
F.A.U. '
Framing
Compressor
Insulation
_ 7, -�
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls "
Party Wail Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final _ 0O
BLOCKWALL APPROVALS
POOLS -SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
COMMENTS:
Final
Utility Notice (Gas) o LAL
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 co
Utility Notice (Perm)
Equipment Location
Underground Electric
Underground Plbg. 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
Pool Cover
Sewer Connection
Encapsulation
Gas Pioina [] FEZ _.✓
COMMENTS:
Final
Utility Notice (Gas) o LAL
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 co
Utility Notice (Perm)
OCT -16-2000 15:05 WESTERN INSULATION
909 686 8786 P.11i21
wWTEIM INSULATION,
FITC.
4911 Latham 9t =t, EUvcrbide, California 92501
Tel, (909) 68b-8760 Parc (909) 686.8796
INSULATION ERTIFICATE
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 BUILDIN13 LOCATED AT-
TRACT 1 PHASE: MARBELLA it -23995-8 PHASE 2
LOT # 45
SITE ADDRESS • - - - , - - .. _ 45,580 COLDBROOK AVE LA GUINTA, CA
-- - - -
EXTERIOR WALL
MANUFACTURER: GREENSTONE THICKNESS: 10.3 " R -VALUE: R-38
9 G : BATTS 8L0
MANUFACTURER: JOHNS MANVILLE THICKNESS: 13" R -VALUE: R-38
CF ATTS BLOW
MANUFACTURER: JOHNS VILLE THICKNESS: 3 5/8" R -VALUE: R-13
_GENE. L CONTRACTOR: +. •CENTURY HOMES
LICENSE NUMBER:
BY:
TITLE:
DATE:
INSULATION CON RAC : WESTERN INSULATION, INC.
LICENSE NUMBER: 481278
BY:
TITLE: OFFICE MANAGER
DATE OCTOBER 16, 2000