9912-198 (SFD)LICENSED CONTRACTOR DECLARATION
�r✓�,� 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
N W Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
o d LO 7i4186 13 �- .laGiitid
LLJ
o Z Date I Signature of Contractor
O�
J U (CD D OWNER -BUILDER DECLARATION
HUJJ r— I hereby affirm under penalty of perjury that I am exempt from the Contractor's
to 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).
t'') () I am exempt under Section ' , B&RC. for this reason
LO
N Date Signature of Owner
OC\1
d Q WORKER'S COMPENSATION DECLARATION -
p Cr I hereby affirm under penalty of perjury one of the following declarations:
Lo 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 � Q performance of the work for which this permit is issued.
CD Q U ( ) I have and will maintain workers' compensation insurance, as required by
CCCJ Q Section 3700 of the Labor Code, for the performance of the work for which this
rn H permit is issued. My workers' compensation insurance carrier & policy no. are:
,It Z Carrier
C r ,4.,- n "r 1-14.3. Policy NO.
�O
J
(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
1 subject to the workers' compensation provisions of Section 3700 of the Labor
•x•77 Code, I shall forthwith comply with those provisions.• ,
Date: Applicantj,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
4 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.
r
Signature (Owner/Agent) _�f 1 f Date
BUILDING PERMIT PERMIT 91,
DATEJAN 0 5 20"6bUATION �+a� .�,Qf LOT �i; TRACT
JOB SITE 45-565 b.{3.a1DBRWK �.tt1CVE
APN 604-044-0,16ADDRESS
OWNER
CONTRACTOR/DESIGNER/ENGINEER
CE1 t1It:•YL".R01M''s11. COR'iItlt.ti`!I"..'1'BS
C1aMP':J.RY C:tCiWEUL C01%f V_l` T1Q1L11S
i535 SO. `D` a'Ii' l t', S'.m 4.200
1533 ash. M' a KZET, STT. #200
SAN BEitNARDINO (,:A 92408
SAN UERNAKIDINU CA 92408
(909MJ _6W7 CBIX 1,1170
USE OF PERMIT
Sif" GLE, VA,.MiL Y DWEI.UNG
SOD-i,E. T63 PLA�C- PCi itfl—I DOES INOT � -40L1 his BLOCK WALL OR
kt3< Vit,, 'twya PLAly C:.kIlECIs. K iULIC TION APP1.11W P'QX MULTIPLtr
SUIiMI')"1'AT. '
TRA -CT CORNSIrrUic _110,14 2,200.00 'or-
P0TZCVrP1A1710 111.
ti+AAZAtiI:;/4n1t1'i7K'I' <,�s.tiu ::}�
4d�^'/'0 ,'!C 0, It I.Ax N
�.Y i.i���A.�A. t"\JA �{
1 �8 •Y i IW f.6!
-i .Y.blk o/U.VU
CQN?3'1'±cLTCV1Cj7a FEE 101'OW-41&-UCQ 575501
1�f 1_i
i'�i,n'ri C►�zi`t� F�`:T 1(,11-()f3i'l..ti't9_"3lft �i45,?�fl
�,w ": �'
i�>±�:Z,t1�.1'a��.'4I. b 1:Y: 1(il•('Ir�,.'121-vCi1 ."�`3..`�J
c . t•
EI1s1~ t'Ittt.'.AL E,.t.,r' s1 ih.2101
,�',
;
13i.t1RcWINii 1 KT3 101-000-41.9-000 SI:3Ui.SE!
`'fit Owl-mrVrtoN &'1?t+ ,s1 1,0141011-`d4l-(moi
C;;Z.:�011JC'• (:tt IC1-(;00��23.11� Y?,t� t11�
;.. �..: i..
bEVfiLCJP0t114;ACT ITi, $i.907.0u
ART IN PUBLIC 1'LA-CES -1t.0 SCC 701-000-255-000
W
tf YlSoTrf
�iii
La:SS ii-VAID C
M(S^m
.. TOTAL 1TltMJ1'VV"_'3 3)klENOW
$3.261.52,
RECEIPT
DATE
BY� ��
DATE FINALED
INSPECTOR
f
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
L- LZ _sp
Ducts
Slab Grade
%--rte-dD® 141
Return Air
Steel
- _iaw 00 (
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
, o -0.0
F.A.U.
Framing
.mt®
Compressor
Insulation
.- t<r _ ;00
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
`-
Exterior Lath
Drywall - Int. Lath -7.'10.00
'ho
Final
Final
_
POOLS - SPAS
BLOCKWALL
APPROVALS
Steel
-Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
-1.- I -IL _a t)
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
\2
O.K. for Finish Plaster
Sewer Lateral
Cj
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
q I
Appliances
Final
COMMENTS:
Final ,o
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
OCT -i6-2000 15:10 WESTERN INSULATION 909 686 8786 P,20i21
WE,c-,m!'TERN INSULATIONS THTC
4211 Latham Street, Riverside, C+di[osnla 92501
Tel, (909) 686-8760 F= (909' 8868785
smATION CERTI DATE
THIS IS TO CERTIFY THAT INSULATION HAS BEEN INSTALLED IN CONFORMANCE WITH
THE CURRENT ENERGY REGULATION, CALIFORNIA ADMINISTRATIVE CODE, TITLE 24,
STATE OF CALIFORNIA;
IN THE BUILDING LOCATED AT:
TRACT / PHASE:
MARBELLA II -23885-8 PHASE 2
LOT #
63
SITE ADDRESS
45.565 COLDBROOK AVE, LA QUINTA, CA
9XTE131OR WALL$'
MANUFACTURER:
13REENSTONE THICKNESS: 10.3 " R -VALUE: R-38
BATTS BLO
'lll
MANUFACTURER:
JOHNS MANVILLE CKNESS: 13" R -VALUE: R-36
CEIL! :
BA SLOW
MANUFACTURER:
JOHN 14LE THICKNESS: 3 618" R -VALUE: R•13
GINgBAL CQNTR/IACTOR:
CENTURY HOMES
LICENSE NUMBER:
BY:
TITLE:
DATE:
INSULATIQN PQ TRACT -GH: WESTERN INSULATION, INC.
LICENSE NUMBER: 4612i
BY:
TITLE: OFFICE MANAGER -
DATE OCTOBER 16, 2000