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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
714M B .HV31/20(
Date 62-3 Signature of Contractor
OWNER -BUILDER DECLARATION4
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 oftperjury 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.
GULDEN!EACIt.� INS. .
(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: ! C f? 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, 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.
` a Jl l .rDate
Signature (Owner/Agent) c,,
BUILDING PERMIT PERMIT#
991 $-ts3z
000 VALUATION g13o,09.w. 123995-8S0 LOT � Lf TRACT 995-8
JAN U 5 2I
JOB SITE
ADDRESS 45-50 COLD33.R+l OK LANE
APN 6("_ _0i6
OWNER
CONTRACTOR/DESIGNER/ENGINEER
�4G'-Prf� cf.> v' t'�Of?r 'l. i, ;;�) `I�•�f, i'�.ffi'1i1G�
e. Yta.t�t, l.:? 4.. • IVI.I �t ltf.l,
• FlITI �Tfl X' CK)"�rt't.,t.. Cf.)RT�`1t. NMIT'S
G. 1{ t. ill,l.. t- ti ) A l tJ.l.
i 535 SO. "U" ;a.i , ET, S E. 4200
1335 Sed. 97 S IUMT, 91-F. 4206
SAN BEKNARDINO C''_A. 92,608
SAN Bi;.RNAXUiNO CA 92408
(L}wil3S1-6007 MCI# 2120
USE OF PERMIT
SA -)-1,0T44 i�1 AN 3FC_ L 0V?,iIT D0I;8 NOT INC.frtiDE'E#LOCK. WALL OR
4+d.3t�L.
TRACT 001451. kUC:TION 2.16S.00 :;F
(3JvkA,GhVCARP0MF 635.00 S.1:
.a�.S�i.�iM.AdtiD\-4N 014arb'tIS RUCffik'�U,�.i
YW�e•�r�:7:iii
3, y ��ct ;i,.
3 tt.IMI I�.If4 C S�l7�€M.�Rl''
CON`TR€iyF10N:F1-,7E t014li 4.18-000 $748.00
r `
emrrt nrt rE:�v is':�• 0•ki�-U�iV $33.50
LLtI:�.J:LAl i2C L A4l'sLS
4�•�..
+,11:A:TRI ;ATS FEE Si36.4918
1.. ►
PLVA4t3INO} kl !�! t}€)il-E}l!t^�UO $.I:wt•.75
2 "' f "
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,._..t
r1li�1.,`11NG T'0`: tfrl.s3n —423-000
DRIVE-LOVIGIR EX,
-30
r'UCt IN !-11.}31,1C PLACES) - i IKSII; 70 1
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S1 TP I' irAf. t.'t ft1Z }2i• (_rf0 N 4Nn Pi..r3Aj F;T41+,C°K
g3v70A7
'R>!`.t'AL ,TRi1 Yf FF&N MY!,, NOW
$3,704.37
RECEIPT
DATE By,—
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
;.,MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Z - t —
Ducts
Slab Grade
Return Air
Steel
Z,.
Combustion -Air.
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
-
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
019
Final
Final
(
POOLS - SPAS
BLOCKWALL
APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
JR_
Pool Cover
Sewer Connection
C31
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final o ($
Utility Notice (Gas) p li
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Futures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
apet—
Final
Utility Notice (Perm) Zl OO
DCT—i6-2000 15:05 WESTERN INSULATION 909 686 8786 P.10i21
WWTERN I'MULAT ON, INC*
4211 Latham Strut, F&,Wskl% CeUfalTAa 92501
TeL (909) 6WO760 Fax 1909) 686-8786
INBUL& ION CSR .ic.�T
THIS IS TO CERTIFY
THAT INSULATION HAS BEEN IN8TALLED IN CONFORMANCE WITH
THE CURRENT ENERGY REGULATION, CALIFORNIA ADMINISTRATIVE CODE, TITLE 24,
STATE OF CALIFORNIA, IN THE BUILDINGS LOCATED AT:
TRACT / PHASE:
MARBELLA 11 —23995-8 PHASE 2
LOT #
44
CA
SITE ADDRESS
45-560 COLDBROOK AVE, LA QUINTA,
WIR108 WALLS:
MANUFACTURER:
GREENSTONE THICKNESS: 10.3 " R -VALUE: R-38
BATTS BLOW
• MANUFACTURER:
JOHNS MANVILLE THICKNESS: 13" R -VALUE: R-38
BAITS SLOW
MANUFACTURER:
JOHN MANVILLE THICKNESS: 3 5/8" R -VALUE: R-13
qg p .CpNjfiACToR:
- CENTURY HOMES
LICENSE NUMBER:
8Y:
TITLE:
DATE:
INSULATION GO a WESTERN INSULATION, INC.
LICENSE NUMBER: 48127
BY:
TITLEi OFFICE MANAGER
DATE OCTOBER 16, 2000