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LICENSED CONTRACTOR DECLARATION
.;thereby 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
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Date i 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
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:
CarrierA° t .frC1 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. - n.
Date: l -. C_ PP
&,� Applicant
C�
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) +� I ' Date
BUILDING PERMIT PERMIT#
DATE VALUATION $132.199.60 LOT 64 TRACT 239!15-8
JAN 0 5 2000
JOB SITE 4.5-. 45 C0Llllit5•0ON' Ls'l i
APN 6""O -W6
ADDRESS
OWNER
CONTRACTOR/DESIGNER/ENGINEER
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USE OF PERMIT
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$31261-52
RECEIPT
DATEBY/
' }
DATE FINALED
INSPECTOR
l_
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL -APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Z- 2'L - a6
Ducts - ^
Slab Grade
T -Z ,,@ Q
Return Air
Steel
Combustion Air
Roof Deck
p:
Exhaust Fans
O.K. to Wrap
g-. e4 -QQ
F.A.U.
Framing
• 20 `
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
• �i v - afx9
V6
`
Final
Final
BLOCKWALL APPROVALS
-
POOLS - SPAS `
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
i- Z t.— cp 0
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
Sewer Lateral
_(ZS [
C1t
O.K. for Finish Plaster
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
I
Appliances
Final
Final 40
Utility Notice (Gas) 0\31
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 0 I
Utility Notice (Perm)
COMMENTS:
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OCT -16-2000 15:10 WESTERN INSULATION 909 686 8786 P.21i21
s,
WEISIPL ERN INSUL TION 9 GNC.
4211 Latham Street, Rlveiaide, Calitbroie 92601
Tel. (909) 686-8760 J'ax (909) 686-8786
RISMATIgN CPR IFICATE
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 -239958 PHASE 2
LOT # 64
SITE ADDRESS 45.545 COLDBROOK AVE, LA O.UINTA, CA
EXTERIOR WALLS:
MANUFACTURER: OREENSTONE THICKNESS: 10.3 „ R -VALUE: R-38
LICENSE NUMBER: 481278
BY:
TITLE: OFFICE MANAGER
DATE OCTOBER 16, 200
TOTAL P.21
CEILINGS:
BATTS
CO
MANUFACTURER:
JOHNS MANVILLE
I,KNEIS S: 13" R -VALUE; R-38
\ BLOW
CE Lt
ATTS
MANUFACTURER:
JO 6 MANVILLE
THICKNESS: 3 5/8" R -VALUE: R 13
GgNERAL CONTRACTOR:
CENTURY HOMES
LICENSE NUMBER:
BY:
TITLE:
DATE:
IINCt 11 ATiniu
CCNTRACTDIL
WESTERN INSULATION, INC.
LICENSE NUMBER: 481278
BY:
TITLE: OFFICE MANAGER
DATE OCTOBER 16, 200
TOTAL P.21