9912-181 (SFD)H
N co
W
O Cn
W
r`
C Z
O O
H�
W
U)
Z
M
L0
N
ON
U °'
CL Q
Z
`rQLX0
0 J J
mUU
O
rn H
1-tZ
cb
d
Q
J
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
ii�2'iSo u ifl/'3ir?41
Date Signature of Contractor ,1�1 !� -; / Y-1
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&RC. 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 Policy No:
GOLM4 EMIL" ISS. MAIC 54406UI
(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,
.l 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: }.- 4- �g zA Applicant—
Warning:
pplicant 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) l iL/. l ' Date
BUILDING PERMIT PERMIT#
991 2-11 t3Y
QAjF�, o 5 2000 VALUATION .1'106,397.60 LOT 41 TRACT 23995-8
OB SITE
ADDRESS 45-544) COLORROOK LANE
APN 604-040-616
OWNER
CONTRACTOR / DESIGNER / ENGINEER
f'k?i°:1`I;T;YC,.I.tUIYL'}L:�'�?\it13;,T111 `.vS
Lfu1,211:YCIZO� LI,LCON4hi'ljtP,'IIIF.4,-,
15 5 SO. "p" mai,, Si I:, ff26
1535 SO. "'L)" SI7kE T, SCE.111200
SAM' F3ERNA1ti: INO CA 92408
S.AN RERNARDINO CA 92408
ry(�91;�i-CC07 C'�a-,fit �l"0
USE OF PERMIT
SNGL:IE FAMILY DWEL.i.1NC
D-LOT43 PLAN 213 - PI7- d !T DOLS NOT I?v{:-7..U-DLEIl i.li,'tS WA11 OR
110-4-115% P A14 CHEC:is..►,tlJA)LiC'TIf N APPLOiD FOR MULTIPI lr
4UUMITM
T1 ACT C0114S`I"RU t ION 1.800.00 St:
P011 0 4-1ATIO 32.00 3
0ARAQ1J, Cr1#tV01 ' 420,011 SV
ESTTP. '.IED 009T 11,;:11' CONIST t.UL'`I'aON
` 106,397 60
I"1 RMff VE SUMMARY
CONSTRUM f ON FFX 101-1011-41.8-0110
Pt, 4 cl-WCR. fra3 10.1-900-434-1118 337. �t1
Ln
MMCTxAI,411CAL I;'G l0a- + v sa`3;-i30iI 547.00
E, UEC'`x�CAL FLIE 101 -000-420-000 $119.90
},LVA413tNkG Ful" 101-000-419-U00 $137,25
c:�)
TRt3?aC3MONintvr::~w-nrsiP W-000-2414 0 Sti► 64
f;:1tN0JNC f7?s"1•~ 1101.-000-423-000 320.00
i
DOVU-O -ITiA .6i+APJkCT FR—E 11.967.00
ARTIN PU'f3LW PLAt`PS - RF8113 101-00G-255-000 $0.99
R113 -f0 Tq.L. CON18-11'¢?t CTION AND P SAM CHECK@C,/��
4fi
,1010
"€'OTAi,, PERMI§' i+' ES DUE NOW
$3,0.59,48
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 r = 06
Ducts
Slab Grade
- 2 Z,� c9P1
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
r?
F.A.U.
Framing
Compressor
Insulation
_Z :
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wail Insulation
Condensate Lines
Party Wall Firewall,
Exterior Lath
V -t • ca
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
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
Sewer Connection
Pool Cover
Encapsulation
Gas Piping
Gas Test
-
Appliances
Final
Final ( \y
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 o (T -
Utility Notice (Perm)
COMMENTS:
OCT -i6-2000 15:04 WESTERN INSULATION 909 686 8786 P.08i21
TE-- R ' INSULATION, I 'C o
4211 Latham Strut, Riverside, Ca!Ornta 92501
'Z. (gog) 686.8700 Fax 1909) 686-8786
E I LION Q 1ff—AiE
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 #r
SITE ADDRESS
43
45.540 COLDBROOK LANE, LA QUINTA, CA
-EXTERIOR WALLS:.
MANUFACTURER:
GREENSTONE THICKNESS:8.1 R -VALUE: R-30
BATTS Bl0 W
MANUFACTURER:
JOHNS MANVILLE HICKNESS: 11" R -VALUE: R-30
CEILI !e:
BATTS BLOW
MANUFACTURER:
JO VILLE THICKNESS: 3 518" R -VALUE: R-13
P:ENEBAL CONRACTOR:
.
- - CENTURY HOMES
LICENSE NUMBER:
BY:
TITLE:
DATE:
0 CONTRACTOR: WESTERN INSULATION, INC.
LICENSE NUMBER: 481278
BY:
TITLE: OFFICE MANAGER -
DATE OCTOBER 16, 2000