9907-568 (SFD)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
Pte,�. 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.
l 1,? 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.
VAI FU N'. D3 tStii`a .t • 8
(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 bf'Sebtion 3700 of the. Labor
Code, I shall forthwith comply with tho"sefprovisions. M. .
Dat: ,.�''% Applicant s �O�' '.JG►-�, '.
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 fo inspection pu oses.
Signature (Owner/Agent) �� �.l Date %~r—
PERMI`j�y�
BUILDING PERMIT
DATE VALUATION �twa`fo'ZE�.,�, LOT 19 TRACTJOB
SITE�
ADDRESS :5-65— CtFLDBROOK LANE.
APN rl Si�-���•1�1��
OWNER
CONTRACTOR/DESIGNER /EN_GINEER
'3:�ii���)p
a,r.
I.
FijrriiijLt'i,.g
1262 W. ARROW R F
12.82 W. AR1R0W 1-rNVV
UPLAND CA 9:P&S
UPLAND CA 911,13
USE OF PERMIT
&.-ING.L R FAid1_IL.VDWE''LL,INTO
SF D- LOT r 19, RUN .M—X - P kR&t T FOES 140T N t i. DE laf r CK 'WALL
sF 1i.7' CW.c`a :I.E2 i�"1.rt�Ai 1,4 A 1.00 Sri"
141.00 3F
(JAR.A.GUYVARk'i"RT 19�,.UiJ i
�:.� n AlgA.t��dV.�i �.4Awv � iJl, 4.•i2'A lr,�r ,a,,.�1�a 3: s•n'lJc��
c�§R6�'^4E�. cart
CONSTRUCTIONVER lorl:-006-41 Sd)°i£D $581.00
�1,11;1JtN '°'K 'I7.h 11Tl..41(io`G r1..418,4rdl.
�L,�.,�,'rrt��a�..r<�aa �t�t-+�t�c-azt�--c►�a bsp��.:�r.
,, �;
KUnMING FZEW .i fit-t31N)-41,x-L1(}t► $148.00
aT,ONO 1b7fY:110I t FEE - RESID 1101 -MO -7,414M $B.I`ci6q
p
1151RAR/ING 1171y:3 1fi6^ULV"'/1 VV� �.nJ.EfW
;+.i �•t•t l.,�
t) IArHIL GI.P `.P. 6MMCT FEE, $1,�I.fN1
7'µt r.7 r
*� Nd
'
L.l
+`-+1. 44MAL f ONS- `f'i?IK'"4T'ON !1,'N'f) P1,4 N C! f rCK
e }�413to4��
..ESS PPIE. F'&ID ffrll" 3
70,00
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
MA
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
4A—
Return Air
Steel
Combustion Air '
Roof Deck
"2 - 7- (e
Exhaust Fans
O.K. to Wrap : 'Z •
F.A.U.
Framing
_
pp
Compressor
Insulation
14
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Z - /A
Drywall - Int. Lath
) - Z -- oo Kb(
Final
Final
POOLS-- SPAS
BLOCKWALL
APPROVALS
steel
Set Hacks
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover ;fir
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
/O I
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
_Z -Glp
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
�l
Appliances
Final
COMMENTS:
Final
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)
-
MAR -09-2000 15 45 14ESTER14 INSULATION ?E�9 686 87E6 P. 09/27
WWTERN INSULATION, INC.
4211 Latham Street. Rlvemide, Califbmla 92501
[tl. (909) 686-8760 Fax (909) 686-8786
gfg%ATION CERTIFYCAT�
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: DESERT PRIDE - TRACT #23995-5A
LOT# 19 PAA/ 1
SITE ADDRESS: 45-076 COLDBROOK LANE LA QUINTA, CA 92253
------------------------------------------------------------------
EXT, RIgi WALLS
MANUFACTURER: Johns -Manville THICKNESS: 3 6/8" R -VALUE: R-13
CEII.Mg. BATTS BLOW
MANUFACTURER: GREENSTONE THICKNESS: 10.3" R -VALUE: R-38
---------------------------------------------------
01ENCRAL CONTRACTOR: AMERICAN COMMUNITIES
LICENSE NUMBER:
BY:
TITLE:
DATE:
I St M110N CONT. ACIM: WESTERN INSULATION, INC.
LICENSE NUMBER: 481278
BY:
6 4zol;�
TITLE: ZCT ON MA GEA
DATE MARCH 8, 2000