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9907-572 (SFD)F- N � W O �L0 W C:) Z C(DOO �co W w I— a U) Z LO N ON U_ °) Z r P O LL 0 J J mUU O ��H It Z ob �Z�yy C) 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 091&34 B .0713 1201 /ate Signature of Contractor A_04er 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 $700 of the Labor Code, for the performance of the work for which this permit is issued. S40I have and will maintain workers' compensation insurance, as required by S ction 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.' q FONT, (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 a Labor Code'��F hall o hwith comply with tho's provisions i 7 P Y �p � "� ."." . D�te: Applicant 4a� .. 1 Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to.criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the' conditions and restrictions set forth on. his application. 1. Each person upon whose behalf this application is made & each.person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this, application becomes null and void if work is not commenced within 180 days from date of issuance of such pe`rmit,;or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property}fob inspection prrpose . R, /19 nature (Owner/Agent) ��Date/ Y e ' BUILDING PERMIT PERMIT# "417•."r72 DAT VALUATION `tJ��l�+iy� j+ LOT TRACT ADDRESS C 45-040 O L�lt?DROO•K 3F.�iN E APN 604.040o.021 OWNER , CONTRACTOR / DESIGNER / ENGINEER INC) HOMES CORP. INCO 1101MES CORP. 1291 W.AAK0W 1fl(iMVAY 1282 W. ARILROW HWY L(PLNN..D C A 91785 UPI -AND C;;A. 31785 (9il9;1`�3'tl-R9'i�$ �;i331..#' :•��1f3 USE OF PERMIT 97' X?a i.0>7' i, l'Li32d ,ts s - F+ X23 i k'tF y k tC�i' IA3i�,i' %h �3�,<",r( - "vl .,i F �Jaa. t�rxva.. 34.0 8F 58J100 8F . N�A �I•'ASN0.CA�°.$•.�M � F�`Y�''A��I.' `�.�..i�yY�A•.l11idp~�2.$O.f °I PERMAT FE -18 SUMMARY. AG"W� ril3�%Fc%#� L>v (70:PtS'>:7 U .T10,aiha.", lflf, i ",i8 tii(3 S65i RIAN rMck Fr3r, 3091-e?f311..430-1IR W41FCX-1A 1XCAL F1. L 103-9015421-0010 M.F4,.Ti ICAI. l BE 10140420••000 $1,19. P)„l.1PVf£3iNC kT-1 E 3.111 °W00-419.000 $1485. S'C'rcOMI ,'a[C>'i' O N FRE - R SIP 1014"-241-W ; sD !rite41laW`U".TL'T .1QI-t"s.101-M-4123-0000 iW FN PUBLIC PLACES-R1'sM,.701-000-2.55-00 �!! V'1:[H1i'AC,7� 9„9L3:A1,FAF'�14C .N� �'i3 (rl RAN CHECK $1,493.68 Fr TOTAL I'.X� M.JIT TM��S DUE 1Wt CV*r RECEIPT I DATE I BY ' if / I DATE FINALED I INSPECTOR AG"W� ril3�%Fc%#� L>v :... a: RAN CHECK $1,493.68 Fr TOTAL I'.X� M.JIT TM��S DUE 1Wt CV*r RECEIPT I DATE I BY ' if / I DATE FINALED I INSPECTOR =INSPECTION RECORD' OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL -APPROVALS Set Backs Underground Ducts Forms & Footings —2 G Ducts I Slab Grade it, lcl— Return Air i Steel Combustion Air Roof Deck Exhaust Fans O.K. to WrapF Framing �'l (�► F.A.U. Compressor I Insulation - Z - 00 149 Vents I Fireplace P.L. Grills I Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wali Firewall I Exterior Lath Drywall - Int. Lath I 4 Final I Final I POOLS - SPAS BLOCKWALL APPROVALS steel. Set Backs Electric Bond I Footings Main Drain I Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final Gas Piping I PLUMBING APPROVALS Gas Test I Electric Final I Waste Lines Heater Final I Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K for Finish Plaster Sewer Lateral Pool Cover I Sewer Connection Encapsulation Gas Piping i Gas Test i Appliances i Final { COMMENTS: I j F { } i j I 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 i Utility Notice (Perm) -10 MAR -09-2000 15!51 WESTERN INSULATION g©9 686 8766 P.21/2? WESTERN INSULATION, INC. 4211 l mtham st[ eet, Rhemido, CftJUbmla 92601 TOL (909) 686-8760 Fax (909) 086-8786 INSULATION CERTEPICATE 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 923995-5B LOT* 1 pz-,41V .y SITE ADDRESS: 45-040 COLDBROOK LANE LA QUINTA, CA 92253 ------------------------------------------------------------------ y ,. MANUFACTURER: Johns-Menville THICKNESS: 3 5/8" R-VALUF: R-13 gjILWQ3; BATTS L04 MANUFACTURER: GREENSTONE THICKNESS: 8.1- R -VALUE: R-30 Gad IRAL CO IRF ACTOR: AMERICAN COMMUNITIES LICENSE NUMBER: BY: TITLE: DATE: INSULATION CONTRACTOR: WESTERN INSULATION, INC. LICENSE NUMBER: 481278 BY: )z TITLE: tevtTION MANA69R DATE MA CH 9, 2000