0006-170 (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
} .i}4 1(/31/2(
) Aate �F'� L'4`� Signature of Contractor g 'I"`L`r-`�
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:
Carrier OOLDEN T.,laOl.ri INS. Policy No. MWC-S440f3 02
(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
wor ers' compensation laws of California, and agree that if I should become
sul5ject to the workers' compensation provisions of Section 3700 of the Labor
¢ro
de, ,I shall forthwith comply with.those provisions,�1
Date:#, -y-6 ./k?: 03 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
Vsignature
Frabove-mentioned property for inspection purposes.I,- L f (Owner/Agent)/i '+ �L�LGt!2° Date R )12 -moi:
BUILDING PERMIT PERMIT#
DATE VALUATION LOT Q1Ct06-9.70 TRACT
5150,449.70 1 0151
JOB SITE
APN
ADDRESS .84%99 C.UJZ NO S:
769 -MI -M.7
OWNER
CONTRACTOR / DESIGNER / EN (NEER
CEId WRQ' CROWE.LL CC1IvI.M(JWITES
ClED311 AY CROWE.LL COI&WIrl !'
1:535 30, *D* SI"KM, . ", ST 0.2,00
1335:303. `1crrRW, r, S'SE. 0200
4N' BMZNARDW0 CA 92408
SAM 13ER1` ARDINO CA 92409
(909)381.6007 cm.A 3120
USE OF PERMIT
SWC -ILL. F. ,y DW11-LIN
SMADT 1, PLAN IBR• Iamw ,[3ors, NnT I.XCLUDS BLOCK wP,.LIZ OR
POM;
CUSTOM CONSTRUCTION 1.993,00 ZF
GARAMUC'ARPC3RT (SA, 9,996.00
Iis'.ill ►`FED Co T OF C:ONy. UCITON
150,440.701'
FEE DEPOSIT 1014W-439-3153 -439>3153 4549.44
C:ONS`1'RUCTION FEE 101-0€0-418-000 SSI&GO
P1.NH CHECK FEE 101.900-439318 $69,26
MECHANICAL FEE 101=000-4i1-000
ELECTRICAL Mr. 101.000m4304*0 $106131
�-° ' t� ►.�
PLI)MS1140 P'RE 101-000-419-000 $137.25
STRONG MOT1034 RESIN 101.000.41.000 st5.04
DRAI31> OP'1:Z '101-000-4.23=000 $20.00
DEV'rKLOPER IMPACT FEE , Ri,9t�,011
r
S'U'k340'fAL CON91IkIT TiL"OkI AND PLA14 M -MC K
$3,716.86
IMS PRE-PAL3IMS
4300.00
TOTAL 11kaw-C YKESVOL NOW
3
O
RECEIPT
DATE
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
ZUnderground
�-`
Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
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
Z 0/�.�
eal—
Drywall - Int. Lath
Final Z
Final
i
_C
POOL - PAS
BLOCKWAd A PROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
— — p L
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
>
Encapsulation
Gas Piping
_
Gas Test
Appliances
Final
COMMENT°S::
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)
MAY=25-2071 15:53 WESTERN INSULATION 909'686 8756 P.02!27
WZSTL magre,
011 Lath=. StMt,.Rivmlde, Ca11t mta92301
f 'Tel. (909) 686-8760 F6x (909) 686-8786
ENSMATLO CMTIFICATE
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, DUNXFAIRWAYS - 20158 PHASE 2
LOT 4
SITE ADDRESS: 78-089 CALLS, NORTE LA QUINTA, CA
&MRIOR WALLS:
41,
'MANUFACTURER: JOHNS MANVXLE THICKNESS: 3 5/8 " R-VALUE: R-13
r CE BATTS BLOW
MANUFACTURER: GREENSTONE THICKNESS: 8.1" R- VALUE: R-30
CE S: BATTS BLOW
MANUFACTURER: JOHNS MANVILLE THICKNESS:11' R- VALUE: R-30
MURAL CQUIRADTCaR: CENTURY HOMES
4
BY:
r
TITLE:
DATE:
INSULA1112bi CONTRACTOR: WESTERN.INSULATION, INC.
LICENSE NUMBER: 481278
BY:. .e�71r
y
TITLE: . h CTIO NAi3ER
DATE