0006-172 (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
7,14188 13 10%1/2(
.•
Date ? Signature of Contractors
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 Cy0I,1)L'N yAQI,.E INS. Policy No. NWC-544069.0
(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
si,hjact to the workers' compensation provisions of Section 3700 of the Labor
,Code, I shall forthwith comply with those.provisions;l
1)r/Date: ;n A'.C/i Applicant 17 },� �` �� G•���`��
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.
ignature (Owner/Agent) F t�``I1/�-'` Date'�/i !r
Cly' '- 0 v BUILDING PERMIT' PERMIT#
0" 4721
DATE VALUATION LOT TRACT
$150,449.70 3 20158
JOB SITE
APN
ADDRESSt',�1I.Ia1s:1g01 E
769.022.-07
OWNER
CONTRACTOR / DESIGNER / EN (NEER
C1:;1rd'1URY CRO'WF7,L Wb&fUNrnES
CENTURY CROWD CdMWWrM
1535 00, *.D" S'17C.=:'; M 0200
1535 30, "17• rS"T.lii25" T,`1.']'.F�, 4200
EERNARDWO CA 92409
SAN BERNAR1: WO CA 92408
(909)381.6007 CP11/i 2120
USE OF PERMIT
BINDLEFAJWl;Y 7BW9L1 JNG
S1z33.1,OT 3 PLAN LAR. PERMIT DOES NOT INCLUDE SL,OC K 'WAIIS OR
P001,75 % PLAN CHECK FEEREDUCTION FOR ISSUANCE OF SAME PLAN
TYPE
CUSTOM CONSTRUCTION 1,80u+;00 SF
GARAGEICARPORT (5F� 9,99S.Oi1
.ESVX113) OST 01P COFSJRUCMo N
r'
y.550,449-70
;
PKgqW FEESU1qyARY
CONSTRUCTION .i�I?.1'+ 101.000418-000 8313 D .
fj � 1
PLAN CHECK PEE 101-000-439-318 $164.82
MECii,AWICAI, FE 101.000.421.0'00 $53.50
RL WTPUCAL PEI" 101-000-120-000 $106.81
PLUMBINO 101000.41941.100 8137.25
S', BOND MOT1CN FEE - RES1D 101-000-241-000 $13.04
K)
GRADD40 FU 101.0010-423-dO1} 120.00
DEVLLOPERIMPACT F'I!:,E $11,907.510
SUIB-:COTAL C0NS`MZ CIIOX Al -W PLAN CITECK
$3,1,22.42
LESS FRE -PAID FEES
$0.00
TOTAU PX'iR�. Yt'. YFFE'S ?M NOW
x;7212.'4'2
f/
RECEIPT
DATE
BY -
DATE FINALED
INSPECTOR
/fC
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
W_
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
— 7-p
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
2
Drywall - Int. Lathj
Final
Final ��'O ( po_2
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
i
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
!/
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
/��
C!`
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
_
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voftage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final r
Utility Notice (Perm)
.MAY -25-2005,.15 54
WESTERN INSULATION
909 686 8796 P.04/27
1.
L
.W...,E0TjuRN Y,SU TION9 INC&
11 Latham StreC2, pww'side"cauanlii 02501
TeL CMi 686.8760 Fax (909) 686,87W'
-Jif -CERtIFIC
INSOL IQ$
THIS IS TO CERTIFY. THATN'WLATION HAS BEEN INSTALLEP IN CONFOAMANCq�,V�TH
THE CURRENT ENERGY'REqULATION', CALIFORNIA ADMINISTRATIVE CODE, TITLE 24;
,STATE OF CALIFORNIA, -IN THE BUILDING lOCATED'AT:-
TRACT I PHASE: DJUNXFAIRWAYS = 201.56 PHASE 2
.LOT #3
siTEADPRESS: _78-095 CALLE NORTE LA QUINTA, CA,
----------------- ........... ..............
mAN'UFACTURER:. JO I HNSWANVILLAE THICKNESS.- 3'5/8 R -VALUE: R-13
BATTS- BLOW-
MANUFACTURER: GREENST'ONE,• THICKNESS:' 8.1- R- VALUE: R-30
CEI GS: ATTS BLOW
MANUFACTURER; JOHNS -MANVILLE THICKNESS: 71 R- VALDE: R-30
CONTRACTOR: CENTURY HOMES
BY:
TITLE:
.DATE:
INSULATION DO][ WESTERN INSULATION, INC.
LICENSE- NUMBER: 481.276
By:
7
TITLE:,:PROD OCTION
'00ANAPER
DATE ep,
MAY 2 5 -2001
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