0006-173 (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
714188 H / 0/3 1/2 f
VD/ ate of f%"ClIc'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.
( ) 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 •001,DMq IAi3LZ 114,9, Policy No. 14WC 444063.02
(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
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 provisionsn 1.
f1�v_Sate-: f
T_ r IL _y Applicant with
:���
o-
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.
I 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. , 1
Signature (Owner/Agent) ~~. �r-E'-% Datebo
V BUILDING PERMIT PERMIT#
0006-17
DATE VALUATION LOT TRACT
:173�i i.� 4 201 �8
JOB SITE
APN
ADDRESS 7g3 -m3 cAu..& Natzw
6 - D2 , 03, 7
OWNER
CONTRACTOR / DESIGNER / ENGINEER
Mn WkY CROWELL COMMUITUIF.S
CFNTfiil2YC'RCaWLILL CC:IvSAUNI M
1535 30, "D° UrRWT, 3TZ 0200
1535 30, -D' M--iRE T, SM 0200
SAN BE ARaJWO CA 92408
SAN' Bi..�-' .ATARDINO CA 92408
(909)381.6007 CALO 2120
USE OF PERMIT -
S;f1e1GISifi.] Ti? Y DWELL D40-
SFD,LDT 4 FLAN 6AR PERMIT DOFZ NOP 1NCLUDY BLOCK WAL.i„ ; OR
POOL, 75 % PLAN CHECK FM REDUCTI YN FOR IS,IUANC.9 Orr SKMR
PLAN TYPZ
CUSTON 'CONSTRUCTION 2:197,110 SP
C: fA,R&0EJCARPORT (SP 9,632.40
3,
NSTI VIAI'ED CONT OF CONSTRUC ON
A 73,82 7.70
pEftfilr FUR S"LWtV AIZY
CONSTRUCTION FEE 101-000-418-000
.a
PLAN C13WK FEE 101-000-439-318
MECHANICAL 101.000.41,'1.000
NLR CTR1CAL ITZ 101-000-420-000
g`j`sfy;
P14LIIA1 FOG IEE 301-000-419-000 $162.,56
„
sTRON0 MOTION ":E - RWq1D 101-000-241-000
GRADING FERE 101.000-423007 $20.00
� 1'� •""
DLvVELOPER iMPACT MPE $1,907.i3U
ryy� �•.,j
SUB -'T0rAL CONS '11ZUC 710N AND PLANCMCX
$3,391,44
LESS PTtF -.PAI-D S
$a DD
l
' OTA -L.. 'PKIP.1 fff .p`E!'ZW S,D'1_T NOW
k
ti
RECEIPT
DATE
BV / J
DATE FINALED
INSPECTOR
t/ ( 1L_
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs _
Forms & Footings
_
Underground Ducts
Ducts
Slab Grade
-2�-p
�,�
Return Air
Steel
Combustion Air
Roof Deck
_p /
Exhaust Fans
O.K to Wrap
g 2O%
F.A.U.
Framing
Compressor
Insulation�.
7 d j
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final y_
BLOCKWAL PROVALS
Final
POOL - PAS
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
/ - fyOlj
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
/2��
Pool Cover
Encapsulation
Gas Piping
Gas Test
!
Appliances
Final
Final
Utility Notice (Gas) r/.�?�P��FR
ELECTRICA Q0VALS
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)
COMMENTS:
MAY-25-2001 1555 WESTERN INSULATION 909 686 8786 P.05i27
IVES'slya"ERN INSULA T'ION9 INC.
4911 LwtbM Street, RLVMide, C4UfOr3sa 92501
Tel. (9091 686-8760 Fox (909) 68648786
INSULATION CMFIC
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: �D-UNA�-FAIRWAYS — 20158 PHASE 2
LOT # �4
SITE ADDRESS: 7"93 CALLS. NORTE LA QUINTA, CA
gM•RIOR WALLS:
MANUFACTURER: JOHNS MANVILLE THICKNESS: 3 5/8 " R-VALUE: R-13
CEILINGS: BATTS .
MANUFACTURER; GREENSTONE THICKNESS: 8.1" R- VALUE: R-30
CEILINGS: I3ATTS BLOW
MANUFACTURER: JOHNS MANVILLE THICKNESS: 11" R- VALUE: R-30
GENERAL CONTRACTO,11: CENTURY HOMES
BY:
TITLE:
DATE:
INSUJ.ATIQN CONTRACTOR: WESTERN INSULATION; INC,
LICENSE NUMBER: 481278
BY: A.
TITLE: P D CTIO ANAGER
DATE
MV2 5 2001
1
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