0006-174 (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
Vate4 ,` < /61 P 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 Sianature 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 GOI.DU)4 EA01.E INS. Policy No. NWC".-.'144063.02
(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 33700 of the Labor
/Code, I shall forthwith comply with thoseaprovisions�Q .
Date: 1. /;�t� �a Applicant ZZ i .r j( f .' G�' iy✓
�t
Warning: Failure to secure Workers' Compensation coverage is unlawful and
'shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
th above-mentioned property for inspection purposes. 1
ignature (Owner/Agent) ' '-j�' Date/-/
' BUILDING PERMIT PERMIT#
DATE VALUATION LOT -x'74 TRACT
SY�Oc'849.70 � 2015$
JOB SITE
APN
ADDRESS 7e.g Ct1 1<, N0 `
769-022-037
OWNER
CONTRACTOR / DESIGNER / EN (NEER
C:04'nIRY CROWELL COWr1UMTM
=qrURYCROWELLCOIAMUNM8
1535 30, TY S'MM. -, W7_0200
1535 30, M�" :3' ?SST, W. .R #f200
SAN BER3ARDDTO CA 924OS
SAN 13ERMAkOINO CA 92400
(909)3$1.6007 CBM. 2120
USE OF PERMIT
SIXGLE I'1ANi11_ Y liWELUNG
SPD -WT 5 PLAN LAR- PERMIT DOES NOT IWC:L.L109 BLOCK 'MALLS OR
POOL, 75 V& PLAN CHECK FEE REDUCTION ICOR ISSUANCE OF SAME
PLAN TYPE
CUSTOM C014STRUCTIU14 1,803.00 3F
C1ARAt3E/CARPORT (SY) 0,906.00
l
RIT111 AI`.�-.3'D COS71 Oir t�"C7.i�i�"MUC. 10N
Isp 4i9 7, 0,
�-r
n.aac.
PERMU SUAdhfARY
f x
CONSTRUCTION SEE 101.000.4184000 $813.00
""• r� • -�`
PLAN CHWK IrEE 101-000-4139-318 -1164,92•sky
, � �`';
' � .
MECHANICAL FEE 101.000-421.000 $53.40
Ft.ACiItIrAi FEE fol-flag-420-0� $106.81
PLUMBING FEE 101.000-419aa1<0 $137.25
�-
STRON0 MOTION FEE d RBSID 101-000-241-000 $0.04
GR,ADINC9 FEE 101-000.423»000 $20.00
�4
DEV'irsiWER IMP.t CrY YEA, $1;4107.00
BUB1 TOIAL COMM±J'MON' AM PLAN C IMC. -K
<•,. $3,2214
IXAS P.R&PAID YMN
$0.00
1VIT"AL PY If 14 41 D1:IF NOW
33,222,42
r.
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
i
�
OPERATIONi
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
:i
APPROVALS
MECHANICAL APPROVALS
Set Backs ' i
_
Underground Ducts
Forms & Footings !
Ducts
Slab Grade t
—Z'% U �J
Return Air
Steel 1
_
Combustion Air
Roof Deck
Exhaust Fans
0. K. to Wrap
F.A.U.
Framing
Compressor
Insulation 1 f
—a
Vents
Fireplace P.L. 1
Grills
Fireplace T.O. 1 i
Fans & Controls
Party Wall Insulation 1 E
Condensate Lines
Party Wall Firewall ? i
Exterior Lath
Drywall - Int. Lath
i
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam !
Approval to Cover
Equipment Location
r
Underground Electric
r
Underground Plbg. Test
Final r i
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 ; i
Sewer Connection
��_
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances {
i;
Final
li
Final i ;
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole I
Underground Conduit;.
Rough Wiring
Low Voltage Wiring ! I
Fixtures
Main Service
Sub Panels {
Exterior Receptacles ;
G.F.I. I 1
Smoke Detectors I
Temp. Use of Power 1
• It
Final "
Utility Notice (Perm)
COMMENTS:
0��e
�l� a
MAY -25-2001 15:r55 WESTERN INSULATION
909 686 8786 P.06i27
'TWITEATERN 'INSULATION IN(m;*
4211 EAthem stmet, Rlvcnide, CaUftnTda 92301
'Cel. PN) 686.8760 Pic "9) 686.8786
INSULATION CERTIFICAT
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 A%
TRACT / PHASE: DUNA FAIRWAYS - 20158 PHASE 2
LOT # �5
SITE ADDRESS: 78=091 CALLE NORTE LA OUINTA, CA
E)CTMIOR-WALLS:
MANUFACTURER: JOHNS MANVILLE THICKNESS: 3 5/8 " R -VALUE: R-13
CEILINGS: BATTS' BLO
-
THICKNESS: 8.1 " R- VALUE: R-30
MANUFACTURER: GRE%8A
.
� SLOW
MANUFACTURER: JOHNS MANVILLE .THICKNESS: 11" R- VALUE: R-30
GENERAL IGONTRACTOR: CENTURY HOMES
BY;
TITLE:
DATE:
INSULATICON CONTRACTOR: WESTERN INSULATION, INC.
LICENSE NUMBER: 481278
BY:
TITLE:. PR ION AGER
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DATE MAY 5 mm
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