0006-175 (SFD)LICENSED CONTRACTOR DECLARATION �t /-
I hereby affirm under penalty of perjury that I am licensed under provisions of d U BUILDING PERMIT
Chapter 9 (commencing with Section 7000) of Division 3 of the Business and DATE VALUATION LOT
—Professionals Code, and my License is in full force and effect. $17 7.70
License # Lic. Class Exp. Date
714188 B I O%' 1/21(
Vate7� %� Signature of Contractor f' A���f<�`� ✓
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 0OLi7&I 1RA0149INS. Policy No. WC -51441068 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
Dode, I shall forthwith comply with those provisions.
ate: ire 'r Applicant '" AY9r? . 1i��: �.�G•�� F i
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days, from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Vignature (Owner/Agent) iryA/, r>E'f4r Date
PERMIT #
t30iX$•3 i�a� TRACT
0
20158
JOB SITE APN ,.
ADDRESS /a -mg cA%. eN NA�Z1�. 769-0224137 1
OWNER
CEN'T`URY CROWET I. C41V1'Mii1ow
1535 30.9)' UMEr, S'I'B, #200
SMM"ARDD10 CA 92408
USE OF PERMIT
SR1C3T,E FAIM LY 3D'I'I.LNO
CONTRACTOR / DESIGNER / ENGINEER
1535 Sn, -D- UMUT-r brV, x#200
SAN T MI"OINO CA 92-408
(900)381.6007 C mAq 2120
SPCI.1.OT 6 Pl AN 213X2. PERMIT DOES NOT .1NC~I.,U13E BLOCK W.AX.A S OR
POOL ?5 % Pi AN CHECK, FEE RKIDUC^t ION I:`O R ISSUANCE E;Iii S.A.P► ,
PLAN TYPE
CYSTOM CONSTRUCTION 22$67100 3P
CLARAt11?1CAftPo r (so 9,682.d0 �
ESTiJ1'S,ATED COST OF C01493.2.2'I CM0I4
173,017.7()
PFRWT YEE SJUMM SRY
f
C ONS- TRUC TION FEE
101.040-418.000
PiI,,.A.14 CHECK FEE
'101 -MG -439-31.8
$1$3A3
MECHANICAL PER
101-000-421-000
$95,50
'ELECTRICAL FEE,
101-000-420.000
$117.13
I'I.d7MBINO RZ
101-(100419=000
3162M
two
S 1'R.ONO NOTI.ON FEE RES)D
101-000.241-000
$17.30
GR.ADINO Met
101-IC900-423-000
$20,00
DEVFLf?PER 1MPJkCT FEE
$1,907.00
Q,JS
SUB -TOTAL CONSTRUCT -10H AND PLAN' CURCK $3,391A4
LESS PTF'-PLVDFEZ $$0.00
RECEIPT I DATE
DATE FINALED I INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings
Underground Ducts
Ducts
Slab Grade/
Z J py
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
,
F.A.U.
Framing
Compressor
Insulation
2 -S-o
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
—/ 4
_
Final/d/ ��—
BLOCKWALAPROVALS
Final
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground PIN. Test
Final
Gas Piping
PLLWBING 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/Z
Sewer Connection
S (l/�C/
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
Final
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)
57,OMMENTS:
i
6
MAY -25 2001 51 -; 6 "'� � WESTERN INSULATION 909 686 8786 P. 9(/27
wm-l-ird" LATION,l
4211 Latham Btmct Rlvrnidc, California 92501
Tel. (809) 686.8760 Fax (909) 5W -87M
INSULATION CERTIFICATE
THIS IS TO CERTIFY THAT INSV.LATION' HAS BEEN INSTALLED IN CONFORMANCE WITH
THE CURRENT ENERGY REGULATION, CALIFORNIA ADMINISTRATIVE CODE, TITLE 24,
STATE OF CALIFORNIA, IN THE BUILDING LOCATED AT.
TRACT I PHASE; DUNA,FAIFiWAYS 1 7*20158 PHASE 2
LOT # ;
SITE ADDRESS- 78-.089, CALLS NORT'E LA OUINTA, CA
CMRIOR WALLS:
.MANUFACTURER:
JOHNS MANVILLE
THICKNESS: 3 5/8 " R -VALUE: R-13
CFJLING$:
BATTS
�BLO
MANUFACTURER:
GREENSTONE
THICKNESS: 8.1" R- VALUE: R-30
ATTS
BLOW
MANUFACTURER:
JOHNS MANVILLE
THICKNESS; 111 R- VALUE: R-30
GENERAL CONTRACTOR:
CENTURY HOMES
BY:
.TITLE:
DATE:
INSULATION CONTRAMB: WESTERN INSULATION, INC.
LICENSE NUMBER: 413.1275
BY:Aiv
TITLE: PF`G IO . ° . ANAGER'
DATE MAY 2'5 7 01..