0006-176 (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
71?4 1 7P . 9 10/3112-C
1/Dater�^_ r'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 WLI; W PAO" INS,
Policy No. N`f�YC-��Qis63.92
(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 provision, t9
JI
Gt ' J`�/:fit Applicant—
Warning:
: `C1
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 applicator 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
+e above-mentioned property for inspection purposes. ./
Signature (Owner/Agent) fi' + I ���-� Date �' E
BUILDING PERMIT PERMIT#
DATE VALUATION ' LOT 0006-176 TRACT
$1.�t3�i49:t� 7 201fif�
JOB SITE
APN
ADDRESS %_w Ct�;:GT 1VOJ�T.F�: `
7t39-02,2-0.117
OWNER
CONTRACTOR/DESIGNER/EN (NEER
CaITURY CROV LI. COMMU`Ia'Z IFS
CF_'r W_Y CROWELL COMMUICfM
.1535;50. "9° VIR ' �', Q IT_ 9200
1535 SO, OD" FnU T, STE 0.200
SAN FE11t1;I'A�r DWO CA 92405
SAT BERNARD= CA. 92408
(909)381-6007 CBUI 2120
�
USE OF PERMIT
si1�O.tJ.iw.•da�[WJJ..Z �dL.Li�%�
SFD< WT : PLAN IfsR- PERMIT Iii?ES NOT PNCLUDE ELOCIti WAIA S OR
POOL 75 %Pi,,M CHECK FIRE IE%mucriow TrC:R.1SSU'.ANCE Ott RAmE
PIAN TYPE
'CUSTOM CONSTRUCTION 11903.09 SF
t3ARACIE(C;ARPORT (Skj 9,996.00
ESTWX= CU1V:1.' or C0N.VME C11701q
1501+ 49,71)>'
C ONSTRUCS`IC'N IEE '101.000.418.000 $818,00
{ � '
PLAN CHECK k'1'E 101000-439-318 S1641.92
z
MECHANICAL, FEE 101.000421 -pup $53,30
ELECTRICAL IVEF 101-000-420-000 $106.81
=- ✓ 4
PI,UMDINO PEF 101.000.419.600 $137.25
STRONG MUYION FEE - REBID 101-000-241-000 $15.04
ORADINO FEE 101.000=423-000 $.20100
rJZV WPE11.11t PACT FES' $1,907,00
SUB SAL CONSIX171014 AI+ D PLAN CNCK
$:3,222.42 '
Li3M PRE-PAMexr.�S
$0.00
ryRECEIPT
DATE
9Y e�`
DATE FINALED
INSPECTOR
�l
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms 8 Footings
Underground Ducts
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 & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
—e
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
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
/— _pv
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
� /�� "'4400,
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 2
Utility Notice (Perm)
COMMENTS:
//—/y
MAY -25-2001 1556 WESTERN INSULATION 909 686 8790 P.08/27
INSULATION., INC.
4211 Lath= SUeet, Rivezelde, CaUf nia 92501
IV, (909) 6"-8760 Fax (409) 686.8786
INSULATION CERTIFICATE
i' THIS IS TO CERTIFY THAT INSULATION HAS BEEN INSTALLED IN CONFORMANCE WITH
THE CURRENT ;ENERGY. REGULATION; CALIFORNIA ADMINISTRATIVE CODE, TITL. '24,
STATE;OF CALIFORNIA,': IN THE BUILDING'COCATED AT:..
TRACT 1 PHASE: ;' DUNAsFAIRWAYS — 20158 PHASE 2
LOT # n ' 7�
SITE ADDRESS: �78-087 CALLE NORTE LA 4UINTA, CA
'.EXT'ERI®R WALL3,.
(dlANUFACT'UKFtR: JOHNS MANVILLE THICKNESS: • 3 5/8 " R -VALUE: R-13
00-1 S _• , BATTS SLO
MANUFACTURER: GREENSTONE THICKNESS: 8.1' • R- VALUE. R-30
C I S: 8AT7S BLOW
MANUFACTURER: (JOHN ILLE THICKNESS: 11' "R- VALUE: R-30
GENERAL CONTRACTOR: CENTURY HOMES
f
,BY:. '
TITLE: I
' r
DATE:
INSULATION "CONWESTERN INSULATION, INC.
-
LICENSE NUMBER: 491278
'4
BY: ,
TITLE: PR !ON ANAGER
DATE MA
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