0006-178 (SFD)LICENSED CONTRACTOR DECLARATION
I,hereby affirm under penalty of perjury that I am licensed under provisions of
C;lapter 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
Date f'- !�� Signature of Contractor ,E / � •�
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
gym,
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 GOLDEN RAC1LE, AIS, Policy No. VWC-544068-02
(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 provisions,
Date: !!� Applicant%�
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines'up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
,construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes. ff�fj 33 (�yJff,/ /)
Signature (Owner/Agent Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT "641/8 TRACT
S15%449,70 9 20158 i
JOB SITE
ADDRESS M_ CA",E N•(yR,11
APN
76�►-022 0:37 i
OWNER
CONTRACTOR / DESIGNER / EN (NEER
CENTtMY CROWELL C01*417ATt S
Cr.:�il' RY MOWLIL Cow iiuml
1535 90. WDII S'SR.lsff; STE, ##'700
153530, V"
Sm •131�'MA"rao CA 92408
SAN F31 TEMWO CA 92408
(909)381-60m c: Uf 2120
USE OF PERMIT
MCsi..E F lr+1.i. Y DV11UJWC
SfrD• PLOT 9 PLAN 113R• PERMIT DOES NOT INCLUDE BLOCK WALLS OR
P00475 75 % PIAN CHECK FEB R1rbtICnow FCiR isauANCE of 3.AN1$
PLAN TYPE
r'
CWTOM CONSTRUCTION 1,803,00 OF
GARAGE IK:J`iRPORT (`QF) 9,996.60
ES'1M�A'1, COW OF CoNbW-1:fC'11011
1A),449.70
PURNE1472 SUMMARY
CONSTRUCTION FEF 101-000.418-000 $818,00
PLAN CHECK FEE 101-000-439-318 $154.62
S
MECHANICAL FEE 101.000-421.000
Tf,1XCTRJCAL FEE 101-00&420-000
PLilNISM0 FIFE 101.000-419.000 513"I,2M�y
STRONO MOTION ISE - RESID 101-000-2441-000 $15.04
GRADINO FEE 101.000-423.000 $20,04
DEVELOPER IMPACT FEE
f 1.r
OUB -TOTAL CONS°-` UCnON AND PLM Cl -WK
$3,222.42
LESS PRE-PAIrd rM3
$0.00
`VXIA1 PTEMM 'x=Eh'S DUE NOW
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RECEIPT
DATE
B/
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
.-'-c0
Compressor
Insulation.rte
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wali Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
�— p
_
Final G``
BLOCKWALL APPROVALS
Final
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
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
Final
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
Utility Notice (Perm)
COMMENTS:
/
x
MAY -25-2001 1557 WESTERN INSULATION 909 686 87% P,10%27
WESTERN I11tSULATION1 I1lc.
4211 Latham street, Rivenift, C&UBorr" 92301
ToL (909) 6864760 Flint (909) 686-8786
INSP-L—ATIOIR CERTIKICATL
THIS IS TO CERTIFY THAT INSULATION HAS SEEN INSTALLED IN CONFORMANCE WITH
THE CURRENT ENERGY REGULATION, CALIFORNIA,ADMINISTRATIVE CODE, TITLE 24,
STATE OF CALIFORNIA, IN THE BUILDING LOCATED A%
TRACT I PHASE:
DUNA FAIRWAYS - 20158 PHASE 2-'
LOT #
SITE ADDRESS:
'78-083 CALLE NORTE LA DUINTA, CA
EXT_ RIS OR WALL8:
MANUFACTURER:
JOHNS MANVILLE THICKNESS: 3 5/8'"
R -VALUE: R-13
CEI
BATTS
MANUFACTURER:
GREENSTONE THICKNESS: 8.1"
'
R. VALUE: R-30
CRINGS:
BLOW
r
MANUFACTURER:
JOHN VILLE THICKNESS: 1"1 "
R- VALUE: R•30
GENERAL CONTRACTQ
CENTURY=HOMES
BY:
f
TITLE:
DATE:
INSULATION
CONTRACTOR: WESTERN INSULATION, INC.
LICENSE NUMBER: 481278
BY:
TITLE: PR TION ANAGER
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DATE MAY
e5 2001
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