0006-179 (SFD)�y LICENSED CONTRACTOR DECLARATION
.1 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 13 X10/31/2(
Date 1 /S7 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 GOLDV-N B,A.OLE INS, Policy No. Mye-8440042
(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. r
Date: Aby' hh ^ Applicant -701 -�C C4J.-b i` A
f '
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. A%
Signature (Owner/Agent) r�`�� j l./ �""/` 1 Date L
BUILDING PERMIT PERMIT#
DATE VALUATION ? ^ LOT , OW64, 79 TRACT
1?3XI7.7() 10 20158
JOB SITE
ADDRESS , l C . NOl C
APN
769-02.2-4#7
OWNER
CONTRACTOR/DESIGNER/ENGINEER
C`M URY CROWEU, COMMINnM
CENTURY CRE?L'i1M..;L COMMI7NIM
3 535 V0.'U' S'A1"r, SIT-- #)200
1535 80. 'ID' STREET, STE, 0200
SAN 1 ERNARDWO CI?s 92408
SM A-E3NAR1DINO CA, 92408
MU 21.
(909)381,60070
USE OF PERMIT
MGM!, FAMMY DWE11MG
SFD• LOT 10 PLAN ZAR- PERMIT DOES NOT INCLUDE BLOCK: WALLS OR
POOL,, 75 Y/ PLA14 CHECK .K9 REDUCTION FOR ISSUANCE OF S"R
PLAN TYPE
CUSTOM CONSTRUCTION 2,107,00 OF
QARWVCARPORT (SI) 9,682.40
ESMA` KO COIWX OF C0I.rTS71WC'1I017
173,917-70
1'Ii RWI' FEE 8'RT&MARY
COMSTRUCTION ME 101.000-418.000 $M.30
.
PLAN CREC K FEE 101-000-439-318 $I8y.43
M CiHANICAILFEE 101.000.421.000
ELECTRICAL FEE 101-000-4.20-000
PLUARTi1N0 PER 101-000-419-000
STRONC4 MOTION FRE - IMI) 1.01-000-2.41-00U $17.33
CIR.AT)INO F10, 101.000.423.000 $20,00
DEVELOPER IMRACT FEE $1,907.00
S13'k3-TOTAL COMM RUC11-10N• t ITD PLAN CT1:F.'CK
$3,331.44
LF,,S3 P)2� -PALD FRUS
$0.00
RECEIPT
DATEBx
/
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION11 .DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
/_��/o
Underground Ducts
Forms & Footings i I
Ducts
Slab Grade ; I
/
Return Air
Steel
_
Combustion Air
Roof Deck ?
�
Exhaust Fans
O.K to Wrap 1. i.
_ ZZ
F.A.U.
Framing J I
/��
Compressor
Insulation
Vents
Fireplace P.L. 1
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation i I
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath ? (
Z
{I
i+
'
Final
Final .I
g�/p_��
POOLS - SPAS
BL66KWALL APPROVALS
steel
Set Backs ,;
Electric Bond
Footings 11
Main Drain
Bond Beam ; {
Approval to Cover
iz
Equipment Location
#
Underground Electric
i .
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Waste Lines
���
Electric Final
Heater Final
Water Piping I
Plumbing Final
Plumbing Top Out ; f
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
f z
/
Pool Cover
Sewer Connection
Gas Piping
Encapsulation
Gas Test
Appliances
i l
Final
COMMENTS:
Final
Utility Notice (Gas) !/lJ--d�
G/
Z. Cr�-t
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit I i
Rough Wiring 1;
Low Voltage Wiring
Fixtures
Main Service i I
+r
Sub Panels ?
Exterior Receptacles I
G.F.I. '
Smoke Detectors I
Temp. Use of Power i
�I
�i
Final
-
Utility Notice (Perm) ;!
_
i
MAY -25-2001•- 1558 WESTERN INSULATION 909.686 8786 P.11/27
ItI
w�
�OVESTERN INSULATIONt INC.
' 4211 Latham SU ft% FAversM Ca=Mla 92301
Tot: (909) 686-9760 Rex (909) 6W-8786
INSULATION CERTIFICATE
THIS IS TO CERTIFY THAT INSULATION HAS BEEN INSTALLED IN CONFORMANCE WITH
THE CURRENT ENERGY REGULATION, CALIFORNIA ADMINISTRATIVE CODE, TITLE -24,
STATE OF CAUFORNIA,
IN THE BUILDING LOCATED AT:.
TRACT / PHASE:
LOTS:
DUNA-FAIRWAYS - 20158 PHASE 2 !
10
SITE ADDRESS:
78=081 CALLS NORTE LA OUINTA, CA
EXTERIOR WALLS:
MANUFACTURER:
JOHNS MANVILLE THICKNESS: 3 6/8 " R -VALUE: R-13
CMUNCS:
BATTS =FJLOW-
MANUFACTURER:
GREENSTONE THICKNESS: 8.1" R- VALUE: R-30
CEILINGS:
BATTS BLOW
MANUFACTURER:
JOHNS MANVILLE THICKNESS:11" R- VALUE: R-30
GEM -N& CONTRACTO&
CENTURY HOMES
• BY:
TITLE:
,
DATE:
lblSULATION
CONTRAGTQR: WESTERN INSULATION, INC.
LICENSE NUMBER: 481278
BY: 1(42;7
A*�
TITLE: PRb CTION WANAGER
DATE MAY
2 5 2001