0006-183 (SFD)1., LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that.1 am licensed under provisions of
Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
Profssionals Code, and my License is in full force and effect.
License # _ Lic. Class Exp. Date
3/9j41 t „ 110/31.12(
bate s 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:
( ) 1, 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).
( ) 1, 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,'Wrm. 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:
Carver 0OLDW RACLE RIS, Policy No. NWC-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: _22�_ .2 /i."t� 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 mork 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. /,
"Signature (Owner/Agent)/�'�'�"� Date`��'�`'�
t'l oa. BUILDING PERMIT PERMIT#
DATE VALUATION LOT 0006.183 TRACT
$173,81.7.70 14 2.0158
JOB SITE
APN
ADDRESS 7
8-073CAr nom
769-022-M
OWNER
CONTRACTOR / DESIGNER / EN (NEER
CENTURY C ROWET, L C0100NITI E6
CEWMA ' CROWELL COArRa L19frl1 S
1535 SO, °lip 8'r1:1 , ,, $J200
1535 80, OD" IM- Ts , = #200 i f
SAN B.C?RNA1RDINO C.A. 9.2AOS
SAN LI' aNAIl DWO CA 924M
(109)381.6007 CB1,# 2120
-
USE OF PERMIT
MG1.Tz. FA -R M -Y DWMTMNG
3170° LOT14 PLAN 2AR • PERMIT DO.EZ, NOT INCLUDE BLOC;IC WADS
OR POO&"coo LAN CHECK OL79 ltiEDUCTi 101 ICOR 1,99LIANCE0Y SAME
PW41 TYPE
CVSTOM CONSTRUCTION 2013'1.00► OF
CA12AGLEICARPORT (So 9,680.40
V67 b+AIXD COSH' OF CO.KSMUC1700
17 43.1"7 70
PER11 D' FEl! 05 R'(:iliSMAMX
CONSTRUCTIOW FEE 101.000-416.000
PLAN CHECK FEE 101-000-439-318 $18143
MECHANICAL FEE 101.000.421-0100 185.50
91,F,CTRICPJ,FRE 101-000-420-000 $117,13
IyLUMiiINO FEF 101-"100-419�000 $162,50
STRO140 MOTION FEE RESID 101-000241-000
GRAD.1110 FZ 101.000.423-000 5 9.ab
DEVELOPER. IMPACT ",Z $1,9tt?.131}
= jr(Yf AL CON u TRMMO.N AND PLAX CMCX
$-3,391.44
LP -38 PRE -FAIT° k�'3T',S
$0.04
RECEIPT wy
DATE
BY 1. L
F
i
DATE FINALED
INSPECTOR
r
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 _ p j
Exhaust Fans
O.K. to Wrap_ _ 6'�
F.A.U.
Framing _a��
Compressor
Insulation 6A7
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
_
Final
L P
BLOCKWAPROVA S
Final
POOL PAS
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 Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles _
G. F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
Oro A-4-"
MAY -25-2001 1600 WESTERN INSULATION 909 686 8786 P.15i27
WESTERN INSULATION t INC*
4211 Latium GUMMA, Rlver6l&, CaUf Td& 92501
Tel, 1909) 686-8760 Fax (909) 686-8786
INSULATION CERTIF1 ATE
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 SUILDING LOCATED AT:.
TRACT / PHASE: DUNA FAIRWAYS - 20158 PHASE 2
SITE ADDRESS: 7.M73 CALLE NORTE LA OUINTA, CA
----------------
T1EiRIOR WALLS:
MANUFACTURER: JOHNS MANVILLE THICKNESS: 3 6/8 " R -VALUE: R-13
CEIIII s: _ BATTS BLOW
MANUFACTURER: GREENSTONE THICKNESS: S.1" R- VALUE: R-30
CEILINGS: BAITS BLOW
MANUFACTURER:- ... JOHNS MANVILLE THICKNESS: , 11" R- VALUE; R-30
GENEFAL CONTRACTOR: CEr uRY HOMES - -
BY. ,.
a' TITLE:
DATE:
INSULATION CONTRACTOR: WESTERN INSULATION, INC.
LICENSE NUMBER: 481278
BY:
TITLE: P TION M AGER
DATE MAY 2 5 do)