9908-145 (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
Date mature of Contractor
OWNER-BUILDER•DECL RATION
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). .
( ) 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 3.700 of the Labor Code, for the
p rformance of the work for which this permit is -issued.
Wl 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 Policy. No.
GOLDEN, fi.��OU Mils. NkVC 511.4063-01
(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 tot a workers' compensation provisions of Section 3700 of the Labor
Code, I /J h comply wi th vls.o
ZDD e: r pplicant
rMlarning: Failure to secure Workers' Impelisation 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, indemnity
& 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. Lagree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter u ori
the,Aove-mentioned p� for inspection purposes.
>6ignature (Owner/Agent) Date
BUILDING PERMIT PERMITN
49fb9•14R
DATV>Cb/ / 1 Jq VALUATION LOT TRACT
S1152,9S1152,963.4042,�.�D 39Z{1.t5R
JOBS E
ADDRESS IN -077, GkLt< E NORTE,
'769-022-039
OWNER
CONTRACTOR/DESIGNER/ENGINEER
CENrr` Y U101 VELL COM.MUNI n'ffis -
C 'IJRv
1-535 SO "D” STRFFT,'STF, 921k
15.5 S0- "D" STREET, Mi. #2W
SAN BEWARD l";i:0 l.. A 9:4013
SAN BERNARD= CA 92 305
061.0 2.120
USE OF PERMIT -
S-INGIA FAMILY DWELt,rNG
,
3FD - LOT 34, PLAN IR. - PEM -OT 13 DES NOT ORTLU" 13L(X'K WALL.
(M POOL, 75% R:I~ GUCi'dON ON PLAN CRECK FEE OR N41A H`,iPLR
ISSURANCP Or, S.ANIE PLAN'iNTIE.
0,18TOM. =M'RUC ION 1,803.00 5:1;
P(12Z0VP A170 189,00 SF
GARAGEAC,AXPORT 310.00 IV
CSSTI.W%T.ED Cl;Wf Of C��'��t1<I+�'�'3M�;'d '
� 2,94 419
PUM1.18 Fk;SL' :!oUMj 4RY
CON':fi'1'1;2`uCTION, :FI: 101-0 004.18-000 S92S.00
PLAZ4 CHECK FU 101-000-439-318 S'163.75.
NIECHANIC.lALFt,:� 101
aeC'1RHCA:L.1uh-.: 1;{21-�t1W-4:?#3-M $Q0.81
P1;U.VH]'N'G F98 . 1014)0419-004M 3143.,25
S`1'RON(J.IkIO TION I','EF •• .RE,91D .121 -000 -241. -WO $15.30
ART 1' PUB1.1'C PLACES -1P. _,%1r: 701-000-2,55.0W
1Xi viY OPffR:OVIPAC;'4'.L E, 51,9+X1:(i{i
SURITOTAL CONgirP :IUCIONe ND PLAN Ci~-tFICK
53,409.02
1,ESS PR &#'AID 1,11.S
$0.00
'4'I<3TAT,.PERMIT €'?t$+.'.S D1r2E'fiC, W
$3•,409.02
RECEIPT
DATE
BY j
is
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings
0
Underground Ducts
Ducts
Slab Grade
Return Air
Steel
Roof Deck
O.K. to Wrap
% p -a
Combustion Air
Exhaust Fans
F.A.U.
Framing
Insulation
z_ a 7
'` ��G-d fp"
Compressor
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL
APPROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
/*
_Underground
UndergroundPlbg. Test
Final
I VGas
Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
j`
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
-1
Pool Cover
Encapsulation
Gas Piping
_
—�—Q0
Gas Test
Appliances
Final
COMMENTS:
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`j olo
Utility Notice (Perm)
j�,,','` JUN -02-2000 16:52 WESTERN INSULATION. 909 686 8786 P•14i17
11AF TEDRN INSI,i'I.ATION9 INC.
4211 Latham eget, RtvamWc, QaanwAi ►92501
Tel. (909) 688.8760 rax (909) 686-0786
INSM ATIOlyl CERTZI 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 BUILDING LOCATED AT-
TRACT 1 PHASE:
DUNA FAIRWAYS - TRACT # 20156
LOT#
38
SITE ADDRESS:
78.072 CALLE NORTE
EXTERIOR WALLS
MANUFACTURER:
iohns-Md=We THICKNESS: 3 5/8" R -VALUE: R-13
CEIUNGS:
8 BLOW
MANUFACTURER:
Johns -Manville THICKNESS: 11" R -VALUE: R-30
CiIWNG
BATTS BLO
MANUFACTURER:
Greenstone THICKNESS: 8.1 " R -VALUE: R-30
GENERAL CONTRA
TOR: CENTURY HOMES
LICENSE NUMBER:
BY:
TITLE:
DATE:
IhISULATIONCONTRACTOR: WESTERN INSULATION, INC.
LICENSE NUMBER: 481278
BY:
. Qu
TITLE: PAMV5n MAMAGEFCU
DATE JUNE 2,2