0006-184 (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 Businessland_
??ifessional's Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
7V4 I 81,
.... t 1 t}131.a'2(
Vate , ,� l��Signature of Contractor z7 %
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 OCL DFN EAGLE rM. Policy No. NWC•544063-02.
(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
bode, Irshall forthwith comply with.those provisions.�/�
Date:.�r� Applicant Z/2 ' ` ✓L.�
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.
Signature.(Owner/Agent), Date"""
C BUILDING PERMIT PERMIT#
DATE VALUATION ILOT TRACT
S150449.7U 15 20158
JOB SITE
ADDRESS 78-071 CIALIX H0P.17
APN
769-022,-0V
OWNER
CONTRACTOR/DESIGNER/EN (NEER
CEkmiRY C£COUGTEUI COMMUA DWS
CIWWRY C-1RO I -L. COMIvIUNC IES
1535 SO: 11D" `31 h__r!`, 71UP ##200
1535 090, "1J" ', v"rF, ##100
81%'krRNARD O CA 9244
BOWARDWO CA 02408
`S.KW
(508)381.60(Y! CBL# .2120
USE OF PERMIT
SINGLE, FAMJ.L..Y DWMLING
SPD -LOT 15 PLAN 1AR n PERBII.IT T)OL? NOT INCLUDE BLOCK WALLS OR ,
POOL 75 % PLAN CHECK FE RE DUCTION FOR ISSUANCE OF SAME
PLAN TYPE
CUSTOM CONSTRUCTION $.803.00 .S.'I'
CI ;R,AOWCA PC3RT (SI) 9,996.04
c�
1;+;: MA= C09I' OF C01Y&TRI CrUOM
1.a6IG,449.70
PER%NT WE SUMMARY
CONSTRUCTION FEE 101.000-418.000 $818,00 "
PLAN CHECK IEE 101-000-439-318 $164.f3"G
MLCfIANICALFE1✓ 101.000.421-000 533,50
ELECTRICALFRk' 101-000-'420-000° $106.81
PLUMBING FU 101-000.415.000 $137.25
'_ � r
STRONQ MOTION IEE a RESii) 101-000-241-000 $15.£
CRADD40 ITZ 101.0004M-000 " $20.00`
DEVELOPER IMPACT FEE '$1,90'7:00
V >.
Sm-wm CONS Li'CIM-ON,lata0 FLAN ( IF'CY,
$3,222,42
L'13 PIiF- PJdD TWO
PERWif JI 8)?L'11; BOW
S3,222A2
RECEIPT
DATE
BY ' ) ,
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION•
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS'
MECHANICAL APPROVALS
Set Backs/
Forms & Footings
Underground Ducts
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck Z- 7-2 -Z;)
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 /
Drywall - Int. Lath
Final - '
jf
BLOCKWALL. PPROVALS
Final �/OF
POd - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. 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
Sewer Connection
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
2<, �� /.���.✓ d� l`-6-�da
, -07�
Final i_
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp, Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles 6
G. F.I. /1
Smoke Detectors J
Temp. Use of Power
Final
Utility Notice (Perm)
i
MAY -25-2 001 16!00 WESTERN INSULATION 909 686 8786 P.16i27
'vii py'SI T INSULATIO 9 INC. 4.
4211 Iatbo= Stfeet, Riverside, c.aII0�0280t
Tcl. "9) 686.8760 Fix (909) 686 8785
YNSULATION&T-rFl
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 A%
TRACT / PHASE: DU.NA FAIRWAYS - 20158 PHASE 2
LOT 1
SITE ADDRESS: 79-071 CALLS NORTE IA QUINTA, CA
R WALLS:
MANUFACTURER: JOHNS f4 ANVIUf THICKNESS: 3 5/8 " R -VALUE: R-13
CEILIN BATTS
MANUFACTURER: GREENSTONE THICKNESS: 8.1" R- VALUE: R-30
CEILINGS: BATTS BLOW
MANUFACTURER: JOHNS MANVILLE THICKNESS: 11" R- VALUE; R-30
r
OE EBAL. CON RACIM CENTURY HOMES
BY:
TITLE: .
DATE:
INSULATION CONTRACTOR: WESTERN INSULATION, INC.
LICENSE NUMBER: 481278
BY:
TITLE: PRO U ION MAN ER
DATE MAY 2 5 2001