HomeMy WebLinkAbout9908-144 (SFD)LICENSED CONTRACTOR DECLARATION
hereby,effirm 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
Va'te�ignature of Contractor
OWNER -BUILDER DEC 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 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 insdrance carrier & policy no.'are"
Carrier Policy No.
GOLDEN EAGLE IRIS. ��rc 544068-01
(This section need not be completed if the.permit valuation is for $100.00 or less).
( )' I certify that iri'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 toe workers' compensation provisions -of Section 3700 of the' Labor
Code, 'sh 14 - sth •ith//��a���,,mply wit rovisions.
D%ate�i 1� plicant
/Warning: Failure to secure Workers ompensatio coverage is unlawful and
shall subject ani 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
.l .
BUILDING PERMIT PERMIT#k
DATE VALUATION LOTTRACT
—17 '20158
JOB SIT /
APN
ADDRESS 7&&70 GALL, NOR.111,
769-(!222-039
OWNER
CONTRACTOR/DESIGNER/ENGINEER '
C'EtSiti.`ICROWELLCt1:MA1UN1'E:1aS
CLI'1iTRYCROEti'ELF.^@v31tii1TN:M?S
1335 Sa "I3" STRE E'1', RSTE; #200
1535 60, "El" STR m l', ST.E. #ryp-
SAN BERNr1RDY NO Cry- 92408
SAN BERV'ARDINO., 3 Qik.92408
iMU 2120
USE OF PERMIT
SIN01,13 PlAM1x Y 17WRLL.fNC�
Sr D -I.Cri 37, PLAN 3k - PFR7+ I 1 DOES NOT MOMY.9 R1_C X Wry L
CN*, POOL, 79/a RFMJCi 10N ON PLAN CtsCK.1-WE OR. t -". .TIP.LE
CS5URANCE OF SAIWE PLAN TYPE,
POW", ATIO 213.00 S
10ARA GE/CARPOR T
� yy dt
,' 'rYiVIA' `6) Csr);�'i't) t:CDI�3 1# 3�C°3'CL 1
; . Q�4�,�S`7.'
PERMIT FGF, SUMMARY
CON 3TItUt;;"i"KIN F U E 101-=419-000
PLAN C>*4ECY FU 10t-000-439-315
1IRCLiANICA •FFE lt�l t18iQ- 2.�-4311!1 ��i�.3tl
E9.FG 1t�tGfaA. -101-000 4201400
PLUMBING FFIP 101-000419-M S1:4i?.S9
�IRONG MO'.ITION £'EE RE -SID 101-090-3414)00
r'.rRA�ii�r:3Flil~ IQtstZEiO-423-t3t:►t3 $2i1.tt0
'
it'TNPUBLIC kdieCKS-11!8:701-0W- .55-
DEWi4^U.71`X1PkCT FEE a94�A�3:1..1u9
.. �1.D,;9�/,l�•tJl�
St3f��TOTALt�Gf+1S'i?Zl.��:1'T.C1Al.!11�Id?.I'.,t1i CHECK
�3,t3t1 .:l5
LES PRE—PAID FES; 3
$0.00
TO ,% PFRAfl'aI & EE3 0UF. Ni301V
$3,808.15
RECEIPT
DATE
BY ; '
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
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
Final
POOLS - SPAS
BLOCKWALL APPROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond'Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
I I
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
_
COMMENTS: ,c
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)
JUN -02-2002 16:51 WESTERN INSULATION 909 686 8786 P.13i17
,- rt
WESTERN INSULATIONS INCe
4211 LwJmm Street, Riverside, Colima 92501
TeL (909) 686-0760 Fax (909) 686-8786
INSULATION CERT I �►TE
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 # 20158
LOT# 37
SITE ADDRESS: 78-070 CALLS NORTE
WALLS,
MANUFACTURER: Johns -Manville THICKNESS: 3 518" R -VALUE: R-13
CEILINGS; BATTS BLOW
MANUFACTURER: Johns- anvl/le THICKNESS: R -VALUE: R-30
CEILINGS; - BATTS BLOW
MANUFACTURER: Csseenstone THICKNESS: 8.1" R -VALUE: R-30
----------------------------
OENER _ L CONTRACTOR: CENTURY HOMES
LICENSE NUMBER:
BY:
TITLE:
DATE:
INSULATION CONTRACTOR: WESTERN INSULATION, INC.
LICENSE NUMBER: 481278
BY:
TITLE: PROD CT MANAGE
DATE JUN 00