0006-185 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
.;C ll#ter 9,:(commencing with Section 7000) of Division 3 of the Business and
Pi;ofessionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
714.188 B ` 1013112(
/ate ` f�) Signature of Contractor'�� )' 1`�•^�I L42
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 COLDEN EA GIA INS. Policy No. XWC444068-02
(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
Zde, I shall forthwith comply with those provisions. t
te: ,%i3 n Applicant "it{fs7 GG✓r1
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.
gnature (Owner/Agent)Date r
BUILDING PERMIT PERMIT#
�'
DATE VALUATION LOT TRACT
$174.817.70 1€ VMS
JOB SITE
ADDRESS %fl -r 9 : AgQ17g;
APN
769-0,22-0. 3
OWNER
CONTRACTOR/DESIGNER/EN (NEER
C'W11MY CROS. COA,4MUM11ES
(M'0.Tt1TP Y CROWI':LL COIbIA UNtM- S
1535 S4. *DV STRWI .`,T . #200
1535 SO, "D° MRM'T, UM #200 -
SAN BEMNAMD1110 {:A 92408
SAN'BERNARD190 C.b1 92408
(909)381.6007 CMR 2120
'USE OF PERMIT
M.TOT 117AIALY]D'vl E L2 O
533•LpT ICs P1.,AFJ 43fie F'IfiilV33'1' 174IiS NOT 1NGl,:t1I)1ti,CiC1C &A11.,S 032
POOL 75 %PIAN CHECK EEE REDU 1.109 FOR IWANCE OF 5.AME
PLAN TYPE.
CUSTOM CONSTRUCTION 2,10 oo 0
aARA.f3FJCA#:F'ORT (So 9,682.40
ES'1'.Ci1fJNITI) CC:!gr OF COfflgmucl om
17:3.017.70
P:RAWi'1'`TE HU 1�" RY
CONSTRUCTION FEE 101-000.418.000 =398.50
� �
PLAN CHECK FEE 101-000-439-318 $183.43
WCNANICAL FF.% 101.000-4.21.000 989,30
-" "
SLEC` RIC,ALIF,ZE 101-000-4.20-000
3'sLt}MB1N0 FEE 101-000-419,-000 t162,50
STRO140 MOTION FEE - RkSI a 101-000-241-000 V7.:18
01"(18 fli(i FE 101-Q.00-423-000 1126,00
0-MVtELOPE17 13t PART F!?G 1:),90!.00
:: :'i ,_;
C.'
BIBB-T(YIAL CONS°.(. UC11014 AND PI,.,AX CMICK
$3,391.44
7. pnza rxm,:P@ed'i7i TrG
IPA,AR
T-()r1'A1., P..M, ,Wi1 I+'�.'1 DUE NOW
0,391A4
4
RECEIPT
DATE
B/Y J
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 1
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
/2
F.A.U.
Framing j ,
/Z—p—J
Compressor
Insulation
Vents
Fireplace P.L. ±
Grills
Fireplace T.O. i I
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall l
Exterior Lath i i
1-17
Drywall - Int. Lath
;i
�
Final _ (�
Final ± 1�
a7 -
6
POOL - SPAS
BLOCKWALL
,
APPROVALS
steel
Set Backs I i
Electric Bond
Footings s
Main Drain
Bond Beam !
Approval to Cover
19
Equipment Location
Underground Electric
I
Underground Plbg. Test
Final ;1
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
_ 4.1.
-
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas) { i
ELECTRICAIi_ 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 I
i
Final
Utility Notice (Perm) ; !
MAY -25-2001 16!01 WESTERN INSULATION 909 666 8786 P.17i27
E�'ErT I1vi�L�1'T°I�i, IrTC
42 11 Latham street, giverstdc, CaNOrafa 72W I
TeL (909) 68643760 Fax (909) 686-8786
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 CALIFORNIA, IN THE BUILDING LOCATED AT:
TRACT I PHASE: DUNA FAIRWAYS - 20158 PHASE 2
LOT #: 16
SITE ADDRESS: 78-059 CALLE NORTf" LA OUINTA, CA
EXTERIOR WALLS'
MANUFACTURED: JOHNS MANVILLE THICKNESS: 3 5/8 " R -VALUE: R-13
-;)CEI BATTSBLO
MANUFACTURER: GREENSTONE THICKNESS: 8.1 R -VALUE: R-30
NQS. BATT6 SLOW
MANUFACTURER, JOHNS MANVILLE THICKNESS: i 1 " R -VALUE: R-30
-
GENV m8AL Q0NTM!QT0fj CENTURY HOMES
BY;
�- -
TITLE:
DATE:
INSULATION GONTRACWESTERN INSULATION, INC.
LICENSE NUMBER: 481278
BY:
TITLE: PRO90TON MA GER
DATE