9908-143 (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,. tic. Class Exp. D%,,,}
ate2gnature of Contractor
OWNER -BUILDER DECL ATION
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
p rf ' ance 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 rio. are:
Carrier OOl'L1:3EN_firlC?L'F, fNf3. . Policy No. KWIC' .044068 411
(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 wor ers' com ensa . rovisions of Section 3700 of the Labor
Co)d,Al�
�i�Z
te: f(pplicant.
rning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to.$100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as•a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a.result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of Such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and'State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
th
above-mentioned prop r inspection'purposes. 7,�
Signature (Owner/Agent) Date
BUILDING. P�E.RMIT PERMIT.#.,%)&143
%y.N. �tt 3�)1'S�
DATELOT TRACT
�� ( VALUATION �� ��
JOB sIT,E ' -/*-Qbh G UffW NOK31; ;
APN 741%1027x039
ADDRESS
OWNER
CONTRACTOR/DESIGNER/ENGINEER
CENTURY C'RO44'E't L :1.93�.Yv MUNl'T`IFS
C.l,.
CENTURY CROWELL, COMMUNITIES
SpI
U 1 i_� .� . G ,tt 3'I.�IZ :iy 42(.�)
1535 SO. 'D' r REPT,, STS. 590
SAN BEXNAR.D11,10 Cry, 91403
SAN BE, :'CNTART.)LNO CA 9240$
C:81.4 2120
USE OF PERMIT
SIRGLE FAMILY 1. WEf, LINK; .
t+1 ) •- L.0 1 3ba Y1,AN 2N, - P. 1 l' 1.JC, k1 f%Yt .INIL.,LULeL•..UL`A;K WALL ..+
oR poof:,, 7n,; Rn. )Uu1`:f.C)N C"i i t?f.A1d Cf -wax mr, oR 14.tuvirTPLE ;
ISS[iitMCE Or, SAAB PLAN'TYK.
CUSTOM :3F
PORCHIT TIO t. S
O.AR.A.Gl'sfCA:RPOR'il•' 41,4.003V
ily�S36t14i ?d'A'k;!) COV4T OF COfl3S'1`A 0111:`'fl'd4➢N
174,15a7.60
}+�rfadi�1�'1' fi<'1CiG �3ttE1•'�IY'Iaid,�'
CO1.f:`;'1TtUC;TIO'N ME- 101,4Yt30411' -Ofbt3 �Jt19.ftf1
PLAN C>tifl;C'k M, - 101-000-439-313 $187.62
rf.•ecrRicAL ha- 101-000420-000 $141.13
fy1.11iNMiA G Fa'! ' •. 101'4)00419000 $162.50
STRONG ,NIOTION FOE - RESID 101 -M -241 -OW 3d'T."
YkA1.11IN G T-Tk.. , 101 -000.445 -WO $20AII)
ART M K1J3Lf4s.1'LsV_f S-.RESIC 701-000-255-000 $.191,39
DEVEGOMR 1A PACT'FEfr
GESS Pti&l AID FEES
$0,00
Taf AL Plerl Mft l> ELN DI<fL? U,'
53,634.80
RECEIPT
DATE
BY / (f f/
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
Roof Deck
O.K. to Wrap=�/_�O
Framing
Insutationc7'a
6C�-__.
z8 -_g 6
6 ��
Combustion Air =:
Exhaust Fans
F.A.U.
Compressor
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
_
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall -Int. Lath
46 4i -IL
Final
�`,��tY'8
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
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 f �!
Pool Cover
Encapsulation
Gas Piping
Gas Test
_
v 6
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
Utility Notice (Perm)
JUN -02-2000 16:51 WESTERN INSULATION 909 686 87B6 P.12i17
TER -N INSULATION, INC.
4211 Latham Strcct, g vvrside, Caiifamla 99 5D i
Tel (909) 686-8760 lex (909) 686.8786
,
ISM ATEON CMT-IFICATE
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# 36
SITE ADDRESS: 78-068 CALLS NORTE
EXTERIOR WALL,
MANUFACTURER: Johns -Manville THICKNESS: 3 518" R -VALUE: R-13
CEILINGS: �iAT BLOW
MANUFACTURER: Johns -Manville THICKNESS: 11' R -VALUE: R-30
'CEI BATTS BLO W
MANUFACTURER: Greenstone . THICKNESS:, 8.1" R -VALUE: R-30
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GENEFtAL CONTRACTOR:_ CENTURY HOMES
LICENSE NUMBER:
BY:
TITLE:
DATE:
INSULATION CONTRACTOR: WESTERN INSULATION, INC.
LICENSE NUMBER: 481278
BY: • Paa
TITLE: PRODUC 1 N MANAGE
DATE JUNE 2,2000