0006-187 (SFD)LICENSED CONTRACTOR DECLARATION
Lhereby 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
ate �� �� Signature of Contractor)
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:
Carver OOLDEN FAOIX INS. Policy No. 114WC-144069.42
(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
Cpde, I shall forthwith comply with those provisions.
agate: G�. Applicant ACA 1; �(�
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.
� 1 _
1 Signature (Owner/Agent)r^r1 .`f' Gj1, Date
VVVVV , , _.. _
lG �o BUILDING PERMIT PERMIT"
DATE VALUATION LOT 0006-187 TRACT
$1.03,017.70 1€ 20158
JOB SITEAA
ADDRESS 78-00 C.sa'A.TXF. NOM.
APN
ICP9-
OWNER
CONTRACTOR/DESIGNER/EN (NEER
M.4TURY CROWELL CONJM'uTTT'. S
CEN WRY CROWRL CC314MUk7I'M11
1535 30. `D1 MRE= OTE. WO
1535:30. nD" 1TSR1; ;,TF all?. 4200 '
SAN BERNARDWO CA 92408
SAN' BM4ARDWO CA 92408
(909)3131.6007 CBL# 2120
USE OF PERMIT
SM61Y, DWELI.JNG
SFCJ:1. T 18 PUjI 4 M. -PERMIT DOP"G, NOT 114CLUDE BLOCK, i .At.;,.4 OR
POOL, 73 % PLAN al WK VEY, REDUCT IQN FOR ISSUANCE OF SAME
PLAN TYPE
CL19'1OM CONSTRUCTION 2,10790 8F
GARAGEIC.AARPORT (SF) $,663.40
Xb"1"A»I TFD COST O3'.COXS"�'1RUCn0X
1.73,817.70
PEAMN Xf'EE 9UMMARV
CONSTRUCTION RE 101-000.418.000
PLAN CHECK RE 101-006-0.39-:315 • V33.0
MECHANICAL FEES 101.000421-000 $03.30
ELl°ZTRICAL FEE 101-000420-000 $11711.3
1, ; ar
Pi.[iivtBiNG FEE 101.000-419-000 $162,50
{'
S2'.f2.ONO MOTION FEE RZS ID 101-000-241^000
GRADING FEE 101.000-423-000 420:46
C
DEVELOPER IMPACT FER
1x _ I .c
t.Ia.
+ ti
•�'"
3LI $-'0TAL CONS` IT+-'qION AM) FLANCFWK
S3,391.44
LESS M -PAW NEa
$0.00
.ff
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION (RECORD
OPERATION
I DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs _
Forms & Footings �� ld
Underground Ducts
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck�,� y
Exhaust Fans
O.K to Wrap Z L9
F.A.U.
Framing —
Compressor
Insulation _ 7-aZ
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final6/ a 6
BLOCF`'.,WALL APPROVALS
Set Backs
Final
POO( S SPAS
Steel
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 `� �p
Heater
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:
��- u 0; 4.j .41- 5a -v
`lsv0 .L.�� di' 6,0-
a-;6-
Finale 6'-
Utility Notice (Gas) `7 •
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
Finaltj/
Utility Notice (Perm)
MAY -25-2001 '16:02
WESTERN INSULATION 909 686 8796 P.19i2?
VESIERN1.NSU LA I N, I s
4211 i,athad.SUmt, Riverside, Ca"Onl&92901
7
Tat. (909) 686-8760 `Man (909) 686.8786
INSIWATIC)N CERTT=IIP'I 'rl
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 / PHASE: DUNA FAIRWAYS — 20158 PHASE 2
LOT # v87 .
SITE ADDRESS: 7E=065 CALLS NORTE LA OUINTA, CA
------------------------------------------------------------------
EICTERIOR WALLS:
MANUFACTURER: JOHNS MANVILLE; THICKNESS: 3 518 " R -VALUE: R-13
CFJLI!IgS: BATTS BLOW -
MANUFACTURER: GREENSTONE THICKNESS: $.1" R- VALUE: R-30
awILII�GS: BAi79 BLOW
MANUFACTURER: JOHNS MANVILLE THICKNESS: 11", R- VALUE: R-30
GENERAL CONTRACTOR, -CENTURY HOMES''
BY:
TITLE.-
DATE:
ITLE:DATE:
IN -SM
LATION CONTRACTOR: WESTERN INSULATION, INC. .
LICENSE NUMBER: 481278
BY:
TITLE: PR TION MA GER
DATE
MAY 2 5 2801