0006-189 (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 # Lic. Class Exp. Date
714188 133 t 10.N5 112:
ate!c" % �' 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
Y I 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 GOLDEN+IAOLE INS Policy No. NW -W060-0.2
(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
Code, I shall forthwith comply with those provisions.
Applicant
r — t;., V
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) �/ (L ✓ Date /0 tA71
BUILDING PERMIT PERMIT#
DATE VALUATION LOT -189 TRACT
$171,817.70 a015€S
JOB SITE
ADDRESS 7a -mi. GPIux i.'vOm
APN
769k-022--038
OWNER
CONTRACTOR / DESIGNER / ENGINEER
CEJ fURY CROW Lt., CO1v21RxN1,i"M
CE)9"URY CROWE•LL COWAUMUS
1555 so, -v O'Iwa, :SSE, 0200
1535 50, "D' MRE n, 7, IR #200
SACT ERXARDrk%T0 CAS 92400
SAW BFKOARDINO CA 92408
(909)381-6007 C1M40 2120
USE OF PERMIT
SFO- t.GT 30 PLAN 2BR-PrRM1T VOYS NOT 1WC1XD? 131,.00F: WAUZ OR.
11000 75 o� PLAN CHECK FEE REDUCTION KNO ISSUANCE OF SAME,
PLAN TYPE
CUSTOM Cgr113TR.UCTION 2107.00 SP
CA11,AGEICA.K.PORT (SF) 9,W1.40
ZY17M91" COS Olt CON"S"7f WCT'10H
173,817.70
plryt�tiltlr��i�rT�'/ryelh3�SyiCti�ytyl�.�IORY
/�4 �g/�
CONSIRUC111011 n?x 101.000.4128''000
PLAN CHWK PEE 101-000.439-318 $183.43
MECHANICAL FEE 101.000.421.000 $95.50
ELECTI;UC:AL. FEE 10.1-000-420-000 $117.13
PLUMk1ING FEE 101.000.419.000 $162.50
ST RONO MUCION FEE • RESID 101 -1100 -VII -000 $17.38
ORADIWO FU 101.000.423.000 $20,00
�,
DEVELOPER IMPACT FREE
4 z'1=..•
SM -TOTAL CONSTRUC110A1' AND IPLAM C fill CX
$3j391.44
T EOS PF.R&PArD. �
$0.00
TOTAL PEFAW 1!TME6 Dn_ h' NOW
&3,191A4
RECEIPT
DATE
BY f
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
�Z—Z 7—� ,�p�/
F.A.U.
FramingS
p/
Compressor
Insulation
—10��
Vents
Fireplace P.L.
Grills
Fireplace T.O.
_
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final ��6��
Final
POOLS - PAS
BLOCKWAL't A`PPROVALS
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
Neater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
/ i/�
G (p
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
_
Appliances
Final
COMMENTS:
Final
�
,d� � lr'.�1' 9— �
Utility Notice (Gas)
- —
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
000 -
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors 410,
Temp. Use of Power
Final
Utility Notice (Perm)
MAY -25-2001 1603 WESTERN INSULATION 909 686 9766 P.21/27
WELIASTERrT INSU— LATION 9 INC e
42 11 Latham stmt, Rivemide, Calitmia 92301
TeL (909) 686-3760 Fax (909) 696-3786
INSULATION CERTIFICATE
THIS 18 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 #.
SITE ADDRESS: 78.081 CALLE NORTE LA QUINTA, CA
EXTERIOR )HALLS:
MANUFACTURER: JOHNS MANVILLE THICKNESS: 3 5/8 " R -VALUE: R-13
C S: BATTS BLOW
MANUFACTURER: GREENSTONE THICKNESS; 8.1' R- VALUE: R-30
CE S: Q__BATTS BLOW
MANUFACTURER: JOHNS MANVILLE THICKNESS: 11" R- VALUE: R-30
GENERAL _C_O_WRACTOR: CENTURY HOMES
BY:
TITLE:
DATE;
INSULATION CONTRACTOR: WESTERN INSULATION, INC.
LICENSE NUMBER: 481278
BY:
TITLE: PR6 TON M,pkAGER
DATE MAY 2 2001
1