0006-191 (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
Prrfessionals Code, and my License is in full force and effect..
License # Lic. Class 'Exp. Date
// 714188 B +� 1013112C
Date n , h� Signature of Contractor;' f f j� �`
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 mai6tain 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 O6LDEN FKAOLE Fbi0Policy No.
?WC,""444069•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
Code, I shall forthwith comply with those provisions`
/ate: f .7- Applicant ' 'i✓"�"} �< l.d . !.%f;
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 permitissued 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.
fgnature (Owner/Agent) Date
� Z "d o BUILDING PERMIT PERMIT#
DATE VALUATION LOT 0-191 TRACT
$173,817,70 22 20158
JOB SITE
ADDRESS 78-057 CA.T.IsF NORIN
APN '
769-022-M
OWNER
CONTRACTOR/DESIGNER/EN (NEER
CUTIURY CROWELL COMb4.TW1DES
Ci'k�7°fURY CRO &L CO1t�7'C1 rI M
i 535 00. TP UIT r, =I 0200
1535 80. "D" STREZT, UrE. #200
SAN DERNARDWO CA 9240+8
&AN BERNARDINO CA. 92408
(909)361.6007 . 0=0 2120
USE OF PERMIT
Maly- 17AMfLy DWI. JUL
SF04,01 3.2 PLAN ZAR•. PZRI+ n1 rion NoT INCLuriz PiI., ov wAus UI2
POOL 73 °t; P LA14 CHECK FEE REDUCTION ik)R ISSUANCE OF SAME
YPE
PLANTYPE
CUSTOM CONSTRUCTION Z1107199 3F
Cl!°a,ii.d GFJCAR.Pi
37'.£JP,lA7 =w 01F C01\i1yIPIAXT1'0 4
13 .�31.7.'7C1
�y +�� .,v 'meq ivy}y��-p�('�R
.IC���r�I�C�U.Ril M SYV1iALi��JARY
F'• !1
CONSTRUCTION FEE 101.000-418.000 $993.30
PLAN CHECK FEE 10.1-000-439-318 $183.43
MECHANICAL FEE 101.000.421.000 29313t1
"� e,;
ELFA i TICAL FPB 101-00"20-000 $117.13
t
PLWADINO FEE 101.000-419.000 $162.30
S3'RONO MOTION FEE • RESID 191-000-241-000 $17.38
ORAD7'NG FEE 101.000-423.000 $20,00
DZ/F,7,.C'PER IMPACT IEEE $4907.00
.. j
SUB -TOTAL, COMSTI.`UCTION AND PI C2 X
$3,191.44
IXSS P7s•Y'.tl� I+S
$0.00
TO'.['d'!LT' T1 'Irv—MISDUE
13,3491X44
RECEIPT
DATE
BY /
DATE FINALED
INSPECTOR
.�
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade f(j6
L4—
Return Air
Steel
Combustion Air
Roof Deck
12 — vD
Exhaust Fans
O.K to Wrap
Z_ —Ig
F.A.U.
Framing
z
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
1h
Drywall - Int. Lath
Final -4
e_
Final
POO LiS -SPAS
BLOCKWALL APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
��.�-:r' o% 6'�a � •�� ala. �,�.�..�,c,
Final
C
2s.�D,C�•��� a : iS. d -
Utility Notice (Gas)
j!��/�
3�/���� 7(, �/zr
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
_
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
_
Temp. Use of Power
Final
17
–C^�
Utility Notice (Perm)
MAY -25=2071 16:04 WESTERN INSULATION
909 686 8796 P.23/222? \
WEST-ERN,lNS'ULATl0Nq
421 1 Lat2Uirn Stitt M='ItIft C Onlla 91301,'
7heJ, (909).686-8760 " Pax'(409) 686-8786
THIS.I$.TO'>CERTIFY THAT INSULATION HAS<BEEWINSTALLED' IN C:0NF0RMANCE,'WITH
THE CURRENT ENERGY' REGOJ ATION, 'CALIFOFtN1A-ADMINISTRATIVE
CODE, TI?TLE:24;
STATE -0.F CALIFORNIA, IN THE BUILDING LOCATED'AT:.
TRACT ! PHASE DUNA FAIRWAYS - 20158 PHASE 2
LOT # :.2..
SITE ADDRESS: 78-057 CALLE NORTE LA QUINTA, CA
1011JUALL3:
MANUFACTURER: JOHNS MANVILLE THICKNESS: 3 5/8 "
R -VALUE! R-13
GS: BATTS • 9LO W
,
MANUFACTURER: GREENSTONE THICKNESS: 8A
-X VALUE: R-30
,,CEILINGS: BLOW
MANUFACTURER: JOHNS MANVILLE THICKNESS: 11"
R- VALUE: R-30
QFINIERAL .COIVTRAC ' CENTURY HOMES
BY:
TITLE:
DATE:
INSULATION CgNT'RACTOR: WESTERN INSULATION, INC.
LICENSE NUMBER: 481278
BY:
TITLE:AP�&AGER
DATE MAY fi 2001