0006-192 (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
1;411l� B'] /14131 d2(
/ G
bate %�' 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
ti
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 ;II A01,T, INS, Policy No. NW'C444068-02
(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, b shall forthwith comply with those•,provisioLn, s:7
Date: r%A '"9, Applicant—
Warning:
pplicant Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1.' Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
gnature (Owner/Agent) �7 ' �` Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT OOW-192 TRACT
-SISO,449.70 23 24158
JOB SITE
ADDRESS 784M 04.LXX XOI?n
APN
769--022-038
OWNER
CONTRACTOR / DESIGNER / EN (NEER
CM4rU Y CRO'WELL COMMUM1Th:,9
CE1dMRY CROWELL COM14112 T "
1535 so. '17" 31mT, bm. 02UO
1533 SO, ODD U` AnM rl"!'L. 0200
SAN BE ARDD1'O CA 92408
S AW DF"E"WO CA 92409
(9091381.4007 CBLA \ 2120
USE OF PERMIT
04GLE P'A�.1f D _1Nd
i
WD- LOT 13 PLAN 1A DOES NOT INCLUDE BOCK, INAI..I. S LAR.
POOL. 1$ Vo PLAN CFIECI� IEEE REDUCTION FOR INUANCE OF SAME
PLAN TYPE
CUSTOM CORMTRUCTIOII 1,303.00 SF
aARAaYjcAI7FORT (SF) £1,996.00
HSTn"C09r OF CONS`I'kdil=011
1:50,449.70
PST M 9131AWARY
� 2�
CONSTRUCTION FEE 01 _01DO 41 LR -000 $818.00
;1
PLAN CHICK IEE 101-000-439-318 $164.83
MI{CRANICAL FEEE 101-000-421-000 $53.50
ELECTPUCAL FRE 101-000-X320-000 $105.81
PLUMBING FEF 1011.000.419-000 S1:97Z
STRAND MOTION FEE = RFAID 101-000:241-CJDO $15.14
��" C •' .:�
OR.A.DRIG PEE 101-000.423.000 $20.110
DEVELOPER IMPACT FEE $1,907.00
EIT031-1WAL COI3SMRU'C'1ION AND PI" CHECK
$3,222.42
LEM PTW-BALD rEFZ
$0,00
'T01'AL I°'.�RNliT MS DIVE NOW
0,222AZ
A
RECEIPT
DATE D
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
T7 DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings � /�
Underground Ducts
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
0. K. to Wrap
Z—,— ��
F.A.U.
Framing
_per
Compressor
Insulation
p� •�-
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
'Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final �� —4 _ G�--
BLOCKWALL APPROVALS
Final
POOLS - SPAS
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
�6 lf':—�j
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
J_
/
Pool Cover
Encapsulation
Gas Piping
Gas Test
Z
Appliances
Final
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)
COMMENTg�
MAY -25-2001` 16:04 WESTERN INSULATION ;••
909,'686 87G3 -.P.24i27
4211 Latham Street, Riverside. Ca1ilbYnm 92501.
Tel. .(909).688-8760 Fax (909) 686-8785
I SUCdA i 101J . -CKRT ICA g E
THIS IS TO CERTIFY THAT INSULATION HAS`SEEN INSTALLED IN.CONFORMAN,CE WITH.
THE CURRENT. ENERGY REGULATION, CALIFORNIA ADMINISTRATIVE CODE, TITLE 24,
STATE OF CALIFORNIA, IN THE BUILDING LOCATED AT;.
TRACT / PHASE: DUNA FAIRWAYS - 20,158 PHASE 2
LOT #'
SITE ADDRESS: A7.8z0bb CALLS NORTE LA OUINTA, CA
IXTgWOR WALLS:
MANUFACTURER: JOHNS MAWLLJe THICKNESS: 3 5/8 " R -VALUE: R-13
CEILINGS: BATTS BLO
MANUFACTURER: GREENSTONE THICKNESS: 8.1" R- VALUE: R-30
C ILIA BLOW
MANUFACTURER: J0kNS MANVILLE THICKNESS: 11" R- VALUE: R-30
SOENERAL CONTRACTOR: -CENTURY HOMES
BY: r
TITLE:
DATE:
INI LATION CONTRACTOR: WESTERN INSULATION, INC.
LICENSE NUMBER: 481278 `"-
BY:
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TITLE: UCTIO ANAGER
QATF MAY 2 5 2001
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