0006-193 (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 E 1or), IiZc
Kate x� � g -,Signature of Contractor ''y� t� � !, 'nom
v' o
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:
Carrier 00LI'i 4 ZAOLE 11143 Policy No. KWC-5440-8-02
(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.
/Date: / f ,)Applicant
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. l
/Signature (Owner/Agent ),� k`��< ('i1 i Date
BUILDING PERMIT PERMIT# ,
DATE VALUATION LOT oOO6-1'93 TRACT
$173,81730 24 20158
JOB SITE
ADDRESS 7 3 "'jiS LaiCli�t I<"
APN t
7FI9�€122-t? �1r`2
OWNER
CONTRACTOR/DESIGNER/EN (NEER
CENTURY CROS L COI&VTUNr1w
CENTURY CROVIaL commumnEs
1535 30. DO STRErr., ME. #200
1535 SO. "Do 7nUZEr, STE. WO
SAM' ItNARI U40 CA 92405
SAN SERNARD190 CA 92408
(900 )381.6007 CBI.# 2120
USE OF PERMIT
SWOLE 1ZAM_ 1l Y' DU1ET:U—RCT
SPD -LOT 24 PLAN 2A- PVJZMIT OOES NOT INI C.LW)F, s1.00K WALLS OR
POOL, 7:5 % PLAN CH90K FRE REDUCTION FOR dSSiiANCE OF SAME
PIAN TYPE
CUSTOM CONSTRUCTION 4107.1)1) SF
aAkPlGVCAR'P0RT("w2 -0,682.40
I=9"TE D O091'JQF Z:ONSZ'R1'7CrJON
17.3,017.70
P9R&U .bT,E SfiEAVVIA Y .
CONSTRUCTION FFA 101-000-418-000
PLIA f CHECK FEE 101,000-4 319-3 1 � $193.43
MECHANICAL FRF, 101.600.421.000 $35.50
L+I_ XTRICAL FEES $117.13
ti
PUJMBING FEE 101.000.419.000
S`f1t ON0 ACTION FRE - RESID 101.000.24f-00? $17.38
OR;h.,i)OW FE,9 101.000.423!.000 $20,00
� I
Z3EVFA 3PER IMPACT In $1,907.00
t
Wk -TOTAL C093TRUC`b 014 A14D >?L" SCK
LESS PRE-P'A7n I
$0.00
TOT- FERMT 13'.E" DVE
i0,391.94
RECEIPT
DATE
BY////:/
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
���l
/
Underground Ducts
Forms & Footings
CA
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
z�Lz �9
Compressor
Insulation
_�
Vents
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final �
Final /�
G�
_ _�/
PQQ $ SPAS
BLOCKWAf
L r9PROVALS
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:
Final�`%
47A , e—, !�
Utility Notice (Gas)
—
.19
O.- eel
ELECTRICAL APPROVALS
400 zo
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
Q
Utility Notice (Perm)
MAY -25-2001 16:05 WESTERN INSULATION 909 686 8786 P.25/2y?
WEUSTER T Ir SULATION 9 INC e
4211 L8t1mm Street, Rlvemide, C1 Uftrnia 92501
- TU. 1909) 686-8760 Fat 1809) 686-8786
f
INsUL TIQN CERTIFICATE
THIS IS TO CERTIFY THAT INSUL.i4T10N 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 # f 24
SITE ADDRESS: 78-053 CALLE NORTE LA QUINTA, CA
[?XT ,RIOR WALLS;
MANUFACTURER: JOHNS MANVILLE THICKNESS: 3 5/8 " R -VALUE: R-13
CEILINGS- BATTS BLO
MANUFACTURER: GREENSTONE THICKNESS: 8.1" R- VALUE: R-30
C IE NOS BATTS BLOW
MANUFACTUR>"R: JOHNS MANVILLE THICKNESS: 11" R- VALUE: R-30
GENERAL CENTURY HOMES
. BY:
TITLE:
DATE:
INSULATION CONTRACTO-R: WESTERN INSULATION, INC.
LICENSE NUMBER: 481278 `
BY:
TITLE: PRO ION MA GER
DATE MAY 2J ZQO1 .