0006-195 (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 B 1 01P3112(
ate,! Signature of Contractors ' F
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).
( )J 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 . (iO.wm MOLTS ma Policy No. WWC-544%0-02
(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.
k6ate f Applicant2__1y_)11 e., /_l i%`.�►.:
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
r& 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. -1 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.
J
ignature (Owner/Agent y� _► • ��� <1 F amt Datef ;
C ' _
d6, PERMIT PERMIT#
;BUILDING
DATE VALUATION LOT -"95 TRACT
91In- 817.70 2+5 20158
JOB SITE
APN
ADDRESS 78-049 CALLE NORM
769-M-038 i
OWNER
CONTRACTOR / DESIGNER / EN INFER
CENTURY CROWF.�'I:.LCVAd30it NI-ITLE--8
CENTURY CROV&- U. COA<IMt NnIES
1535 SO. °IL° .TYR: ,7, = #200
1535 00, `D* S1 i7, 917- 0200
SARI' BIVERdNARDINO CA 92408
SAZti'i NARDINC1 CA 92408
(909)381.6007 CBL4 2120
USE OF PERMIT
MNG) -Fl 1iAMM Y DwfT L UN'C3
F.
SMD- LOT 26 PLAN IA -PERMIT DOES Mar INCLUDE BLOL`ii.'S+ ALLS Ott
POOL',. 75 04, PLAN CHECK FEE REDUCTION FOR ISSUANCE OF SAMP,
PLAN TYPE.
CUSTOM CONSTRUCTION 21107.00 SF
OARAQXfCAR_POkT (SF')
EST.1.'IRft, Xr" C'09r OF CONS;i RUCt'10N
17;9,917070
CION aTRUCTION FEE 101-000-416-000 sookso
-
PLAN CHECK FEE 101-000439-318 $153.4;5
� `t n• - -
MECHANICAL 101«000<421.000 sa9,ip
ELECTRICAL FEE 101-000-420-000
tLUM13INGFEE 101.000-419-000 $1621se
r'�Pf�
STRONG MOTION FEE • RESID 101-000-241.000 $17.39
CRADINCI FEE 101.000.423.000 $20.00
UsEVE )PER IMPACT T<PL9 I, o�.t ►
-.`., .
X
y'"
�•
s
,
SUB -TOTAL, CONST:f UC-1'Ii •f3M AND PLAN C"'. IEC1r,.$3,'391..44
IHSS PFi' PAT0I
r $10.00
i�C 'Ai31?9-W- ''f �,S DTJF NOW
4-3; '
RECEIPT
DATE
Bv
DATE FINALED
INSPECTOR
----------------------------------------
t
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
Z--
Exhaust Fans
O.K to Wrap
Z
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath�-
Drywall - Int. Lath
Final � /3 _� �
Final 7 �71--�%
PO S - SPAS
BLOCKWArI
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
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
Test
_
Gas
Appliances
Final
COMMENTS:
7-2&-"
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)
MAY -25-2071 1606 WESTERN INSULATION 909 686 87E6 P,27i27
WESV RN INSULATION o INC.
4711 Latham itmet, Riverside, CaUommia 97301,
Tel: (909) 586-8760 Pax (909) 686-8786 .
INSULATION CERTIPICl�']CE
THIS IS TC CERTIFY THAT INSULATION HAS BEEN INSTALLED IN CONFORMANCE WITH
THE CURRENT ENERGY REGULATION,PCALIFORNIA ADMINISTRATIVE CODE, TITLE 24,
STATE OF CALIFORNIA, IN THE BUILDING LOCATED AT:.
TRACT I PHASE:DU NA FAIRWAYS — 20158 PHASE 2.
LOT :.6
$ITE ADDRESS: 78-049 CALLE NORTE LA GUINTA, CA
EXTERIOR WALLS:
MANUFACTURER: JOHNS MANVILLE THICKNESS: 35/8 " R -VALUE: R-13
CEILINGS: BAITS BLOW
MANUFACTURER: GREI NSTONE THICKNESS: 8.1" R- VALUE: R-30
CEILINGS; �SATTS BLOW
MANUFACTURER: JOHNS MANVILLE THICKNESS: 11" R- VALUE: R-30
GENERAL CONTRACTOR: CENTURY HOMES
BY:
TITLE:
DATE:
INSULATION._CONIRACTOR: WESTERN INSULATION, INC.
LICENSE NUMBER: 481278
BY:
TITLE: PRQIDATIONLANAGER
DATE MAY f5 2001
TOTAL P. 27 .