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9907-564 (SFD)LICENSED CONTRACTOR DECLARATION I Fj2reby 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 l 9a"tedIV Signature of Contractor+/l( 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. `}t 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: Cartier Policy No. STATE e'i.)70 14!)W73f.-9G (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 she Labor Code, I shall forthwith comply with thgs�e provisions. Dater? ri I!;; Applicant- Warning: pplicant 1.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 fO�r inspection purp r ses. �S ig ature (Owner/Agent) / ate BUILDING PERMIT PERMI+756y DAT.'� VALUATION !Q �1 WT1R; TRACT Aj�5 aA ADDRESS .,`X35 ► i>a l it i3 i3 13 T JOB SlTq APN "04140.021 OWNER CONTRACTOR/DESIGNER/ENGINEER PkIr+fl f1J'064t:C 'rlt 1fkD �, ru....t �do..•+Y3 \..r ♦._. al 3trt"+PI T'Ir i, 4175` '��.1 i3 �!��7Y►1.... a., ♦ �.i �:ai ►'.rtec�trr slaty `a. i232 W. ARROW ifWY i. PLANIJ CA !W85 UPLAl U CA 91.785 USE OF PERMIT SllNe;iLF FANIL07 DWELLING LO T 14, PLAN 2C 3 -K - �HMILT OWLS NOT LNCF.f: DE OL OCK WALL UtR A_K_)L. 75+ o I0WW. r [0N 4_1N PLAN t: t .*K FI--X FOR Mlsl.'3'Fl L11 (881JAf+lCE OF SAME PLYW TYPE. 'iRA,CT l,ON SI RWC'rION L 566.iit J1C1Rt;,t*'1't f10 151.0010 IFrF�.,taa>+s � rte v�t'a' sSy fx,! SF rs & L)i�r�. Y ru) 'r,, «' ` Ya �.i � `' +.�+J� 7 R =�6! lwi�.�iy V 82.50 93,782.50 Mr18411T I' E% SIUMMAR-1" CONS'TFtUC 1f'i0N F .a, 10.1.4)()4)-400'-{H8(i iti35.49t3 Py." r"ECK ¢rx► 2l!#-flfiii e R•i�sc �1Y?.{g ikUKTILIViieAll, FEE 3i1.�L1'(E.1CAil,:f';� li�l•-£H3�42@r0�{f St1..4.2y PIAMVI 31Nt,3 FM 101.40-X119-0131 OR AMNO PIPT; t t� t 11tX1.42�-M311 � � ► _ , m. viTa.CiI at t�','Ff'AC"1' mml $1,107.00 4.. s 'TOTAL P-MMIT FEYS DUE Y+l0W t.Z,t►� k.1f+ b RECEIPT DATE BY r 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 f 2 "Ll Exhaust Fans O.K. to Wrap of- p • 6O F.A.U. Framing i _ _ of) Compressor Insulation t.1 J4- Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath • Z (o ptt ,Gsif Drywall - Int. Lath Final Final POOLS - SPAS BLOCKWALL APPROVALS Steel Set Hacks Electric Bond Footings C V _p© k 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 OX for Finish Plaster Sewer Lateral P — Z fo —do Pool Cover Sewer Connection Encapsulation Gas Piping Gas Test gs 9 , Appliances Final COMMENTS: 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) MAR -09-2000 15:44 WESTERN INSULATION 909 686 8786' P.07/27 VVTT IrTUhATIIT ®, I1we 4211 Latham aawt, Mwnlde, CeUrnia 92801 Tel. (909) 606-8760,Fax (909) 686-8786 iNsuLA i ioN cErriFicATz THIS IS 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: DESERT PRIDE - TRACT #23995-6A LOT# 16 N,,41V2 SITE ADDRESS: 46-135 SUMMERBROOK COURT LA QUINTA,. CA 92253 9MR108 WALLS MANUFACTURER: Johns -Manville THICKNESS: 3 6/8" R -VALUE: R-13 CEILINGS: BATTS LO MANUFACTURER: GREENSTONE THICKNESS: 10.3" R -VALUE: R-38 GENERAL COIVTR,ACTOR: AMERICAN COMMUNITIES LICENSE NUMBER: BY.- TITLE: Y:TITLE: DATE: INSULATION CONTRACTOR: WESTERN INSULATION, INC. LICENSE NUMBER: 481278 s BY: TITLE: OD9 5ftION MAN ER DATE MARCH 9, 2000 /y ;,