9907-566 (SFD)LICENSED CONTRACTOR. DECLARATION
I hereby affirm'unde'r penalty of perjury that I am licensed under provisions of
Chapter 9 (commencing with Section 7.000) of Division 3 of the Business and
Professionals Code and my License is in full force and effect. -
-License# '. - Lic. Class Exp. Date.
0.16�: . 7r.3, f 0
ate_r�?��,✓ Signature of Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that l 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 3.700 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
Sectid'n 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 Policy No.
(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 fbr'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 th se provisions.
Date: _��� Applicant_-�� �
L.,1Narining: 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,16 the cost of compensation,"darriages as provided for in Section 3706
of the Labor Code, interest andattorney'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 1'80 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 f � riinspection purposes.
x
Signature (Owner/Agent) Date��`��'✓�
PERMIT
BUILDING�PERMIT
?_;
j
DATE_ vAI i inTrN ' i +�yl }ti � LOTI TnACT
JOB SITE If f
ADDRESS
APN
OWNER
CONTRACTOR / DESIGNER / ENGINEER
11INi..iO HOMES C10'Fil, ..
Ni 01 HOI'N'dEe C10 -PIP. � ..
1782 W..AR: OW14WY
12922. W ,f1R€ii.)W H%VY
UPLAND 3 CA 9170
UPLAND CA 91795
USE OF PERMIT
iiJWCriXR 1cw4111,YLbULLK6
W& OT 17, PF<KK 4:.. •• i?OWd'Il;0.138 VM IICI.UM M1Cst" K WIIN 3.
0.4. POOL' '75N- MrClCTYC: N ON K. AN 6 }ffi4.,' Ff;k'' ,, ItOlk MUd..'£.la?l E
I38l: ANC% OF UAML-*'NLt T-4 `t`•`t:PF',
TRACT CONS' Z' IUCTION 31.
mCtLLt63?/?s`l' o 14.00 SF
CL1lER�Cdl71l;A.F83r'(yl��' 583.0 iii
r,111,117111 .111)c SRs�"'�n•' 'i�vs 6 ue°�rrv'�'�i'+
UA1414 . , .iuB
y=��'�ac}c.^al.clia.l.,
PLAN [[p)� rP9��.'�T!
F�-��1/0��� 7/�, '•/V�'/1�1}1"`�;T
nC1f�'p�9;!�C+�� pY'•
1, Y.W4.l71ttv86.AL A`':�':i: - l�i�"41Dll;•c�4 3' it SA 7.*1
�IrUM�rs��'�r:�fW-�l3[-�Yi3-4i9•yil�(i ��4�.�1�
'°R � f ; i
�`
4' 3'i$f.'t�C�l l��"�'Tl`l�.l'�1� - �Y.W?�'�.� ��f ^t�-•��'.f-Q�tj< �'9t7 i',�
re
fit e' 73d ; l BUB PLAC b.S - R8=701.-000-255-000
LESS PIM. -PAID F d1Sd�.i.
•.�f.fj�0
. • O i AI, .C.N•i��1.V Ir d? ESi: S—DU.E NO ..
1•+f70.. -f yip
RECEIPT
DATE
BY ',
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings6
—
Ducts
Slab Grade
r
Return Air
Steel
Combustion Air
Roof Deck
12 •Z
Exhaust Fans
O.K. to Wrap
Q 11 - On
F.A.U.
Framing
/ - 17, -OQ b4
Compressor
Insulation
/ — / . dp
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
l "
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL
•APPROVALS
Steel
Set Backs
Electric Bond
Footings
Z .t
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
a
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
/ ZCo- �� A �*
Pool Cover .
Sewer Connection
Encapsulation
Gas Piping
Gas Test
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) 3 • f4-
MAP. -09-2000 1550 WESTERN INSULATION 909 686 8726 P.20i27
WES'T'ERN INSULATION, INC.
4211 Wiw= GUIM, Rlvweide, California 94501
TZL (909) 686-8760 Feu "9) 686-8786
MffMATION CERTIFICATE
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 1923995-5A
LOT# 17 PLAN
SITE ADDRESS: 45-115 SUMMERBROOK COURT LA QUINTA, CA 92253
------------------------------------------------------------------
EXTERIOR WALLS
MANUFACTURER: Johns-MenvilleTHICKNESS: 3 518° R -VALUE: R-13
CEILINGS: BATTS LO
MANUFACTURER: GREENSTONE THICKNESS: 9.1" R -VALUE: R-30
GENERAL COW: ClO AMERICAN COMMUNITIES
LICENSE NUMBER:
BY:
TITLE:
DATE:
INSULATION CONjBACl'OR: WESTERN INSULATION, INC.
LICENSE NUMBER: 481278
8Y: 4e�o S44X
TITLE: D TION MANAam
DATE MARCH 9, 2000