9911-090 (SFD)LICENSED CONTRACTOR DECLARATION
I hPrPhy affirm under penalty of periury 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.
Ltt:ense # Lic. Class Exp. Date
71dI�8 � If�J"�lJ2{ii
Date f ` %1 .1 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
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.
J) I have and will maintain workers' compensation insurance, as required by
Se tion 3700 of the Labor Code, for the performance of the work for which this
per it is issued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
GOLDII N EAGLE I14S. NVC _"NW4111-t11
(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: �� r Applicant r
[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 Ci *°
g p y V, •,and State laws relating to the Liu 06 '
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) /' Date
BUILDING PERMIT PERMIT#
DAT4) � VALUATION Slotp"7" LOT 214 TRACT z-Vng^i
JOB SITE
ADDRESS 45-535 SUNJORO OK LANE
APN I70i1-W l77•°6T+16
OWNER
CONTRACTOR/DESIGNER/ENGINEER
''F\.rtJRYCK0.'I?IJLCOtVIMUIN!'i'IES
CF;3S.rR.TRYMf;ME..L., (F;A%itJNrr1.ES
1535 SO. "D" 3""['R RF, S'a'F,. 6200
Isms .30. "G" 9MEEIT. sTQC. 4200
SAN BER.NEi.ji INO CA 424M
SAID BFIC.NIAR ANO C'.A. 924i&
USE OFPERMIT
wlyjUJ;F.AN11LVD JN %)
t3,i� f3-LOt 24, PLAN 2C';R .PjFkMiT i)OP, N01 Ii+}t7.UX]�i Bitii�i4 W.Nrf,i, Ofd
Yk.'XI)L ,75"'6 Ri31.){.I n'i(.)xd'1O PLAN (1ii•.4X ITfh..FOR hdUt,'11PLE ISSUJ04NLIE
OF Sys 1'4JAN 'tYPE.
TRACT CON IRT C,T10N 1. WA.00 ST'
VIORMVATIO 32.04 S
QA[ AGf:i(.'r8ttlaC.iKT 420.01) ak
PERMIT YEA SUMNIARY
(1Y_)N1S1X(fC'1J0N FFX- 101-OJo -418-000 ?4.00
ot•aw rrl"F(T VFV Si37,70
1kCX"I %N1C:AL lMT t01.0004 «-000 547,00
ELLIt !'1tk".ALFfik& tot -060-4.20400 $10.90
PIXM131w' FM 101-0{ 19-" 3 J 37,25
`41VOW11tQ� iTfl�t �k�" 6L4»iif11 1t14 {�!?fl-7 i t1iY11 4!{1.1
Q41RAIDG4113 Val, tot -OW-4231-000 $20.00
A;2'i' N PATOLI KAlAiS'i -1t 041, 701-t0)w2`15 0— 1
1 I.R41 -YrMi. C7nN,k7M1 KMON AND PLAN VITEC K
$3,05048
LESS, PRE -PAID FEES
$000
RECEIPT
DATE
BY
D E INggD
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings
Z
Underground Ducts
Ducts
Slab Grade
Z, —/-I —CO
Return Air
SteelCombustion
Air
Roof Deck
3 . Z —42V Ae4j
Exhaust Fans
O.K. to Wrap
. [ d QD
F.A.U..
Framing
tj—t $-6d
. Compressor
Insulation
J S 0®
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls'
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
S • g -00
Final
Final
BLOCKWALL APPROVALS
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
-t,
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
-L _ Co
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.1.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
AUL--ez�—euuu _x•11 1 WLbIERN INSLILHIIUN a r 7
WSTERN INSULATION, INC.
4211 l atham Street, Mvemide, CaWbn la 92501
Tel. (909) 666-6760 F*x (909) 686.8786
I11T§04 ION CBRTIFICAA
THIS IS TO CERTIFY THAT INSULATION HAS BEEN INSTALLED IN CONFORMANCE WITH
THE CURRENT ENERGY REGULATION, CALIFORNIA ADMINISTRATIVE CODE, TITLE 24,
STATE OF CALIFORNIA, 1N THE BUILDING LOCATED AT:
TRACT / PHASE: 23995-7 Phase 1
LOT # : 24
SITE ADDRESS: 45-538 Sunhrook Lane
La Quints, CA
EXTERI-Q8 WALLS:
MANUFACTURER: John Manville THICKNESS: 3 ALUE: R-13
CEILINGS; BATTS BLOW
MANUFACTURER: Greenstone CKNESS: R -VALUE: R -3O
CEILINGS: BATT BLOW `
MANUFACTURER: John envil/e THICKNESS: 11" R -VALUE: R-30
®ENEjALMMACTOR: Century Homes --- -
LICENSE NUMBER:
BY: 1
TITLE: v
DATE: —
I- I iiAG I UH; WESTERN INSULATION, INC.
LICE BER:4B12T8
Oy!�E MANAGER
4ULY 25, 2000. ,
E
TOTAL P.11