9707-121 (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
/D.te , 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.
( ) 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 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 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' compensa ion provisions of Section 3700 of the Labor
j�C de, 1'sh)a&f ieth�niit' comply, wit " ose provisions.
te: � `Y!,I r 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. r ,
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 bove-mentioned prop rtyfior nspection purposes.: r
i nature(Owner/Ag� t),.' " Date -1
9
BUILDING PERMIT PERMIT# CONTROL#
1 g„}x_aZf 5599
DATE � 1%j�//� VALUATION' rti�r �s�3 LOT �ir� TRACT ',•�R�,y{ }
ADDRESS % �:?.'a�:ll�t9:it1+<q.1-0k i6.t�NU, JOB SITE
APN
OWNER
CONTRACTOR/DESIGNER/ENGINEER
i%lor it`% Mr'�.i al"+:' I'll NO i)
I1C! W. Alii isICA J. 1W% e
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tyi't,tlftif t i_'A. Qi 187-
00.Hf`) t.''A c+f titw
f`a7'.1Nif4s-7i!?}:x +'C;f.fk
USE OF PERMIT
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11' A,w+' 07,1I f: OR IX_' 11 Qiitii i. } i. a.;0', lv
n+' « `i n.'A.`1 1 Di`�V" `f�i :e'i."i% i4'
A,00 iie
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NIGLI 4N.NK"AL Ila,' 101-W*-4`2.1-(lW
>ir,�:+".t°f tt:E�D, a 3 #i: IUi.-jafiv-�i7�3 til�•C! SIf)6.e�
*='LOivt#l#t+G Flih S,140,00
r'trte, WVVIONTF4ft_ fens.()) 1Io})tFKf1r11.^`31-(wain
PVC 2ew-1w'- :4s
PAIR(yr!N't, Ct•) 11XY) PLAN, i"1"J1' CI�
ViS %1
qq E(+ ( a,.izt �j �'D s:^r,Q
i..r,t:s..ra3 iia 3."t .r�a.� i. ,.6....!
rry r�r�
AUG 0 8 1997
RVI'Al, PERMIT VERS 001i, NOW
CITY Of: LA C-UINTA
RECEIPT
DATE +
BY
DAFI LED
INSPECTOR
JE
I �"
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
p
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
1&4
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
7
Compressor
Insulation
Vents
Fireplace PIL.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final �f -
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
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
OX for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test1171072-17
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.I.
.Smoke Detectors
Temp. Use of Power
Final za
Utility Notice (Perm) 4vor IV/
COMMENTS:
M
MAR -09-2000 15:49
C4
WESTERN INSULATION 909 696 e7eG P.19i27
T� IN ULATI ', TNC�
4211 18fhfsm Street, RIVC MIde, California 92501
TeL (909) 6860760 Fax (909) 686-8786
INSMiATION C ICATE
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# 14 Pl- AIV y .
-SITE ADDRESS: - - - _ 46_175 SUMMERBROOK. COURT LA aUINTA, CA 92253'
EXTERi_ 6i WALLS
MANUFACTURER: Johns -Manville THICKNESS: 3 5/8" R -VALUE: R-13 r
CIRIUNCS: BATTS LO W
MANUFACTURER: GREENSTOIdE THICKNESS: 8.1" R -VALUE: R-30
------------------------------------------------------------------
QFNERAf GQNTRAC_TBR: AMERICAN COMMUNITIES
LICENSE NUMBER:
BY:
TITLE:
DATE:
INSUWI N CONTRACTt H: WESTERN INSULATION, INC.
LICENSE NUMBER: 4131278
BY:
TITLE: *WDV51rioN MANAGEIV
DATE MARCH 9, 2000
V
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