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0101-134 (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.# I Lic. Class Exp. Date Date! Signature of Contractor a OWNER -BUILDER DECLARATIO4 ` 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. 0TATF IAM0 16141112 (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 s ,hall forthwith comply with th • se p 43is ons. ") ,,,� Date:` .. Applicant Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his application. 1. Each person upon whose behalf this application is made & each person at"' whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance.of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby. authorize representatives of this City to enter upon the above-mentioned property for inspection purposes. �.44 „ Signature (Owner/Agent) Es"' Date BUILDING PERMIT PERMIT# DATEVALUATION LOT L�,i©IA34 TRACT l It w) ��:��23 291.22 JOB sVr a APN ADDRESS t I. W -W UITU: d'bPWXY 769441.-019 OWNER CONTRACTOR /DESIGNER / EN INEER 39q,95 0 1RA IROAD MAX 2pp�//yy39 5,43y���i'��<�yy�y��{{,.ROAD 19.7.04 �,yy q 11 /1 „ �':l`D�'�Li�ZKi7./J.18 c�k 91 301 �� yy //�� t'k`.�S4W6IPJ-.. b]�8.� X t.,A 91301 (818)879-4800 CB110. USE OF PERMIT MARIA; RPMLY DWELLING .-W1)4gAN 1r110'12 ;taYr.R 'I E' 'OC7 i i3T INCLUDE Bail t3t". d , t.o51k'r?Gl t ill i1�.'alr° kt �� d3,'P o PLAN C'HRCK FTE ECEDkiMION FOR 1030.Al+3CZ Ofl+ S.(s A.E FV04 TYPE WrIlou CaMUTRUCTRYN JIM 1. 00 SP r 001, "ATIO ;'uQM Sir C$AFiACITUCARPOR`I' (S) 9,427.60 9911MAIDW CO r OF e0fiS?i'XKUCHO 163"W3.5511 PLA1d c": rr1,ECK YEE 101-000-43,9-31 chi MECHANICAL 1199 101-000-421.;003 $35.50 EUC TWC,<AY1,Y"—Z 101-000-420-000 $: 11, oil PI.eU.MBtiY�.�+ FEE 101-000-419-00,0 SOUP :a i"Yw0MO 39fI WION PEE, a MID 10) -000-241-000 $16.53 OR AI DIN0 WE 101.000.42'3.0 0 zNtWOt'ItUCTUM,Mt, 225-00 0-443-342 sI,907.00 L& VRFY-PAW M. ON II&L '53 WIN JAN 12 2001 E. r,S . TV.# 1`15Wa DUE OVAr 3'. m RECEIPT DATE BY DAT NA DINSPE R INSPECTIQN RE�:�Rn 51 ' OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Forms & Footings gj/L Slab Grade 11 Steel Roof Deck O.K. to Wrap Framing Insulation ��-,p�,rtv Fireplace P.L. Fireplace T.O. 7FS_ ( _Ducts �� _ l�/ ,6 _ _ SI!! 6(ZJ Underground Ducts Return Air Combustion Air Exhaust Fans F.A.U. Compressgr Vents Grills Fans 8 Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Onnnrall -Int. Lath p ��/ _ Final��9I3 a BLOCKWALL APPROVAL'S . Final POOLS - S PAS Steel Sct 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 /f��2�p� Heater Final Water Piping _ Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sir Connection %/,30 Encapsulation Gas Piping Gays 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 /�'r�-3 Final Utility Notice (Perm) WESTERN INSULATION, L.P. 4211 Latham Street, Riverside, California 92501 Tel. (909) 686-8760 Fax (909) 686-8786 INSULATION 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: THE LAURELS @ PGA WEST #29122/PHASE 1 LOT #: 1 SITE ADDRESS: 55264 LAUREL VALLEY. LA QUINTA, CA ------------------------------------------------------------------ EXTERIOR WALLS @ 2X6 FRAMING: MANUFACTURER: JOHNS MANVILLE EXTERIOR WALLS @ 2X4 FRAMING: MANUFACTURER: JOHNS MANVILLE CEILINGS: MANUFACTURER: CEILINGS: MANUFACTURER: BATTS GREENSTONE =BATTS JOHNS MANVILLE THICKNESS: 6 3/4 " R -VALUE: R-19 THICKNESS: 3 5/8 " R -VALUE: R-13 BLOW THICKNESS: 8.1 R -VALUE: R-30 BLOW THICKNESS: 11 " R -VALUE: R-30 GENERAL CONTRACTOR: GREENEWAY DEVELOPMENT, INC. BY: TITLE: DATE: k INSULATION CONTRACTOR: WESTERN INSULATION, L.P. LICENSE NUMBER: 794484 BY: O TITLE: PY(O/DOCTION MANAGER DATE JUtY 11, 2001 WCertificate of Occupancy City of La Quinta Building and Safety Department OF,.°�' This Certificate issued pursuant to the requirements of Section 109 of the Uniform Building Code, certifying that, at the time of issuance, this structure was in compliance with the various ordinances of the City regulating building construction or use. For the following: BUILDING ADDRESS: 55-264 LAUREL VALLEY Use Classification: SINGLE FAMILY DWELLING Occupancy Group: R-3 Type of Construction: Owner of Building: GREENWAY DEVELOPMENT INC. Building Official VN Bldg. Permit No.: 0101-134 Land Use Zone: RL Address: 29395 AGOURA ROAD #204 City: AGOURA HILLS, CA 91301 By: DANIEL P. CRAWFORD, JR. Date: APRIL 9. 2001 POST IN A CONSPICUOUS PLACE r