0101-132 (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
%� 4 0��1f;U
Date�� J Signature of Contractor •Xe'' ""
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 aria 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.
std' A 'sMIA) 1d1412i1
(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 tho a pro)�jsio s.
Date: Applicant i
f �.
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 resultof 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.
Signature (Owner/Agent) _� '>: /� . Date
BUILDING PERMIT PERMIT#
/
DATE VALUATION LOT 6101 1,,12 TRACT
19122
JOB SITE I
APN
ADDRESS
!;5 2242 LAV7ff . VA'TJ-JfY
74 9-447dle-069
OWNER
CONTRACTOR / DESIGNER / EN (NEER
T., i
"ter ' x'... "V.Psir � f_,'vYW,0Pb0'AT .W C
251395 AGt'Ai3'R AR0.10 f904
7,0395 ACKYURA ROAD 04•
PA301TRAk Ir X_q CA 91301
ACODRA.Ili LS CIA 91301
iE11 8,879-4800 C'.CHLO
USE OF PERMIT
S["1 =Ta ..AN, :1HR LOT 02-PX1tM1T WEN 140T 1Nf:.LUIDE
1? S7 iC LTi R , 'lE�tt ej�. 9iftk�i �1iA! �PF1tr1. t�y£.'1"4'i�o PLAN CHFI K 1E?
1'.,1;1at. VF1rJ.H Y4018.14 U1.:17MIX [S►�Rx,5jWC X OF PLA, 14 TYPE.
CUSTOM CONST11:U0''1)UN 2,mpo 21?
1301;'09PATIO .194.00 SP
( RACI lUa4.iPORT (3F)
CCDM" OF 1010RITIVU(NION
19017/020
g��.R. ``��yy��q��'`77Yv�►, �)'� y,Jy'� f� p�y..;�'.1;0TAX4'x.1)
evOMS a RUCTS-011 FEE ; 011-D00-418.01 I 6058,00
PLM4 CRECK FRX 101-000-4394H9 $196AS
2iii'R-71-I,PMAW.C°m.MIT, 101,.000.421.000 $9830
1..1J 1XTR;,iCAL FEF 101-000-420.000 SIX=
PLLfY+/.tD-THOFeTle 101.000-419-000 St€3 SO
STRCYNCI M: T101A4 FUME -13N, ID 101.000-241.-000 $19.07
ORe`A1'Y'NG FEE 101.000.423.000 $20,00
1.3Vi Y?:1AV3 P IMPACT FRE, �1T94^r.pEs
LES01 PRFZ�PAW FM
$0.00
{d'..MALtl J.-1:04MIT, MIJd.PSJ'J,.r'LTO
JAN 12 2001 . _ --
a0I7 Y: Uk_ L ( U
RECEIPT
DATE/ j y
' Y
D FI v� MPECTO
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings
Underground Ducts
Ducts
Slab Grade
3/s�
Return Air
Steel
Roof Deck
_
Combustion Air
Exhaust Fans
-
/
O.K. to Wrap
- - _
�_
F.A.U.
_ -
it
Framing
v
Compressor
Vents
A
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
_
Drywall - Int. Latr:
sf a 0
Final
/i
Final
POOLSr SPAS
BLOCKWALL APPROVALS
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
_
/y �l
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
OX for Finish Plaster
Sewer Lateral
Sewer Connection
_
g�O1 t'p�
Pool Cover
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 ✓--�1 __
Exterior Receptacles
G.F.I.-
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
-
NOV-21-2002 THU 03:56 PM FROM:GREENEWAY DEVELOP
Or
FAX:7607719931 PAGE I
VCITY OF, INTA'
UILDING & 6 P WENT.
a 1.0 012
E I REad-PS N
LAQU01TAVI ce'� .
Contractor GREENWAY. DE
Penrlt mber 0101-132
POST- ON JOB IN CONSPICUOUS E_
INSPECTOR MUST SIGN ALL APPLICABLE §PACES
q
I
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 #: 2
SITE ADDRESS: 55242 LAUREL VALLEY. LA QUINTA, CA
------------------------------------------------------------------
EXTERIOR WALLS @ 2X6 FRAMING:
MANUFACTURER: JOHNS MANVILLE THICKNESS: 6 3/4 " R -VALUE: R-19
EXTERIOR WALLS @ 2X4 FRAMING:
MANUFACTURER: JOHNS MANVILLE
CEILINGS:
MANUFACTURER
CEILINGS:
MANUFACTURER
BATTS
GREENSTONE
BATTS
JOHNS MANVILLE
THICKNESS: 3 5/8 "
"BLOW
THICKNESS: 8.1 "
BLOW
R -VALUE: R-13
R -VALUE: R-30
THICKNESS: 11 " R -VALUE: R-30
GENERAL CONTRACTOR: GREENEWAY DEVELOPMENT, INC.
BY:
TITLE:
DATE:
INSULATION CONTRACTOR: WESTERN INSULATION, L.P.
LICENSE NUMBER: 794484
BY:
TITLE:' PRO U ION MANAGER
DATE JULY 11, 2001
a
Certificate of Occupancy
City of La Quintal
Building and Safety Department
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:
Use Classification:
Occupancy Group:
SINGLE FAMILY DWELLING
55-242 LAUREL VALLEY
R-3 Type of Construction: VN
Owner of Building: LA QUINTA VILLAS LLC
Building Official
Bldg. Permit No.: 0101-132
Land Use Zone: RL
Address: 29395 AGOURA ROAD #204
City: AGOURA HILLS, CA., 91301
By: BILL GORDON
Date: 11 /21/02
POST IN A CONSPICUOUS PLACE