0101-136 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapte,�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,
Date 1 . w f; Signature of Contractor -; r �
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 I - Policy No.
SANE FUNI) 16141.22
(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 praui'Sio S. »�
Date: �a� � Applicant �14I'll w
Warning: Failure to secure Workers' Compensa on coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost.bf 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 0
for a permit subject to the conditions 'and restrictions set forth on his,,,,.; .�
application.A
1. Each person upon whose behalf this application is made & each person ate .
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.
Signature (Owner/Agent)' i id sy 0 � 1 Date } At
BUILDING PERMIT PERMIT# i
DATE }} j VALUATION LOT TRACT
JOB SITEAPN
ADDRESS
.aM7pp,,��c - 2?X LAIM , VALLEY
1W-44.1-019
OWNER
CONTRACTOR / DESIGNER / ENGINEER
7,9395 .r^••tGOUR'.."+><RGAUP OZ04
29395 AAf w0T. RA ROAD #21D1
AGOYa:lZAIU LS CA 93301
NC30DTR'A3== CA 91301
USE
�O�FFPERMIT t� yam{ g� ��y� g yy �{�
a:lAdU�LE J 0,ftA Y.6i..+.Y� DVn7JX1S�t CJS
.
SS�S3-PL,.AN 200 LCd"> 7V".2041;' i`dd)�?s'rd4�� �?+3� ,f3iii'
D1.0eK'W.A1AR00UDFtWKWAY APPWACK -7514 PLAN CHECK fes??
k1RD131G'fJO', +i FOR 3diU"VV1P13 XSA,14CE OF SAMP, P .AN TYPE
4;:0'01024 00049'Ca'1rUC'i7IOW ?,2,55,0. 5F
P#'.Ht WP,ft TI0 250.00 SP
04AR-AGRICARPORT (W) .0,427.60
COA;3T1tUCTIOW FEE 101 P000-418.000 9131100
PLAN C3P3 WX PKII 101-000-439-M $195:06
pICHOPdvk"AL FRE 101 -000.421.000 $92.00
r
1+1.8C TPjC .4L 101-000-420-000 $122.05
17WM8IN0 VIU, 101.000.419.000 �tr6,�t1
47vo )NO MC9T1C'iN VEY .: RE.,WD 101-000-241-000 $iat.€fE
UIRAD13140 FRE
i3WE•Y,i PPM IMPACT YBU
� r
4a4se..t+g -
�iSUHADTX' L CON UICTION AND Py�a 1a1
,49,1'.37
y�ry����yu��vv: q�yylt/�0r. pp 1��e� qyy
(�{3�ph�
_. JAN :12 2001LA
T y u
RECEIPT .
DATE e'
1 f :r
,BY
4 �1 �. f'3
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
PATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms &Footings
_
Ducts
Slab Grade
t ,
3l,S�vi
Return Air
Steel
Roof Deck1�
_
Combustion Air
aust Fans
O.K. to WraRz'
�/ L
F.A.U.
Framing
�6,(
�
Compressor
Insulation
�� D /
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
6 �/
Final/a8��"
���i C�f�,pLN
Final
POOLS-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
Waste Lines
/�/Pj ��
Electric Final
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
• Shower Pans
O: K.: for Finish Plaster .
Sewer Lateral
Sewer Connection
3/6/ ��
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
Exterior Receptacles
G.F.I.
Smoke Detectors
r
Temp. Use of Power
Final
Utility Notice
_
0�0___d
' "
(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 # : 3
SITE ADDRESS: 55220 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: 35/8 " R -VALUE: R-13
(:::iOW
THICKNESS: 8.1 R -VALUE: R-30
BLOW
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 UC ON MANAGER
DATE JULY 1, 2001
0
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: SINGLE FAMILY DWELLING
Occupancy Group: R-3 Type of Construction:
55-220 LAUREL VALLEY
Owner of Building: LA QUINTA VILLAS LLC
Building Official
vni
Bldg. Permit No.: 0101-136
Land Use Zone: RL
Address: 29395 AGOURA ROAD #204
City: AGOURA HILLS,CA., 91301
By: BILL GORDON
Date: 2/28/02
POST IN A CONSPICUOUS PLACE
11 1