0101-138 (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
11825:50A % / 0 , t
Date . �' Signature of Contractor v -
OWNER -BUILDER DECLARATION F
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.
S'T &TY REND 161022
(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,
1 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 e pro, sio s.
Date: �J p Applicant F
Warning: Failure to secure Workers' Compens Ion 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 toy
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)ff11 /• Date Ihv ; r
BUILDING PERMIT PERMIT#
DATE VALUATION LOT TRACT
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OWNER
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USE OF PERMIT
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RECEIPT
DATER
OR
INSPECTION RECORD
OPERATION
DATE
T
INSPECTOR
I
OPERATION
I
DATE
INSPECTOR
I
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
- Forms & Footings 01
Underground Ducts
Ducts
Slab Grade
Return Air
Steel
Roof Deck 16
Combustion Air
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing- 4e,
Compressor
Insulation
Vents
'iFireplace P.L.)
Grills
Fireplace*T.O.
Fans & Controls
Party Wall Insulation'
Condensate Lines
Party Wall Firewall
Exterior Lath
DQrywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKP'ROVAL
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
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
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
Temp. Use of Power
Final
Utility Notice (Perm)
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:
55-176 LAUREL VALLEY
Owner of Building: LA QUINTA VILLAS LLC
Building Official
vni
Bldg. Permit No.: 0101-138
Land Use Zone: RL
Address: 29395 AGOURA ROAD #204
City: AGOURA HILLS, CA., 91301
By: DANIEL P. CRAWFORD JR.
Date: 9/5/02
POST IN A CONSPICUOUS PLACE
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#: 5
SITE ADDRESS: 55176 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 " R -VALUE: R-13
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: P D� TION MANAGER
DATE JUL 11, 2001