0102-122 (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
Date 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' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions. ,
Da e-7—k2a/6 I Applicant `"` " � E .,e V r'a" % 1V . .
r sw-v
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 providedfor 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, indemnity
& 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.v
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) ��' t.'l t u'1_ �* Date},, r�'r
BUILDING PERMIT PERMIT#
DATE VALUATION LOT l h�,�j"� �r,� TRACT
$2 *7AD 2 2951
JOB SITE
APN
ADDRESS
OWNER
CONTRACTOR / DESIGNER / EN (NEER
C"E'@x`d Cirri' CAtC9WE L COMWAMORS
CWTd.1RY t'M' Off° E L CtaMMUMM{
153:5 aQ. `-" x .3':4�'�.:�'d r, gn-, #'4.a0
1535 1,30, I'D" SM -11t. V; SIM11 0.700
IWA BElcWAMMO Cit. 52408
ZVN' bElZKA.'ItDY'dat 0 CA 92408
(9139)381.6007 G`nuft 2 i 20
USE OF PERMIT
KING -12 171W. ILY J�"'�f.�.,'1.'. D,4101-.
SFK—)-P1-A :.'A.R L.KM f'90.1l'i DOES 140 INCI..109
OtOCKWAL10001JORTIfKWAY M't'iROAC H
CUSTOM C011SI"RUCTION 2,395.00 ,3F
POPIcsi lr�1 ATIQ MAI SF
fU. ;f-E,k OUC'.d'�Ri?c9R.!` (90) 3 4,0:4A10
'99'CMAT`.l`D COST Off' C 0-111 1RUd:'ITCON
:100A55719C1
�,p y�/y �;�� Q/yy�p��,y
, r MAT ��,CUPE Y9'+1i4L9OMARY
wONSMUC•TI0N FEE 101 nfsM418.000 MOO
f"L&N S:`.NEX3C FFIR 10t-000-439-318
MEC".kf.ANIC"AL VE1 1011-000-421-000
1*6Z1VIC AL 11Z 101-000-1420-000 �IdIZ.�t
PLi9MBRI01-TTIR 101-000.419-000
S7'Ft,ONO MOTION FEE -53M 101-000-241.000
G". DINPER 101.000.41,23.0100 'S.AINi
� EVEL,OPKIR IMPACT rils $11,90": %t0
ART W 1'i1BW i't.+AC's �' • JtX31001-000:-255.00 t ��0,0t►
�4i1�-T"C:`,i;�+.l'. tat��1,2Ci'�i:'��14:i1� 6.'�T.p I':I:,,ta9t' C:�11+".•t;7C
,1 S 1.r3�
-
TO P KIMIT. YJMS 3.7 R! to JF`I 0 `-
4
FEB 22 2001 �----
RECEIPT DATE d
BY,
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION DATE INSPECTOR OPERATION DATE • INSPECTOR
BUILDING APPROVALS MECHANICAL APPROVALS
Set Backs Underground Ducts
Forms & Footings . ✓�`�Ducts
Slab Grade /� Z �� Return Air
Steel (/ Combustion Air
Roof DecTc cExhaust Fans
0. K. to Wrap _ Q� F.A.U.
Framing�j_ Compressor
Insulation ,3l/ Vents '
Fireplace P.L. Grills
Fireplace T.O. Fans & Controls
Party Wall Insulation Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
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
Electric Final
Waste Lines ZFP—d-
% Heater Final
Water Piping Plumbing Final
Plumbing Top Out Equipment Enclosure
Shower Pans OX for Finish Plaster
mel mr Lateral / _ Pool Cover
L Se ver Connection �l �U� Encapsulation
s 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)
1
OCT -16-2001 16!49 WESTERN INSULATION 909 6B6 8786 P.02i19
` WESTERN INSULATION L.P.
4211 I-thm— 9U=t, Rivcmidc, California 92501
Tet (909) 086-8760 FaX (906) 880.8788
INSULATION CERTIFICA'T`E
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; =DUNA
FAIRWAYS #29686/PHASE 3
L
0OT # :
2
SITE ADDRESS-
78=1-62 CALLE LAS RAMBLAS, LA QUINTA, CA
EXTERIOR WALLS:
MANUFACTURER:
JOHNS MANVILLE THICKNESS: 3 518 ° R -VALUE: R-13
CE GS:
BATTS BLOW'
MANUFACTURER:
GREENF/BER THICKNESS: 8.1 " R -VALUE: 11-30
CEILINQ3:
BATTS BLOW
MANUFACTURER:
JOHNS MANVILLE THICKNESS: 11 R -VALUE: R-30
GENERAL CONTRACTOR:
CENTURY HOMES
BY:
• TITLE:
DATE:
INSULATION CONTRACTOR:
WESTERN INSULATION, L.P.
LICENSE NUMBS : 794 84
BY:
TITLE: P UCTION MANAGER
DATE TOBER-16, 2001