0102-099 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
�'hapter 9 (commencing with Section 7000) of Division 3 of the Business and
ill�ri3fessionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
i�r .f 1tDi31�2C
Date w=# ��`f Signature of ContractorY � a�
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 contracti5p with licensed
contractors to construct the project (Sec. 7044, Business YProfessionals
Code).
O 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 Labgr 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:
Cartier v 1p5yaa a l7 cif Policy No.
COLI . N G.e7.�w+IZ rol. .:Y 7v �n••aa"s'ti�Flf'�'? a
(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 , 1
Date's i f`' 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.
Signature (Owner/Agent)! �� �� °� ��� Date J1;a?.JtI
`f
.
BUILDING PERMIT PERMIT#
DATE VALUATION LOT TRACT
JOB SITE
APN
ADDRESS
ig-ISOCALL,S LM F AXIBLAS
Etr9-<Y.,~ -029
OWNER
CONTRACT�OyR/DESI/GyN7�E�Ry/EN7.IINEEER
py�ye���yvryq� ��y�*►� ply �t �y� L
i-�4L�.ird.�'V+YrX�t?ai. LCV.�O,\ft1u10.y4'lt�.�r+.C'id�.dSL!.8
.^ems yy��y�ry.y��y
NT �.V).V,]6LS9Tl�+✓r�d`d�3.L.t. -8
y�L".4V�a.�.��I.Jr�Y.:.
1 515 Ad1.), oil," C IM�.�.�L'i:t i �—M ONO
Fri,��T^.C7.:�.1��SYa�.�+.�r9.+
1 .51.41rt SO, ODI k9 �, . @.r" A r F2.Jt.:, 42.0 .�
SAN B r +.14AR1:3AN0. CA, 97A08
I&W Bl R1),,Tfi.' 1A1, 0 CA 92408
(909)381.6007 CE UJI. 2120
USE OF PERMIT
i.U9t.ti. .rl:� - .1J WP.LSSd.nlS'04`7
WV4%.A1+2)#R LOTS P&R141T DOES NOT ))VCLAII)S
APF'l tt"JAr 41.75% PIAN CHECK € F
RE -DUCTION Ek)DA, %ixlJLT)i'i E ISISliAN E, OF S"E K.A.W '3 PIr
CUS'R'f:M -CORD*TR€ CTION 2,101.0 SF
PORC.HUPATIC1 206.0£ SF
]WMAM) +OOS1' 010 C01til5M1jeX70H
PE t UT )f'. E SUMMARY
Ct3,NSTR.1.1C".iiO N ITZ 101-000,418-000 1Rr !i,fta
P1,.AN CHV47X FXV: 141-000-439-318
,MICHANIC &L ria: 10) 400-1.21 -000 498.50
LL EC TRIC:AL!Rr 101 -000-420-IMO
PLUAkB1140 FIR 101.000.419 -WD $1640
STPIGI O MO'T)i)1;9 WE - USID 101-000-241-000 $17,66
t?ADIWO FER 101-cW0-23y%V) T20100
l�yPPL p.fPMCTT19 1p 2,25-p00—P3-342 $1,907.00
S1-'CMAi.
$3,411.91
FEBa22
20 yy
Q.
LA uUml
RECEIPT DATE ( --7671BY
p
,DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
I DATE
I INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set BacksC,��
Forms & Footings
Underground Ducts
Ducts
Ducts
Slab Grade
�� i'�
Return Air
Steel_
Combustion Air
Roof Deck
� _3 de`
Exhaust Fans
O.K. to Wrap
�
%
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
3
--
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wali 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
_
Waste Lines ,3 Zg/a/�
Electric Final
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
b.wver Lateral
S giver Connection ` t'
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
Temp. Use of Power
Final
Utility Notice (Perm) 4 j
�.�
OCT -16-2001 16:50 WESTERN INSULATION 909 686 8786 P.W/18
WESTERN INSULATION, L.P.
4211 LaU= Street, Riverside, Calltbrnla 92501
Tel. "Q) 886-8750 Fax (0001688-8786
INSULATIAN CERTIFICATE
THIS IS TO CERTIFY THAT INSULATION HAS SEEN 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
SITE ADDRESS: 78.158 CALLE LAS RAMBLAS, LA Q.UINTA, CA
EXTERIOR WALLS:
MANUFACTURER: JOHNS MANVILLE THICKNESS: 3 5/8 " R -VALUE: R-13 .
CEILING&; BATTS BLOW
MANUFACTURER: OREENR/B THICKNESS: 8.1 " R -VALUE: R-30
CEILINGS: 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 NUMBER: 794484
BY:
TITLE: PR U I N MANAGER
DATE OrCTOBER 18, 2001
:
I .
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