0102-106 (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
714188
Date, k ' „ 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:
Gamer 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.
iDate:& i 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 attorneys 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)-" Ts -A * �'"�- ' Date`:: 1 _,_,_ 3',
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 01024106 TRACT
V2001/ 7180 S I iD 6
JOB SITE
ADDRESS
APN
78-4 70 CALLE LAS RAYMILAS
7-6.9-021-019
OWNER
CONTRACTOR / DESIGNER / EN INEER
C'.�iu"iUR �'3't.OVrI'LL COWli:CT.3.+ITYUS
CTI-14`°d'l IZY is°ROW)"lix COMMON"W's
W's
1535 so. T9I�'t-RMf VITT 0200
133:5 �,10. "134 un:t�.ium" ra-e noo
DMIARDk 'O CA 92408
SM REWARD= CA. 9,2408
(900)381.6Ciml g- 2120
USE OF PERMIT
SPUr`.%.A11: AR.'LCITS F'tERRAIT DOV1s NOT iN+LIAJD9
BIAWB; W.&):".IPOOi..M#1:TV WA"s''A'FPROd CH, 5% PLAN CHECK YR
RROIJCTIO'K FOR h4U1 d':!PI.I° ISSUANCE OF SAUL,` 4'W4 'h"YPE.
CWTOM CON ` RUC""T]aR Z319.15.0 sy
Poack1.rpAno ' 213.00 V
�.±'s.�'..AQWC.s►RPORT X50 51,04,40
OUT 01Y 0.41w+��b7�.G.AC�.'lti.�Adi!-
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A".1iF.,%u-�i7,�A��.71�-E 9�f.YdWALV1S3ASY.'$
CONSTRUCTOR YZE, 101-000-4184W, MINI
PLAN CF131I.FCK 1'NIC 101-600.4139-218 $201,85
MECHANICAL ITZ 101-000.421.000 392—Mll
FLECTWCAL10EV 19,01.000 312&61
FIXIMMO FEE 101 -000419-000 W2150
STRONC^D 3 OTICYN FRE -11.A SID 101 -000-2A I -0010 $ D. f1
mk6 .D1. w Pus 1.01.000.43-000 $20.00
Lh1)V7.E1.,OPE1@. IMPA.0T FRE, $1,94t'B fDO
ART 1N PUBUC 1"£:+f+,,Clr27.11.U'1'S 701.000.255.000 $20.00
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k��9iaTv.�3, ua�S
22 2001
`g ,FEB --.
S a
RECEIPT
DATEBY
4
DATE FINALED
INSPECTOR
INSPECTION RECORD
=ti OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings
_ _ `
y 3_ �/
//
(�1
Underground Ducts
Ducts
Slab Grade
_
Return Air
Steel
_ ,&zz
Combustion Air
Roof Deck
3 Q
_
Exhaust Fans
O.K. to Wrap
d�
F.A.U.
Framing
Insulation
_ _
_
/
�A'
Compressor
Vents
Fireplace P.L.
_�j
Grills
Fireplace T.O.
Fans & Controls
Party Wali Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
FinalY.M./PROVAL
_Q
POOLS - SPAS
BLOCKWAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Waste Lines
_
3/Z��f
��t
Electric Final
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
_
_/_
r�
Pool Cover
Encapsulation
Gas Piping
M
Gas Test
_
/
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
O�
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)
OCT-16-2001 16:5.1. WESTERN INSULATION 909 686 8786 P.05i18
TERN INSULA'T°ION, L.P.
4211 Lnthom Street, Riverside, CaUornla 92301
'hl. (909) 686-8760 rax (909) 686.8786
INSULATION CERTIFICAT
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 / RHASE:_DUNA FAIRWAYS #29588/PHASE 3
LOT#: 5
SITE-ADDRESS;--76-170 CALLS LAS RAMBLAS, LA QUINTA, CA
----------------------------------------------------------
EXTERIOR WALL§•
MANUFACTURER., JOHNS MANVILLE THICKNESS: 3 5f8 " R-VALUE: 8-13
BATTS BLOW
MANUFACTURER: GREENFIBER THICKNESS: 8.1 R-VALUE: R-30
CE LICE LI INGS; BAITS BLOW
MANUFACTURER: JOHNS MANVILLE THICKNESS: 11 " R-VALUE: R-30 '
GENERAL CONTRACTOR CENTURY HOMES
BY:
TITLE:
DATE:
INSULATIONCONTRACTOR: WESTERN INSULATION, L.P.
LICENSE NUMBER: 794484
BY:
TITLE:P 0 U 10N MANAGER L�
DATE 0 ER 16, 2001
I
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