0102-107 (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
473418S B I W14 1/2(
Date 4 J i ` Signature of Contractor rl `
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 penaltyof perjury one of the following declarations:
( ) I have and will maintain a'certificate of consent to self -insure for workers'
compensation, as provided fo'r 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.
0011DEMVA.01.1 ill hili:
(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,_,l shall fofthwith comply with those. provisions._„..
Date: s ti + tf Applicant-
Warning:
pplicant 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/AgenV y» Date s "
t)
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 01011.07 TRACT
$200 57.137 F 7 29586
JOB SITE
APN
ADDRESS
OWNER
CONTRACTOR/DESIGNER/EN (NEER
1 153 5 !.0. V MIM1. .71T+. ikZ00
15 5 so, v7 u.CEa.''=i n.& 02M
sAN'.t31d`ltWARDINO CIA.. 92408
101BF—M PM.11 0 CA 92AO8
2120
USE OF PERMIT
S-FD•1?LA'N:3RR LOTI PERMIT 33t;• 2S NOT INCLU02,
It9I S"1titVA Sl1PC�a'ild�f V1 � i�.fi F'1tL7, aCSi. 1':iAN 4CMECK 79E
RMUC'TI01-4 FM F.I 01,TIPLE ISSt;1,ANCK OF;1 AZ P1.,AN TYPE.
CPSTOM CONST RUC:T1011 W95104 OF
POP,C3-11PAT110 214.x} sp
+1T LgFJCe its+=9 s �s?�j 11,054A0
W1~3WERUCosION 1±ER 101-000-418000 999190
PLAN CHECK FFE
MECHANICA.L FEE 101-000.4,21-000
ZekeRCa R1 .L F119 101.000-420-0010 �i f2.6I
PLUMIIDTOO FEE 101-000.419.000 $162,50
S'.I`Rt8I+9O M.Ci7'ti31+I M, - P. &SID 101-000-241-000 $20.0.5
GRADDIG K, Er 101-000,423-000 M.06
MPACT FEB �1,9�7.Ltfi
ART 1W PUBUC PIACES - REST+w 7�11�+3#3'Js2�s•��3 �2fi,aG
. �{'�i�Ei<•'i't�'i.icu-. C�`i��;?.,Tc:�iC� .mss;. ;(=.�.A1~tw �II?�f;
��a�9 t .� �
ISM PRE-Jc?SIV-D 2 rKE
d ,
FEB 22 2001
tAl
JI A 8 V k LA Qui
RECEIPT
[6
DATE'
, iB4Y
�y�.�
DATE FINALED
INSPECTOR
"t(}�
i.
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs '
Forms & Footings
`7 6�
�G�/
Underground Ducts
Ducts
Slab Grade
��d
Return Air
_ -
Steel _
Roof-Ue-ck ' .
Combustion Air
Exhaust Fans
O.K. to Wrap
_ , -�'
F.A.U.
Framing
Insulation
/�i
Compressor
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 PPROVALS
.
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
Electric Final
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
QQ _
Appliances
Final
COMMENTS:
Final
/Z/!
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)
OCT -16-2001 16:52 WESTERN INSULATION 909 686 8786 P.07i18
r
VMS E" INSULATION t L.P.
4211 L-atham StMtt, RhleMde, Callfbrnim 92501
Tal. (909) 6%-9760 Fax (909) 686-8786
i
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:w---DUNA FAIRWAYS #29586/PHASE 3
PLOT
# : 7 r
SITE A 6 RE8S--78.182 CALLE LAS RAM®LAS. LA QUINTA, CA
-------------------------------
-EAMRIOR_WALL6.:
MANUFACTURER: JOHNS MANVILLE THICKNESS: 3 518 " R -VALUE: R-13
CEILINGS: BATTS BLOW
MANUFACTURER: GREENFIBER THICKNESS: 8.1 " R -VALUE: R-30
-CSILL IGS: �BATTS--"BLOW
MANUFACTURER: JOHNS MANVILLE THICKNESS: 11 " Ft -VALUE: R-30
GENERAL CONTRACTOR: CENTURY HOMES
BY:
TITLE:
DATE:
INSULATION CONTRACTOR: WESTERN INSULATION, L.P. _
LICENSE NUMBER: 794484
BY: 7
100
TITLE, PRO C ON MANAGER
DATE OCTOBER 16, 2001
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