0102-101 (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
'3141 38 B1 s19:i a 42(
Date,? 2n r ' ' Signature of Contractor -r, y\
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) 1, 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).
( ) 1, as owner of the property, am exclusively contracting with licensed
contractors to .construct the project (Sec. 7044, Business & Professionals
Code).
() I am exempt,brlder 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. "
OPJxANNN
(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 thosetprovisions. ,
Date: ` ?..{'% Applicant 771 + ,t' f 1�, .
4 '
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 _ ;5
for a permit subject to the conditions and restrictions set forth ori his x'
application.;s
1. Each person upon whose behalf this application is made & each persomatr
whose request and for whose benefit work is performed under or pursuant;to''s;,
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.. tt
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. y �r
Signature (Owner/Agent)+ 'l'f�%x� Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 0102-101 TRACT
S1 �7 251586
JOB SITE
APN
ADDRESS
OWNER
CONTRACTOR / DESIGNER / EN (NEER
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USE OF PERMIT
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176 17_5 #
4:•ORW.F;0TAG'N FES 101-000-418-000 0 9109.40
PLA14 CHECK FE11r, 101-000-439-318 $196.12
t!ll Wi'1VA341CAL M- Mi � 10t-000-421-000 03130
>?'D.;�&.* D'RJCA;L. PUP 102-000-420-000 V v y, D 3
'D'L13MMO FRE 101-000-419-000 %161159
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RECEIPT
DATE, 1,� t
BYE +
DATE FINALED
INSPECTOR
INSPECTION (RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings
Slab Grade l O�
Underground Ducts
Ducts
Return Air
Steel
Combustion Air
Roof Deck
d a
6 _
Exhaust Fans
F.A.U.
O.K. to Wrap 2
Framing _
��
Compressor
Insulation
Fireplace P.L.
/
/�/
�
Vents
Grills
Fireplace T.O.
Farts & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior lath
0 II -Int. Lath
D
7
Final �?-�-a� �'
Final
POOLS -SPAS
BLOCKWALL
A PROVALS
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
_
Waste Lines ,9 ��/
2
Gas Test
Electric Final
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
J Sewer Lateral
�J_
` ` -(Ju—
_
((/�'�-
O.K. for Finish Plaster
Pool Cover
Sewer ConnectionQ
Gas Piping
(� /
/-–
Encapsulation
Gas Test
Appliances
Final
COMMENTS:
Final 7_J�Zz/ �
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.08i18
WWTERN INSULATION 9 L.P.
42 11 Latbam stmt, R*mke, cgIltomla 92601
Tel•. (909) 686-8760 Fax (909) 686.8786
INSULATION CMTIFICATE
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#295861PHASE 3
C -LOT #
SITE ADDRESS: 78=188 CALLE LAS RAMsLAS. LA QUINTA, CA
---...................... .-----------------------
EXTE OR WB1
MANUFACTURER: JOHNS MANVILLE THICKNESS: 3 5/8 " R -VALUE: R-13
Cel S: BATTS BLOW..
MANUFACTURER: GREENFIRER THICKNESS: 8.1 " R -VALUE; R-30
CEILINaIS: (:: BAITS BLOW
MANUFACTURER: JOHNS MANVILLE THICKNESS: 11 " R -VALUE: R-30
GENERAL CON?RAQTOR: CENTURY HOMES
BY:
TITLE:
DATE:
INSULATION C®NTRACTOR: WESTERN INSULATION, L.P.
LICENSE NUMBER: 794484
TITLE: PR U ION MANAGER
DATE T ER 16, 2001