0102-108 (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 B 1 cif"sc 1 /,2,i
Date--~- I , i 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).
( ) 1, 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 conserifto 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.
COMEN MOLT,, INS.
(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.
Date:. Applicant ` w f ^ r -Q,7'
`%;'
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) 1�t 9 Yf Date,
BUILDING PERMIT PERMIT#
DATE VALUATION LOT (�� �,Qi TRACT
719586
JOB SITE
ADDRESS
APN
M-1.94 0W.91AN RW. IDY.AS
OWNER
CONTRACTOR/DESIGNER/EN INEER
('W'URY CIZOWBUI CCOMMUSM19
C"Gi,'•V1'i.FFC.T CROW ,,L i OMWIT h IZZ
1535 w). -iy 'mm` , BrI2, fil.00
1535 .so, v +o'p"1r ri nz mv)p
,W BERl+iARr 1N10 CA 92t!•OS
VANBERN4'aIi':iNNO CA 92Q&
(909 351-aw CDV- 2.2.20
USE OF
PERMIT
[[Mr ) AUL l DW 4LMO
SIM—Pi AN AM 1.0TO PE1:,1R T 1.70E.S NOT INCLUDE
8LOC!"WAL3SM00UT)WEu 'AY•APPRt;ACKM PLAM CRECK 79.9
REDUCTION FOR ML7LTIPI,.t 'MIUt1 CE OF SAME ILA N TYYPX
A
C: 3OTON CONSTRUCTION ,''.4.445.00 SP
S'On!'R.C4l.J.l{.�All'LO 21+.00 A01F*
iFE'D COST 0l!` CON STI R UCT101
290,457 ;W
yERTW
.V�LA6+.ry1:�4'��/e.•0q,�'l{R�/1�{1y/6�1`p6r7.�`�) RLA1Y
j�q r�{�pp �OQ�j (��q {�{�y�I� {�
°ll�d�ii`d J'SI\09Wi#\%6tl ♦,++^.lJ ��714�•'LlV�"pC J��✓�.4 'Ti.7JI�i%'
MAN CHECK FEE $,201.m
MEOHMIC AL FSE U&SO
r%1",�';1zIC'.V1TM, Oe$.bf
PLUMi�1"1rN(] F&E 101.000 -All 9.000 $162=50
STRO140 Lu3OTION IFEE , Rfw= 1411-000-241 4*0 izi os
0HANN 1 V99 101-000-423 1"=') $20.00
M.M.0pr4lWIR&C`k''''P Si}k'i.fii3
ART 1N PUBIC 1'1ACM - RNSIL 701 p000,455-60i��3,$20,00
ar A.
a
I
CO1 IMPItf'M0114 ., W D 1:'';LAN CHWE X
FE6 22 2001 DIAL °Y. 6IYVE NOW
vi,��%x151
IXr r ve LUVJ,
RECEIPT
DATE'
B
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION I
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings
Slab Grade
Steel
Roof Deck
O.K. to Wrap
Framing
Insulation
L� % _
/ 7 �/
/�d /
�/ ���!
_ _
, /
Underground Ducts
Ducts
Return Air
-Combustion Air
Exhaust Fans .
F.A.U.
Compressor
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
_
Drywall - Int. Lath
�� �T
_ �
Final �Z _� _Q, �G�
BLOCKWALL/ PROVALS
Final
POOLS - SPAS
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 3/���(i
Water Piping — �/
Gas Test
Electric Final
Heater Final
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer LateralQ►
Sewer Connection
_ _
a'p'
49'�
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) C
OOT -16-2001 16:53 WESTER14 INSULATION 909 666 8786 P.09i1:3
iii �C' R11TT INSULATioN L. Ps
4211 Wdlam Stma, Riverside, Cal kr lia 92301 '
T14. (909) 686-8760 Fax (909) 6864786
EN -81 LAT/ N C RRWIcATF
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 #29888�,"4SE 3 —
SITE ADDRESS 7 18 g4 CALLE LAS RAMBLAS, LA QU1NTA, CA
EXTERIORWALLS: - ----------------------------- -
MANUFACTURER:
CEILINGS.
MANUFACTURER:
CE�,LINGS:
MANUFACTURER:
JOHNS MANVILLE
BATTS
GREENFIEER
BATTS
JOHNS MANVILLE,
THICKNESS: 3 5/8 "
�w
THICKNESS:
BLOW
THICKNESS: 11
BY: RAL CONTRAOTQP! CENTURY HOMES
TITLE:
DATE:
lNSU L TION CONT : WESTERN INSULATION, L.P.
LICENSE NUMBER: 794484
TITLE; PRo U ION MANAGER
DATE 0 ER 16; 2001
4
R -VALUE: R-13
R -VALUE:?° R-30
n a°
R -VALLIS! R-30
-T.