0102-102 (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, ,�� 10/31/2(
/31/2(
Date,,, r ��' t Signature of Contractor'1
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:
Carrier Policy No.
i i7t-rr� " IA0U 1 .9,
(This section need not be completed if the permit valuation is for.$1,00.00 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 wv
Warning: Failure, to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the L"atior Code, 'interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his a
application. X19
1. Each person upon whose behalf this application is made & each person:at r
whose request and for whose benefit work is performed under or pursuant to "
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees. .
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is,,'ii
correct. I agree to comply with all City, and State laws relating to the building w, %1
construction, and hereby authorize representatives of'this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Ag' nt)s N 1 `' �> v -41 -Ar Date`°r •_�
BUILDING PERMIT PERMIT#
DATE VALUATION LOT &)''!► •A13'1 TRACT
2954016
JOB SITE
APN
ADDRESS
70-2W CAUX T`r c� S Ri{ M. D.L"
769-021.4,M9
OWNER
CONTRACTOR / DESIGNER /ENGINEER
.VdUgbv Rj Y
CFG-
,0,�UW(
e�i p✓yOWSWCOY4d 6i
1 D.45 SC,, "D''Vf.�'.??�:T, ar.r.F. �ar(tO
1535 d10, T"MRM ME1010
RRMNAtZ )WO CA 92409
S.WB.YWARDINO CA 924043
(909)381«600 ME VL 2120
USE OF PERMIT
MrD.Pi:,dt-NNIAR LOT 10, PERMIT 00 M, :WXP xNCLUIDE
.tiP1.,0XCHECK RE
1'.1v`DUC;l'10W VOR, PtR:U1,T??'f,Y, TSOWIMCE i3?'.e/1.4's E PL&W T'YPR
MWTONI CONSTRUCTION Z107.011 OF
Pokcil1fP11.no A16.008P
E3d�1At:?j4�,,aFtI$° (S),6C240
:' rMIN.1ED colvi t OF COMMU mmor
176.5.5'7.W
CU.N9TRUCTION FER 101-000-418-000 O N
PLAN CHWK "El 101-000-439-319 $186,12
MJAN'1C.blLM 101-000-421--000 $98130
91,ECT11ICAP.,lnl& 101100"2f -000 $1117.13
PLUMBING "IF. 101.000.419.000 $162.30.
ST111ONGe=T10H fE1W., SIM -1x) 101- 000-241-000 .$17.56
ORtk1)'t?�0 FEE 1.01-000,423-000 $20,00
INFRA, FLUC,!'Ui E, FEE 2`2,5-000-443-342 $1,9tv.00
e, 9
x
tj 11.13
SUB -TO .CC7.1~i"UM[1'C°TION AM 1"'`(,AN CHI
S-4,41191
d11 3 TIM -PAD MRS
$0.00
1110 P=Mf :Y DUE Avow
FEB 222001
RECEIPT
DATE, } {
BY ti}'„
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade/d
Steel
/ (
ReturnAir
Combustion Air
Roof Deck
`
� k
Exhaust Fans
O.K. to Wrap
.S'_�3d
(
F.A.U.
Framing
�f
�l J
Compressor
Insulation7
K-,
G/L'
Vents
Fireplace P.L.
r
Grills
.Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
% 3�0
Drywall - Int. Lath
ZJ—
_
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
Electric Final
Waste Lines
3D/��
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
1 Sewer Lateral
_ _
Qr
_
Pool Cover
Sewer Connection
_a.
Encapsulation
Gas Piping
_
Gas Test
_7
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)
�
OCT -16-2001 16:53 WESTERN INSULATION 909 686 8786 P.10i18
WENE2PTERN INSULATION 9 L. P.
4211 Latham Suet, Riverside, California 92501
Td. (909) 686-8760 Fax 1909) 686-8786
EKSUL&TLON CEIDFICATE
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 IRWAYS #29686/PHASE 3
LOT #: 10
SITE ADDRESS: 7 - CALLE LAS RAMBLAS. LA OUINTA, CA
EXTERIOR WALL;
MANUFACTURER: JOHNS MANVILLE THICKNESS: 3 518 " R -VALUE: R-13
CEILINGS: BATTS BLOW -
MANUFACTURER: GREE418ER THICKNESS: 8.1 " R -VALUE: R-30
CE S: BAITS BLOW
MANUFACTURER: JOHNS MANVILLE THICKNESS: 11 " R -VALUE: R-30
GENERAL CONT_ ACTOR: CENTURY HOMES
BY:
TITLE:
DATE:
lblr2IjLATION CONTRACTOR: WESTERN INSULATION, L.P.
LICENSE NUMBER; 784484
BY:
TITLE; PA0 CTION MANAGER
DATE O)ZTOBER 16, 2001