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0102-113 (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 141ti8 � �filti J� y f �tiFYi,f�� Date �� 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: Carrier a d/y t y y} j� y {y g8yyEE¢� Policy No. yy 54406 8 42 (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:: l .��, j Applicant '­;%` A"1 ;, ,r;.,c Z Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his application. 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancella4tion. I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for inspection purposes. 1 ' e Signature (Owner/AgentDate"" BUILDING PERMIT PERMIT# DATE VALUATION LOT TRACT It$ S.a 196. LA0 11 29,586 JOB SITE APN ADDRESS ��tCC ^ry�, LAS ��roe �Np + pA 2�!6 �v.�+.1.,LE. 1}..tAS �'1�AXTR,A,aM; !��CI� ry Aa* rYy5y !{9uv"VIL.4.^'tifdr� OWNER CONTRACTOR / DESIGNER / EN (NEER MWW:? Y CROWELL COMMUNi'i' C''1"IMIXY, 0?!C!1VaLL Ct'3hmihTi 1ps 1535 SID, V' 9i 1 .2a, gn?, #200 1534 0, W -Do Z4C,1 EIFT, 6TE, 0200 W-TWER MA:DR-10 CA 92408 S.»AJ':I?3)f?R'hd./ARDWO CA n-108 (909) 81.6'0V7 CBLft 2120 USE OF PERMIT ,�3117)uPLAN.IAl L -OTA 1. PERM]T DOY-a pIOT INCi. DF, 131 CICif�r itL� �:tal dl"�C;i1i�G� ' la,PPROA.CH.`M P14AI? >G°SEM TTZ VWurl"Y:1014 �VYZ Mlld..'1'MG1, MUS:UANCE OF $AURE PI.,Aa3 TYPE, Ci.1; 707 C00TRUCTION 1,801no or PORCHIPA T XO 180.0 SP �.1E�AC31:�t'"A1�.V�01�f ��F� 9 9Ce.00 M1TAT f 1108 (OF COINS'M11 710H Ie?X3A0 E'cT S�VdI.A. i. ly �pMe _ CONSTRUC'1',1t3NF:'Y 101.000-41 8n000 198100 PLIAsd C:OWK FEE 101-000-439.315 AFMI'Mx 1,, M, 101 1,000.3.21,000 3f1ti.30 F lye`! WC,AL ME, 101 'GOD -420-000 $106.81 P1..Li14i1 mFite 1,01-000-41.9-000 $143.1:3 >a°k'1LO1• O MOTIM4 ME ,. %'Y -SID 101--000-241-000 $13.35 0i ) INin VIXF 101-000-4 ". -000 tpa:,t o 'G1`'e�'i;:F►ali�ilC�'"t11�:i�'� ^�''�-(IL8L1*;����`.� $1,9D 0® m� j iAS-'£�C3rll s 1133'1"3 LYC'1`ft1 ,,3 .1,51�114� ;T ".tyles S3,251.12 w YJ!, 38 PRE—P.ATDFEF.0 $0,00 ` FEB 2 2 2001 TCYVAwP,L ".15 IR E TKIM $3,2sin morry (uf C-1Ui '9 { RECEIPT DATE BY` DATE FINALED INSPECTOR. x,14 INSPECTION RECORD OPERATION - DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Forms & Footings _ / 00-1 [vim Underground Ducts Ducts Slab GradeGf ReturnAir Steel Roof Deck O.K. to Wrap ,�� lY/J/ Q� U"' Combustion Air Exhaust Fans F.A.U. Framing �= O� �� Compressor Insulation � Vents Fireplace P.L. Grills Fireplace T.O. Fans 8 Controls Party Wail Insulation Condensate Lines Party Wail Firewall Exterior Lath Drywall - Int. Lath Final _Final 2� / v/ / POOLS -SPAS BLOCKWALL dPI�ROVALS 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 ������ 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 77 � Q Encapsulation Gas Piping Gas Test / 2 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)02�� p) �� OCT -16-2001 16:54 WESTERN INSULATION 909 686 8786 P,11i18 WWTERN INSULATION 9 L.F. 4211 Latk= Stunt, Riverside, Callfnmia 92501 Tel, (909) 686-8760 Fax (909) 686.8785 INSULATION CERTIFICA E THIS IS TO CERTIFY THAT INSULATION HAS 86EN-INSTALLED IN CONFORMANCE WITH THE CURRENT ENERGY REGULATION, CALIFORNIA ADMINISTRATIVE CODE, TITLE 24, STATE OF CALIFORNIA, IN -THE BUILDING LOCATED AT: TRACT / PHASE- DU.NA FAIRWAYS #29586/PHASE 3 L -OT #- 17 SITE ADDRESS: 78-208 CALLE LAS RAMBLA6, LA 4UINTA, CA R WADS_: MANUFACTURER: JOHNS MANVILLE THICKNESS: 3 518 " R -VALUE: R-13 CEILI BATTS MANUFACTURER: GREENFIRER CEILIN SATTS MANUFACTURER: JOHNS MANVILLE �ow THICKNESS: 8.1 " R -VALUE: R•30 SLOW THICKNESS: 11 " R -VALUE: R-30 GENERAL CONTRACTOR: CENTURY HOMES BY: TITLE: DATE: INSULATION CONTRACTOR: WESTERN INSULATION, L.P. LICENSE NUMBER: 794484 BY: p TITLE: PR DU ON MANAGER DATE 6CPAER 18, 2001 k 11