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
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