0102-109 (SFD)LICENSED CONTRACTOR DECLARATION
I ,hereby`a rm 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. Cla-s Exp. Date
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 affir"m. 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.
$iOLi EIN KAOatE1'x S, ?v' 4�rRt�'��E�dsft• iBa
(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 �' `;t_ Y-1a2�Al A
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. a
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 a
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. e
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. i
Si nature (Owner/A ent)4Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 0102-109 TRACT
$.11M457-00 7..:2 SSti�i
JOB SITE
APN
ADDRESS
)x..2..2 CATZE LAS RANWIL
-ls*SmJ'.u�F - g -
OWNER
CONTRACTOR / DESIGNER / EN INEER
CMI1RXC0 WkL coT £)' S
COMPLYtZWELL 1U0k14N [)N 1x3
71535 400: 11M c1YRRZ1 A'�Y200
153:5 S01 41SbZETI-r, b -M 7200
SAW EIIIH.WI M)1`NO A 5',2408
SA1':C3EIWAR ,1190 CA 92409
2120
USE OF PERMIT
rVbU,PAyL7Y LMMy4
11170-PIA.M38M, L.OT12 Yf?, i1R r OUppY war 1'P rulbo r:
B14`KWALxMlh' OO'fJOf IVP- '1AY ,t1 P,PR4)AC1,' 5Y* PLAN €`.H EWTr. FEE
TtE.DX1CTJON F01t MULTIPLE ISSUANCE OF SkME PLAN TYPE
C VlITOM 1.100M'U C i iON %FYJ oo mid .
POR.CKf; ATIO 7,i3.f3i18111 .r
WHOTRUCTION = 101-000418-000 S"310
ALAN t':HRr K ",E, 101-000.439AwS18 $201.88
MECHANICAL FSIs",ja. 101-000-421-000 193.110
tOX&C:
INSPECTION RECORD
OPERATION
=DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
Set Backs —�/��
Forms & Footings G
Slab Grade _/j Q� �_
Steel / •; '/ . •
Roof Deck "_ _ _d
O.K. to Wrap �. ��
Framing
Insulation
Fireplace P.L. ei
MECHANICAL APPROVALS
Underground Ducts
Ducts
Return Air
Combustion Air
Exhaust Fans _
F.A.U.
Com ressor
P
Vents
Grills
Fireplace T.O.
Fans & Controls
Party Wali Insulation
Condensate Lines
Party Wall Firewall _
Exterior Lath
Drywall - Int. Lath
e
�
Final �
�-v
BLOCKWALL A0 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 ���
Water Piping
Gas Test
Electric Final
Heater Final
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral _ )
F Sewer Connection ��� (
Pool Cover
Encapsulation
Gas Piping
Gas Test
o
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 ! 3 _d
Temp. Use of Power
Final
Utility Notice (Perm)
WES'T'ERN INSULATION, L.P.
4211 Latham Street, Riverside, California 92501
Tel. (909) 686-8760 Fax (909) 686-8786
INSULATION CERTIFICATE
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 #29586/PHASE 3
LOT #: Ci
SITE ADDRESS: 78-212 CALLE LAS RAMBLAS. LA QUINTA, CA
--------------`----------------------------------------------------
EXTERIOR WALLS:
MANUFACTURER: JOHNS MANVILLE THICKNESS: 3 5/8 "
CEILINGS: BATTS BLOW
MANUFACTURER: . GREENF/BER THICKNESS: 8.1 "
CEILINGS: �BATTS BLOW
MANUFACTURER: JOHNS MANVILLE 'THICKNESS: 11 "
GENERAL CONTRACTOR: CENTURY HOMES
BY:
TITLE:
DATE:
INSULATION CONTRACTOR: WESTERN INSULATION, L.P.
LICENSE NUMBER: 794484
BY:
TITLE: PR DU ION MANAGER
DATE 6CTOBER 16, 2001
t
R -VALUE: R-13
R -VALUE: R-30
R -VALUE: R-30
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