0102-103 (SFD)'LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
CiIapter 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 f_ 1C9d�Br'2�
Date I 1 't Signature of Contractor !�•��, 17 d -r I %i
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 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.
(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:? .� • Y Applicant fid'''
_ .�•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 Sect'on 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) ~Ir • 1 i * t 11LA61 Date:
r rti:
BUILDING PERMIT PERMIT#
DATE VALUATION LOTi TRACT
JOB SITE
APN
ADDRESS
8-218 CAUX LAS R&MM AS
769-021-02.9
OWNER
CONTRACTOR / DESIGNER / EN (NEER
"a"Frt�r3R•�sr'nCR,�cG�'t����eqFE�L..yy..E.,��drryyU��^1�+ttJrr��rUnkJ.i'i�a
�`�}A�t,+��t." 1111d:Gf�►'r�Yd��[.Y►.�.'S..�+fCyY.N.yP�aJinI T,t��,
153'500,',Ld"V.r:Cl,S:rS,X,W.1BL Vf2,00
1535'11110. ,t�di�':�i r.liTE v�200
SAN R_ ERNAM1;N 0 CA 9ZI 08
SAW BERU:F la,.D190 CA 9.2408
L
(909)381-61MI tS1'A 21.24
USE OF PERMIT
X1.14%8 FA LY D..Y LINO
i3OTIT Pi?1d.rbUT DOES NOT 114f.;l: UO
3l L` lA).1 1 4 Qidf Fi A .t� ?�ROE,%k'(• ' � FLOW CHECK "M
149PUC`3ION ;I OR M'f3Y.,'I'I1 41e, ISSUA.14CE OF LAMS PLAN TYPE
PO'R:C TPA TIO 306,00 S,{
CrO3.1VAUC'1`ION 101,!000-418-00 $909.44
PLAN CHECK FLIE 101x000-439-318 $196.12
i'OXI1:ANICA6;i; E 101-000.421.000 MUD
£�=1 101-000420-000x/111*7 I
Al
pC'�Id^'I}t.13��-�4`tC0k,•�(0+��0]i0 Q$
,(By'.(���z:Yy'JG�6''I'UUP:''tj{.�C991�y,gA'(L
T N\61giA71E` O AT "J" 101 mt 00-4.1 i;Y"i OO $162.50
1137111 tJAbR1 fiJ PJ tGlrg lt/ •
orzArva vim 101-000-M-000
fo
y '150S..'MAT, CO&3`MMU&I''TON AWD AM CHUM
IMS L'.R'..3-PG1D:£�,I�,8
$0100
WAND
2 2001 TOO FI ' V DX%IT0W
FEB'
ATY L
RECEIPT
DATE I
BY
DATE FINALED
INSPECTOR
eri f
r� • • }y •
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING AP R/OVALS
Set Backs / d
Forms & Footings //(
Slab Grade �
Steel _ 2
Roof Deck
O.K. to Wrap ��
Framing
Insulation %y�?
Fireplace P.L. / %
MECHANICAL APPROVALS
Underground Ducts
Ducts
ReturnAir
Combustion Air
Exhaust Fans
F.A.U.
Compressor
Vents
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
_
Final Z : 3
- =�l
BLOCKWALI, APPROVALS
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 ,�_�6 j
Water Piping
Gas Test
Electric Final
Heater Final
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral�^`�
� Sewer Connection
"`/ /
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) 67' 027' O
WESTERN 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: DU_NA-FAIRWAYS #29586%PHASE 3
LOT#:- 13
SITE ADDRESS: 78=218 CALLE LAS RAMBLAS. LA QUINTA, CA
------------------------------------------------------------------
EXTERIOR WALLS:
MANUFACTURER: JOHNS MANVILLE 'THICKNESS: 35/8" R -VALUE: R-13
CEILINGS: BATTS BLO
MANUFACTURER: GREENF/BER THICKNESS: 8.1 R -VALUE: R-30
CEILINGS:
BATTS BLOW
MANUFACTURER: JOHNS MANVILLE. THICKNESS: 11 R -VALUE: R-30
GENERAL CONTRACTOR: CENTURY HOMES
BY:
t
TITLE:
DATE:
INSULATION CONTRACTOR: WESTERN INSULATION, L.P.
LICENSE NUMBER: 794484
BY:
TITLE: PROfiUC ON MANAGER
DATE TO R 16, 2001