0102-110 (SFD)LICENSED CONTRACTOE DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter"D'(commencing with Section 7000) of Division 3 of the Business and
P�6fessionals Code, and my License is in full force and effect.
License # Lic. Class 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 & ProfLasionals 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 tiy' -`
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 /app p 1 /�} ry rr ��(ppry�ryy Policy No.
L,IhO��f�1,�� R'A�1Xi�efiJ d7.Vf,Yf dM•W �"�Y'1��tIYi��IP)
(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: f r Applicant++
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
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)
N.:,:ak' .r". at Date `71
�� - -,• vY
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 01024 10 TRACT
p Ott
14 29$86
JOB SITE
ADDRESS
APN
7&,.224 CterAX ® At
�n ty ra.k
OWNER
CONTRACTOR / DESIGNER / ENGINEER
C99TURY (Rt1 ET,:i%. C -OM : I MN,
ILMI URY CR.t3W7� LL C(AMMI37UE S
1535 30, wD# Frf-W r, UTE, 02.00
1535 SO, nD' STREET, M 0,200
SAN EMNARD O CA 92408
SAN BF.TWARDWO C.A. 92408
(S*9)3, 81.6007 QU9 2120
USE OF PERMIT
Ar&Fp*,.S D IMLyNG
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SK,341LAk1:3t?R t,.OT14 k'EIt.ANT UCY33 NOT iNtr3:fiDE
, tF,T)uC.1,i v it'oTI muvriput rin><7mm, OF sAMx :P.F A.m TYi< K
COl' S TRUC TION 2,39..S.00 81!
P0q,C4VP&TI0 213.00 Brit
GARAGEMARPORT Q%) 11,054.40
476`1�..Try'.Ep.�gaVp XLYS{�i �yE,gftgM�fiFaT. a,
�L.'a
0q[tptn-,p6':0} t 09!fp
101 -WO -418,,000
PLA14 fi:l•3lZ9 PEJR $201.85
dI C'rT tGlil., F E -Z $93,30
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.f"kdR�itl�ddT,S Y, dLA:a - 4Y.+1C"���-°�C�i°f1Wrj �C�ib �N
ST'RONO NOTION FEE - MID 101-000-2.A 1.000 $ 0.01
ORAD We ."a 101-000-423-000 $20,00
Di� }�x,iuP?UJaAC'1 FZZ $1,9f37.Otf
ART DI 3'UB1,10 PLA 99 - HS11 701 -G0Q-?Z5*000$20.00
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SMI 40fiiAT,(:OMrRIIM109AND P AWafP-MC
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W'22 2001
seas Q QUA
RECEIPT
J.DATE'(
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR.
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS - .
Set Backs 7 _
Forms & Footings _ _
Slab Grade /Return
Steel
Roof Deck y_�� `��
O.K. to Wrap _ 1�
Framing ,3 ��
MECHANICAL APPROVALS
Underground Ducts
Ducts
Air
Combustion Air
Exhaust Fans
F.A.U.
Compressor
Insulation
-!
�Z�/
��
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wail Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
BLOCKWALL A'j 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 APPRO ALS
Waste Lines ���6 _O /d�
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
) _�)
�'p`
)
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
LA
Utility Notice (Perm) 9 - Z Q ( Air
OCT -16-2001 1655 WESTERN INSULATION 909 686 8786 P.14i18
4211 Latham Stmet, Riverside, CaSfo da 99501
Tel. (909) 686.8760 Pax (909) 685-6786
INSULATION CERTIMA
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:EAII AYS #295881 H SE 3
LOT# : 14-
SITE ADDRESS: 78'224 CALLE LAS RAMBLAS. LA QUINTA, CA
............ -................................ ---------------------
€XTISIOR WALL&
MANUFACTURER: JOHNS MANVILLE THICKNESS: 3 5/8 " R -VALUE: R-13
CEILINGS: BATTS BLOW
MANUFACTURER: GREENFIBER . THICKNESS: 8.1 R -VALUE: R-30
CEILINGS �BATTG BLOW
MANUFACTURER: JOHNS MANVILLE THICKNESS: 11 " R•VALUE: R-30
GENERAL CONTRACTOR: CENTURY HOMES
BY:
TITLE:
DATE:
INSULATION CONTRACT -0-R; WESTERN INSULATION, L.P.
LICENSE. NUMBER: 784484
BY:
TITLE: PRO UC ON MANAGER
DATE OC19SER 18, 2001
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