0102-104 (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
Date Signature of Contractor —,Z'�P 11 .6 y h
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I a,n 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 avid will maintain a certificate of conseni'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.
00LPDEN NWC- 1769.02
(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: i —t yE 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 Safetyl-
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 v-
& 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)"��it �i +- �+' f. { Date `. f*
BUILDING PERMIT PERMIT#
DATE VALUATION LOT TRACT
$1 11161.So 15 295845
JOB SITE
ADDRESS
APN
78-2.V CALIX, A RAMBLAS
7691-0210219
OWNER
CON,�TCRACTORIDESIGNER/ EENN NEER
CONTRACTOR
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USE OF PERMIT
SFD-PLAN-288 LOT] 5 PEP MIT IINCI, Unp
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iZfi;I2Y:9C'11014 lli'?R MULTIPLE kI,:3UAlICZ OF SAME PLAN TYPM -
i
PORCMI. r 10 X06.00 Sty
9,6$2.40
I ESTIAW., 11M t:Q.iST OF COMt7MON
176,4557M
tt05M FEW, &UNWARY
WNS#'f'RC.IC' ION ."19 101 -000- .18-0,00 010 00
PLAN C13;P: K PRE 101-000-4.149-318 $196.12
MEOPANI54AL F91 101.,t100-421.000 $98.50
i..f4w, 101-000 420-000 $117, I3
FLIUM14HO FM 101 -C00 -419.00f siols0
01RDNO MOTION IVIS n .Resin 101 _000-M _000
ORADINO'FU ,� 101-000.423.000 $20.0
3NI FIAff"RUCTURIS PIZ .225t000-443-342 $4,907.00
4 '
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SUB °fWAL COI k T3' ON .AND PLAIT C;1M(°3:tr
$3,411.91
IM -513 PRE-PAMMRZ
$0100
vat ,1D �`.$?MT F M DXIE NOW
Vj4.17,91
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RECEIPT
DATE ff' /J
°BAY .
DATE FINALED
INSPECTOR
INSPECTION (RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings
Slab Grade
Steel
Roof Deck
O.K. to Wrap
Framing
Insulation
Fireplace P.L.
_ _
-�
� /�
_<
6 /c/_ -�
- - Z
�Z3_ 6J
�zY d�
/ /
�,�!
/
�r�
Underground Ducts
Ducts
Return Air
Combustion Air
Exhaust Fans
F.A.U.
Compressor
Vents
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
CK3-?-1-57
t-'
Final
POOLS - SPAS
BLOCKWALL
PROVALS
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 3� / `y
Water Piping
Gas Test
Electric Final
Heater Final
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K•. for Finish Plaster
JSewer Lateral
Sewer Connection ul O(
i�/l//
;( —
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas) W5,
ELECTRICAL AOPROVALS
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) L-0 r'
OCT -16-2001 16:56 WESTERN INSULATION 909 686 8786 P.15i18
vEOTERN I10TSULATIONv L.P.
4211 Latham Street, Mvcreide, Ceti mia 92501
Tel. (909) 886-8760 Fax (909) 686.8786
I11 S ATION CERTIFIC TE
THIS IS TO CERTIFY THAT INSULATION HAS BEEN INSTALLED IN CONFORMANCE WITH
THE CURRENT ENERGY REGULATION, CALIFORNIA ADMINISTRATIVE CODE, TITLE 24,
STATE OF CALIFORNi-230
T:
TRACT / PHASE:A FAIRWAYS #295861PHASE 3
LOT N SITE ADDRESS: CALLE LAS RAMBLAS, LA 4UINTA, CA
EXTERIOR WALLS:
MANUFACTURER: JOHNS MANVILLE
CE S:
MANUFACTURER:
MANUFACTURER:
BATTS
GREENF/BE'R
BATTS
JOHNS MANVILLE
THICKNESS: 3 5/8
CbLo�
THICKNESS: 6.1 "
' BLOW
THICKNESS: 11 "
A -VALUE: R-13
R -VALUE: R-30
Vy R -VALUE: R-30
GEIUEML CONTBACTOR: -CENTURY HOMES
BY:
TITLE: #
DATE:
INSULATION CONTRACT -GE: WESTERN INSULATION, L.P.
LICENSE NUMBER: 794484
BY:
TITLE: PR ION MANAGER
DATE OtTOOER 18, 2001