0102-111 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
- Gha�ter 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
Dat' 1 r Signature of Contractor-1)),
ontractor1
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of p3rjury 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 haveand will maintain a, certificate of consent to self -insure for workers'
compensation, as provided for by Section 37,00 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 3,700 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: Applicant
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of'the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person'at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees'
2. Any permit issued as a result of this application becomes null;,and'void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to: the, building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) •�yk1 4'!4 ��E t -'-(-.A Date • Z1 t
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 0102-.113. TRACT
%6 958
JOB SITE
ADDRESS
APN
.78-2.1% CAILLF, LAS MkKNIA'S
70L-031-1=9
OWNER
CONTRACTOR/DESIGNER/ENGINEER
CENTURY CR0WFUJI Cok&ir {7�fltr'.f
(' 3' URY C,R0'VY¢,t1'.a., CI iWL Nrrla:aS
1.115 151 Q " MRM11L firl_&
1535 SOS `".T3" UJ.IUM M? W0
. AN WOtA1�ak S;1NO CA 92408
I3AWB;,a' NAM)WO CJS. 92408
(909)381-6007 l"rBL4, 21.20
a
USE OF PERMIT
SFia-PT.,AMI.OR LD T'16PERMIT M7VI NOT aNCLI VUe
t3iha!"14� 1�F.(► IY�Ia�ill l$'T ' i?�l*r .t`�)E'�f�41I�w% , tl� MAN tyidT3rCK RE
ITI:DUC T'IC f POPMUL-T1:1PLE ISSUANCE OF rRAPAS P1. A.14 TYP.is+.
CAMTOM CONST RUC �: ION 21391/00 SF
; 0,RCHIPA11[O 213.00 SP
A:RACI-Va AI'1'ORT° Pore 31,014.40
YMIATED CONT OF CO—TWI (MON
Im"O am
C01401'I2iJt!,`C` ION .IEE 103.000-418�000 "93.09
PLAN C,T+IWX RE 101-000-439.318 U' 61.€45
talC.HANK 41 ,PER 101-000-421-000 sats.io
FILEIC`.I.`Tc.1C, AL F81E 101 -000 -420-000 $123.61
PL.T1M3 THOIwx 101.000.419--000 SIRISO
STT ONO MOTION TION I+ • 1tZ$II3 101-000-241-000 $20,0.5
GRAMM FREE, 101-000-423-000 f# 320A
i3WFLO'PER IMPACT FEE $1,+30.00
h%%VN' i11UHie1C PL&CFW - ROX 7 l'i400-255.000 $20.00
y •. � th.
Y " S PREiPAID FV3:3
$0.00
FEB 22 2001
`
•RI ° e U_ F LA QU A
r
RECEIPT
DATE " f
�. 1. r
BY
•d, a, -� .
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
b
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
Set Backs
Forms & Footings
APPROVALS'...
g� dC
MECHANICAL APPROVALS
Underground Ducts
Ducts
Slab Grade
Steel
Return Air
Combustion Air
Roof Deck
O.K. to Wrap
Framing�_
Insulation
_ _
/
�GG
��
Exhaust Fans
F.A.U.
Compressor
Vents
Fireplace P.L.
-�
-
Grills
Fireplace T.O.
Fans & Controls
Party Wal) Insulation
Condensate Lines
Party Wali Firewall
Exterior Lath 'e
Drywall - Int. Lath
l
Final
Final
/Z /9
POOLS - SPAS
BLOCKWALL[
A ?PROVALS
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
Waste lines /
Gas Test
Electric Final
Heater Final
Plumbing Final
Water Piping
Plumbing Top Out
Equipment Enclosure
Shower Pans
OX for Finish Plaster
Sewer Lateral 99
Sewer -Connection �' I`—� — U
��
` JiGL
Pool Cover
Encapsulation
Gas Piping
[2_2-72Z�U
Gas Test
Appliances i
Final
COMMENTS:
Final Y?//
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 rT% �9��
Final
Utility Notice (Perm)
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:
DUNA-FAIRWAYS #29586/PHASE 3
LOT #:
16
SITE ADDRESS:
------------------------------------------------------------------
78-236 CALLE LAS RAMBLAS. LA QUINTA, CA
EXTERIOR WALLS:
MANUFACTURER:
JOHNS MANVILLE
THICKNES 3 5/8 " R -VALUE: R-13
CEILINGS:
BATTS
BLOW
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:
TITLE:
DATE:
INSULATION CONTRACTOR: WESTERN INSULATION, L.P.
LICENSE NUMBER- 794484
BY:
TITLE: -PRO
DATE OCT
ON MANAGER
16, 2001