0102-105 (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
71418kV
Date ' �f-,r,l j�, Signature of Contractor,.� y�
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 affirm under penalty df 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:
Carder Policy No.
OXY Wn. EAOLE M1
(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:' 3: = f Applicant--,P-J:
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings
9J / _
7/meg ��Z
Underground Ducts
Ducts
Slab GradeC`
Steel
Roof Deck
O.K. to WrapG���
Framing
Insulation
Fireplace P.L.
�s -ter
_
�y S Q�
40 l
_
`
_
ReturnAir
Combustion Air
Exhaust Fans
F.A.U.
Compressor
Vents
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
ExterDrywall-Ior th
Drywall -int. Lath -22
GE�`91
_
Final �� � �'-�
,.
BLOCKWAI A04PROVALS
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 Q/tel f�
Gas Test
Electric Final
Heater Final
Water Piping
lo
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral_
Sewer Connection q j
�
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
_
Final
COMMENTS:
Final
Utility Notice (Gas) �
ELECTRICAL A PROVALS`
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)
OCT -16-2001 16!57 WESTERN INSULATION 909 686 8786 P,17i18
' iii °TERN INSULATION, L.P.
4911 Latham Street, Riverside, Calitbmia 9450
TIL (909) 6WS760 Fax (909) ON -0786
INlULA'T 0X CLRTIFICATE
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:6�'
FAIRWAYS #29586/PHASE 3
LOT It : .
SITE ADDRESS: 78-242 CALLE LAS RAMBLAS, LA Q,UINTA, CA
EXT RIOR WALI a•
MANUFACTURER:
JOHNS IWAWILLE
THICKNESS: 3 5/8 " R -VALUE: R-13
SEILINGS&
BATTS
BLOW>
MANUFACTURER:
GRE&WISER
THICKNESS: 8.1 " R -VALUE: R-30
CE N S:
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: i "
TITLE: PRO ION MANAGER .
DATE OCIWER 15, 2001
4