0102-112 (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
7141 fA B 10611?r
Date — f`)l f/�= Signature of Contractor`••,/ A,?l :-4
� r r�•:.r vim— ..�.
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).
( ) 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 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:
Cartier Policy No.
MUNN SAMA TWO.
(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: ••-• it Applicant 10, *'
Warning a 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. t
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 P
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 buildin
construction, and hereby authorize representatives of this City to enter upo�'5
the above-mentioned property for inspection purposes.:
fc 1
Signature (Owner/Age i)'_ /)h �.% R%/ �` Date t
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 0102412 TRACT
$2(tq; 4V,W I e 29586
JOB SITE ;
APN
ADDRESS / �r,y�'ypa A�+� t��6
19.248 i.+K541 E LAE RAWELAN
I
OWNER
CONTRACTOR/DESIGNER/ENGINEER
ITNO 'i%'�.Y�g��y."R��O Wr 1,��:q."yop•�m�lmumfl�;SC�/v'T��1�q.ip
CROWY:t..�1..,1�Y'O7)�:�,lst�pll�T�e.�nMT
1:x;35 O.- ) o are ' '. y W. 1 4 200
1535 490. D, eY��� Zrl Ulm 1'i.200
4
CA WOO
(909)381,6W? C'BVf 2120
USE
lOF1PERMIT
K�J�\:4M e�•3.'.". YJ:i4f.6.,r�w ��..�.�I F'847
rs 'CIVAy�i :' ti�I. k s�iN % ► ,i 'l F c�ea 1.%541a PIAN CHECK Per!"
H21)U TION Wit F,4X.Yi.,'1' L—E .ISSU hWrX OF SAME PLM i 'rfPF-
C8dUOM CONvOTA:`CfCT)OW 2,30190 �V*F
ilARAOls'i'MARPOR (M 11.054,40
7t"ERMU e`r'g SUMSAR
V41PRCs50'" Fee � 413 nfli113�1 Labt�tlV �99�,iaf3
V!,.i1CHECK TtE iSlt4f1Liel-si��-�R$
MLGhNICA "81150
1k%WJ'RLCAL FM 028.61
P LC1IS;1 0 T490. $162,30
STMONG 140110N PEE n RES16 101-000-2141-000 $20.05
GRADING FRX 1 d t w4 00.423•d30 $20.00
Orl-'� EL 011FI ?, IMPACT r 1 $1,907.01)
ART IN PUBLIC ?L&1 3 -AW-1r. 701-000.25.1-000 MOO
,g
LE.". r PRX-PAI? F. "
$0.00
q I'X,'�r1S# i�S 3s����y'1�..a
WAF
FEB 222001;
U Lei Qua
RECEIPT
DATE j; }'BY
"'�
DATEFINALED
INSPECTOR
,
INSPECTION RECORD
OPERATION
DATE
INSPECTOR.
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings
9�
Underground Ducts
Ducts
Slab Grade
//��/
Return Air
Steel
Roof Deck
Combustion Air
Exhaust Fans
O.K.to Wrap
2 Q
+.
F.A.U.
Framing
Compressor
Insulations7
¢ `I
�ys�
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
8/��•
�UJ
Final
Finall
l
%
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
Gas Test
Waste Lines �����i�
��
Electric Final
Heater Final
Water Piping
%% as
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
j n �_,�
I v� C/
Pool Cover
Encapsulation
Gas Piping
Gas Test
cr
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
t�
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 #: 18
SITE ADDRESS: 78Y-248 CALLE LAS RAMBLAS. LA QUINTA, CA
-------------------------------------------------------------------
EXTERIOR WALLS:
MANUFACTURER: JOHNS MANVILLE THICKNESS: 3 5/8 " R -VALUE: R-13
CEILINGS: BATTS �BLOW-
MANUFACTURER:
GREENF/BER THICKNESS: 8.1 R -VALUE: R-30
CEILINGS: BAITS BLOW
MANUFACTURER: JOHNS MANVILLE THICKNESS: 11 R -VALUE: R-30
GENERAL CONTRACTOR: CENTURY HOMES
BY:
TITLE:
DATE:
INSULATION CONTRACTOR:-- WESTERN INSULATION, L.P.
LICENSE NUMBE : 794484
BY: NUM/
TITLE: P D CTION MANAGER
DATE 'OPITOBER 16, 2001