0106-227 (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 # z Lic. Class Exp. Date
714 1 RES B
t, H•
Date Signature of Contractor—
OWNER-BUILDER
ontractor 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 insurancecarrier&.policy no. are:
Carrier Policy No.
C3t�I11.7E:?7 l�t��i? I1ti1�. 1�t1C-�RE.�3•�3
(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: J. i', 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. I.
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) - ' r + - Dat4_-
BUILDING PERMIT PERMIT#
DATE VALUATION LOT (�g,{�fy-�'�) ' TRACT
Qe
295C 5
JOB SIT ° `""""--+-+.--
APN
ADDRESS
"f C#`di�13:�'nid`.A.�.�LTn �XGS� �,/Fi.N,f.4!'YA�W
i-�J`""�!.{.g.^•�Je%X/
OWNER
CONTRACTOR / DESIGNER / ENGINEER
Cain T iRY CROW.KE 1 COkbSW:Tl III S
CENTURY Y QT.0V71 LL C,"OMSi 11,Tf LURE
1535 so, mmm. Iii. #200
15.915 71101. ":D" STREP11'T, :3'1'E #Z00
;_1IgBERNARDINO CA. 92408
;W'ah"ARDINN CA 9.2408
(909)381.600 MIL4 2120
USE OF PERMIT
•!1'1 FIR a =01-111AT
f2433Csl .1}.41§ .�'" ;u i1vC
39" V &STEMIN PLACE
Sl7,lZ . 1,07% RILAN 2A. f:TER.MiT ;G'CYES'NOT 11SC ;;,:tlOE BLOC K W: ,14.,
P001, OR DRVI WAY APPROACH,
i
CUSTOM. C`C3NS14"W(YrION 21107100 OF
PORt711>fPATIO 2061„00 sF
a A.-RAWCAV°ORT 494.00 OF
'
S'SONS RUCTION ,FIS 101.000-4,18.000 S909A
PLAN CHECK vim 101-000-43.9-31 8 S744.47
MROH.i NIC,A'I. KR101-000-421-000 $93.30
SIZECTRIC°,AL.1gE' 101-006.420-000
P'1.i1'MBINO 9'Cte 101.000-41,9.000
00 �27.db
STRES?it"t MOT"SON Pi►.jS: A R�'.S�iTiE3 101-000-241-000
t3S 1YaC1 i+F.: 101.000.423.000 $20.00
2125-000-443-342 31,907 00 <.
�I
f,
. MM-TOTAL0.0A t..' A X• r' .f"'S..`1C 11,136.2
C,il{), OF Lh1, LIiNTA
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD -
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings �jd
yY�
Underground Ducts
Ducts
Slab Grade
�Zo/O•�
Return Air
Steel
Combustion Air
Roof Deck
O.K. to Wrap
C)(
/J / /'
Exhaust Fans
Framing/-
Insulation
V `
�%��--
���
Compressor
Vents
Fireplace P.L.
; •
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wail Firewall
Exterior Lath
Drywall - Int. Lath
_
Final
Final
/
e
POOLS - SPAS
BLOCKWALL APPROVALS
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
---999
/Z��
Electric Final
Waste Lines
`( G��
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
/ _ _ /
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
rjo
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
4'
Utility Notice (Perm)
FE2-18-2002 14:10 WESTERN INSULATION 909 686 8766 P.04/24
WES'T'ERN INSULATION 9 L.P.
4211 Lath= Street, Riverside, California 92501
Tel. (909) 686-8760 Fox (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 TR#29586 PHASE 4
20 1
SITE ADDRESSF78-268 CALLS LAS RAMBLAS, LA QUINTA , CA
EXTERIOR WALLS,
MANUFACTURER. JOHNS MANVILLE THICKNESS: 3 5/8' R -VALUE: R-13
CEILINGS: BATTS BLOW
MANUFACTURER: GREENFIBER 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: PRODUCTION IfAANAGER
DATE: FEBRUARY 18, 2002