0106-231 (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 ' f • r 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).
( ) 1, 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' compensatlon 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.
CK JIM" Y Afl1,p,INA 1'i1�C-�9336�•i�a
(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 shalll;forthwith comply with those provisions:
Date: , Applicant Y",, -ti
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 cf 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/AgentFflsJ Date >7f� • •��✓
CT I'ST"
BUILDING PERMIT PERMIT#
DATE I VALUATION LOT 0106-231, TRACT
2.9586
JOB SITE '-�^+..,
APN
,
ADDRESS
19-292 iAy"tZ'LASMN
"031)
OWNER
CONTRACTOR / DESIGNER / ENGINEER
Cyr,.3;�'41 Y CROWM CO�.,L+tSli"NI'iIHS
tiMMf.fi?Y CRC!'VlEzr•1., C'QNMOPkl
1533 s a, ov sam. a., M-_94200
15:5 so, "V ami-: r" ore inoo
$.AN1A13RKARl 190 C;.A MOB
MW BEWARDWO CA 92408
(909)381.6007 CHLO 2120
USE OF PERMIT
ar".NGd.3sFAINLY DIc$I.-.;C,.UNO3�!tl'4
ESTER1 11.ACZ
�D -'.-C+#...OT ?A P1 AN V - �`1t'•1MIT 120Z'y NOT INC,'�,1fDE �FIZC�:'�i��
PCK%R I.11#IV X141.�4,'y".�1.�'.�I`�C3.f1c&"H. 76% 4•'d�PiNCHWK ME OST Mp,,al
IRSU AiWE OF SO,.ME f"-'k.AI4 "I SPL? AP£'LIP.D.
U L — 6 2001 LL
CU
qqI EST♦/W Cdd MM S Ciq T 3 g 00LCITI
PC11�C"A TI'{7 l3.G0 Sk
C$.N RACt�€ ARPO1$T S64.00 STS
OF LA QUINTA
FINANCE DEPT
1981 �JIA.� COST OF COk�iS'��.�k�'i'C;rlos
200,4 pW
r�;
R OHMAMP
(,IONVHUC, T1ON ".2. 101 {-0430-4.1 6-000 1993.110
P3.A14 C3 FAX P1e'.it', 10144-0-4,19-91 16" pol.85
MYVIilAN3f,.M,R 101-000.421.000
flIAC'1'RICAL ME 101-0004F120-000 X238.61
MU1u1DINO FEE 101--000-419-000 El l so
Sit'ONO NOTION 6 • RESID 101 0.241 -000 $20.05
(WRA,1?lAlO Er",f?E 101.000.423.000 120:310
ARS' Its 1yUBUC PL!.C: S - RE'= 701-000-255-000 $20,00
C'H Com!':.
V3,SS1..51
IM113 PRE -PAID FM
$0100
Ie�M1{ .Lp�vy�yy'��Np/G��iyy'�A y■ �ayWp�j Q�. �19.�'j�'$� �/�p'(��
MTA -1, 3 !4J.b`O4t.�a6A, P�LY'✓IS DUE '.V Y}+
�R��p �qq y
tl•315*161
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
r
- INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms Footings
V_/_d�
_
Underground Ducts
&
Ducts
Slab Grade
�L 7_�
Return Air
Steel
(
n6�C
Combustion Air
Roof Deck
"�0'
Exhaust Fans
O.K. to Wrap
Framing
�! -�
�/
F.A.U.
Compressor
Insulation
�;
Vents
Fireplace P.L.
_
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
_
Exterior Lath % y—
Drywall - Int. Lath Zpy-D�
C
_ -
G�✓v
Final
Z
Final
-�i-
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
_
Electric Final
Waste Lines
Heater Final
Water Piping
_
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
_ - -
�� 3�
�
Pool Cover
Encapsulation
Gas Piping
Gas Test
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
Final
—7—
Utility Notice (Perm)
-
16'
FEB -18-2002 14:12 WESTERN INSULATION 909 686 8786 P.08i24
WESTERN INSULATIONO LdP.
4911 Laths Street, Riverside, C4UfarrAa 92501
TeL (909) 688.8760 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 TR#29586 PHASE 4
LOT # 24
SITE ADDRESS.. 792„CALLE LAS RAMBLAS, LA QUINTA, CA
b............................................
EXTERIP2B WALLS,
MANUFACTURER: JOHNS MANVILLE THICKNE55: 3 5180 R -VALUE: R-13
CEILINGS: BATTS BLOW
,MANUFACTURER: GREENHOER THICKNESS: 8.1 P. -VALUE. R-30
CE BATTS BLOW
MANUFACTURER: JOHNS MANVILLE THICKNESS: 11 " R -VALUE: R-30
GENERAL CONTRACTOR: CENTURY HOMES
BY:
TITLE:
DATE:
INSULABON CONTRACTOR: WESTERN INSULATION, L.P.
LICENSE NUMBER: 794484
BY:
TITLE: PRODUCTION MANAGER
DATE: FEBRUARY 18, 2002
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