0106-232 (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
P pfessionals Code, and my.License is in full force and effect.
License #_ a Lic. Class Exp. Date
Date Y r{' Signature of Contractor*
3 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
,a 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: r...} s 41 . Applicant—
... Pf
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) at ' t�-'� EJB 2 Date /� �� e2
PERMIT PERMITN
//BUILDING
DATE O f VALUATION LOT {��9 TRACT
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1+,'6RCHMICAL FES 101-000-421-000 �94,50
FI=T' ,EGAl, FFF, , 1014*0-420,000 $1117.13
PLUMBING ME 216,2150
Si'ROHOMO1ION 1YFI1r A [MID 101-000-241-000 $17.66
slRA.3 NOR, 1014000423-0100 x100
1i�? d N. 1TC1 i)S RIX 223-000-443-342 $1,90.00
SOB-° _rAL. CIONST.1Q;:CTC:['ION AND 1 LAII.4 C:1UM
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TOVA, rfmM- 1, BIEL9 :A)'fJ r NOW
14,1791
I
RECEIPT
DATA h r
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
e OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings
6_
O /
Underground Ducts
Ducts
Slab Grade L —8l
Steel
�j�
Return Air
Combustion Air
Roof Deck
O.K to Wrap
Framing
Insulation
Fireplace P.L.
_
/
�� �(� ��
/ �_
� "
Exhaust Fans _ LL
F.A.U. _
Compressor '�
Vents
-
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wail Firewall
Exterior Lath
Drywall - Int. Lath
_
r
Final
Final
POOLS - SPAS
BLOCKWALL
APPROVALS
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?��lJ 6�y
Water Piping /
Gas Test
Electric Final
Heater Final
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
Sewer Lateral
Sewer Connection
_ _
Ci ,cT
O.K for Finish Plaster
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 _
Utility Notice (Perm)—'%
FEE -18-2002 14!12 WESTERN INSULATION 909 686 8786 P.09i24
.y
WESTERN INSULATION, L.P.
4211 Latham Street, Riverside, Cakf=ia 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:
f—TRACT/PHASE: DUNA-FAIRWAYS TR429586 PHASE 4
LOT #: 25 .`
SITE ADDRESS:, 7L8.298 PLLE LAS RAMBLAS, LA QUINTA , CA
..................................................................
EXTERIOR WALLS:
MANUFACTURER: JOHNS MANVILLE THICKNESS: 3 5/8' R -VALUE: R-13
CE BATTS BLOW
MANUFACTURER: GREENFIBER THICKNESS: 8.1 " R -VALUE: R-30
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 MANAGER
DATE: FEBRUARY 18, 2002