0106-233 (SFD)LICENSED CONTRACTOR DECLARATION w
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
7.14188
Date'"; !T! Signature of Contractor�sT�-;J
OWNER -BUILDER DECLARATION
1 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 penaltyAof 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 3706of 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:
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 shallrforthwith comply with those provisions.
Date:Applicant _ �✓'
X •
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. (f/
Signature (Owner/Agent)'`' u'�>-�-_ Date
'Ii 1
1
. .. T w. -..R _ �...-•..w..• . , r.- �.. .M ... e.
BUILDING PERMIT PERMIT# i
DATE_ f/j0 VALUATION LOT 03.06-233 TRACT
�'✓� r 7 26 25
JOB SITE ! v "" "^ —
ADDRESS
APN
OWNER
CONTRACTOR / DESIGNER / ENGINEER
LAVrS CAO 94QW01"VI6M3
C WRTRYKRL4UCOMdrNEA&A
VAN, M:1~3A THO CA. 9,2408
13JU RWHAM'.t O CA 92408
ft32I X500 CSIh 2120
USE OF PERMIT
Mli1 OMPAMLY DAV. Nel
3990 IVENIT R]'. Y PLACE
503 *.WT 16 PLAID 38. PERMIT DO&S 1e'fOT INCLtiVE KDOC;
)�f;t), SitR+t4'iT4`7`.P:lplBa1 F;�% i31;a�3BC In
1Mw�'4'9�&C�'P;��'�5':��d�.��3'��'f�.Ai�k�Y,t�t3. "'�-��.`"�.'�'_.-e•�..-. ��13.
JUL
- 6 2001
%��oj��� ��r�3��������.Ttt�•�� ��� �++ ;��
tUME(CA PORT gt
.off
F!
SCE DEPT
CO;1;}'1'ilUCTIONE.. ).0) -000-41 B-000 $993,00
PLAN C'IfKV,X: ",T, 101-000.439-318 $201.95
Mt"yC1LbMt."IAL FEE 101-000-421•-000 $931"
4.�XrA ��,CALFEE, 101-000-420-000 $128.68
PLUMBA40 $1621"
TRON13M011:01?i FrX w REBID 1,X31 "W=441 -000 $30.05
ORADOW W 101-000-42.3-000 SAW
D)W IDPER. IMPACT PEP, sl,4neil
Awr W PUBLIC PLACM - RESME 703 _000.2551.000 $30.00
SIM•'1ti'ATRL, twONSTIR.UMION P.M.) MAfit" CH ,, Cir:
$3,551.51
M33 Pte; -1=. TWO
$0,00
RECEIPT
DATE / BY
DATE FINALED
INSPECTOR
INSPECTION -RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs p
Forms & Footings v
Underground Ducts
Ducts
Slab Grade
Steel
Roof Deck� /
O.K. to Wrap G
Framing �[l2 /
Insulation C
�'�—
Retum Air
Combustion Air _
Exhaust Fans _
F.A.U.
Compressor
Vents _
Fireplace P.L.
Grills _
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
_
2�,y'�/�Tj
Fina{
Final
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
I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Plumbing Final
Water Piping
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Gas Piping
Gas Test
t _/
Encapsulation
Appliances
Final
COMMENTS:
_
r J
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
Fina{
Utility Notice (Perm) _ _.�_ _4
FEB -1B-2002 14:13 WESTERN INSULATION 909 686 8766 P.10i24
WES'T'ERN INSULA°T'ION, L.P.
4211 Lath= Street, Nverside, CaW*mia 92501
TeL (9D9) 686-8960 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/P_HA5E:—HA FAIRWAYS TR#29586 PHASE 4
�IOEA-'D
#26� l
SIT
DRES `78-30 �CALLE LAS RAMBLA5, LA QUINTA , CA
.......-•----------,----------------------------------------------
EXTERIOR WALLS:
MANUFACTURER: JOHNS MANVILLE THICKNESS: 3 518 " R -VALUE: R-13
CEILINGS: BATTS BLOW
MANUFACTURER: GREENFISER THICKNE55: 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 MA GFR
DATE: FEBRUARY 18, 2002