0106-234 (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
' •f•'.1 �;3.Q�,i .lYl 4.
Date—, Signature of Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjLlry 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:
Carrier Folicy 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:.: v t`Jd,•. Applicant . r"�„i
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 asa 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/Ager i) Date 7/ '//I l
Y
BUILDING PERMIT PERMIT#
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OWNER
CONTRACTOR / DESIGNER / ENGINEER
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RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & FootingsVEl-
_
Underground Ducts
Ducts
Slab Grade
Air
Steel
Roof Deck
Z
Comb
Combustion Air .
Exhaust Fans
O.K. to Wrap
F.A.U.
—�
Framing
Insulation
_
Y �r
Compressor
Vents
_
Fireplace P.L.
C2 _
Grills
Fireplace T.O.
fans & Controls
Party Wall Insulation
Condensate Lines
_
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
_
Final
Final
_
�� r2 2
��
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
5ewer Connection
ZV7 -t/=7 &-
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
%2—
yUtility
Utility Notice (Perm)
:),
FEE—IB-2002 14:13 WESTERN INSULATION 909 686 8786 P.11.24
WESITEARUNI INSULATION, L.]P *
4211 Latdmm Street, Riverside, California 99501
Tel. (909) 686.8760 Fax (909) 886-8786
INS'trkA ION 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
rLOT # 27
(SITE ADDRESS: 78=310CALLE LAS RAMBLAS, LA QUINTA , CA
---------- -r=---- ---------------------------------------------
EXTERIOR WALLS:
MANUFACTURER: JOHNS MANVIUE THICKNESS: 3 5/8' R -VALUE: R-13
CEILINGS- BATTS BLOW
a
MANUFACTURER: CREENFIBER THICKNESS: 8.1 R -VALUE: R-30
C BATTS SLOW
MANUFACTURER: JOHNS MANVILLE THICKNESS: 11 " R -VALUE: R-30
GENERAL CONTRACTOR: CENTURY HOMES
BY:
TITLE:
DATE:
INSULATION CONTRACTOId: WESTERN INSULATION, L.P.
LICENSE NUMBER: 79��4pp484
BY:/C7L�
TITLE. PRODUCTION MANAGER
DATE: FEBRUARY 18, 2002