0106-235 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter9 (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
714-1:88 1121 r
Date Signature of Contractor"
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 insurance carrier & policy no. are:
CarrierPolicy No.
1ry y, max" INS'.
t7 y,y t ry
(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 " Applicant
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil,fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a- permit subject to the conditions and restrictions set forth on his
application.
.1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void,if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
"_
Signature (Owner/Agent) "11 ,�uc� F 4a Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT QI�Y�II TRACT
/i iti 7i f #�'eI3 2fS2+' 9.`;'CiEz
JOB SITE
APN
ADDRESS rraj qg�+ �y Y y y�c p��yqy�. //.�•�//��¢¢y��2 A
70-3.9% Me�1+lig. F .�.61Fti9p1 /33.VV_SCSYM.i7LAS
• IfQE..P'-6,v .Y, 't 1
OWNER
CONTRACTOR/DESIGNER/ENGINEER
1533.1101'DflTR!?.�EL SITI, 62 IX)
3 535 so, 'IV F RT �s t, ME, 0.200
CA 92409 U9
B. BETWARD11NO CA 92A.08
(909)381,6007 CSLO 2120
USE OF PERMIT
KNITTER &AS41OCWfF.8
S1903ZF1kk?f�3M'k i31 '71,TZZ0
3990WE 'fElt1.,Y PLACID
SI2L-110T:91�LMdA, - 'PERMIT d,T INC]lILsaLDi:K 7AiAL,
POOL OR ;f17%VAYA tRtFCK .M PLAWPECK rEF,ON ILTIPLE
ISSUANCII OF SAME,f I.&N. 7Y'f Le'•1,PP1.1X0,
CUSTOM CONSTRUCTION 2,5.95.00 SF
PORC;ifPATIO '20.00 SP
GAitl+109h'.ACARP T 564.00 SF
lC S R�+.t�.tad�.. ED •bv' u4S1 J'.a�1P' tcrsu�.1.1•+�'Y$ ,R�ti.,.c,at«o'RY
2,90p'k�.�? 1.80
•nom
pg yy� y; ,{q� OM
JL.(Q7telll,&.ryY�a4!(iC.�.r t: i6.➢L�V%fy.L�Vj ARY
�kJyr�lCMtrrd�t+�6q`
0 00,Ty p-}'�M'0 Q 0D
101-0004118-000
K103 Cf•I.%GX "tE l of -006,4 3-'-319 $203.95
MECHANICAL FER 101,000-421-000 $09.50
4£i,;_fr, 'PJ(:t .3.•E'ji 101-e-frIJ:dt20-0'00 $128,01
STROND MOTION FEE - RIWI0 101-000-241.000
Ka
9;?O"'L.OPER. Y114PACT PEP.,
ART ,IN PUBLIC PIAC6 P '"j-4
JUL - 6 2001
SM -TOTAL. MJK
FINANCEJPjPF1jg `y P , L
QD
I OTAL 1}'i�'l�3.'`f Fgk'h DUE WOW
-$ e
RECEIPT
DATE /
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVAL
Set Backs
pp _/
U" /�j0 %�
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Steel
Q
a ?��6 j
Return Air
Combustion Air
Roof Deck
O.K. to Wrap
�/_ � Z �
Framing b_D
Exhaust Fans
F.A.U.
Compressor
Insulation
J %
Vents •
- —
Fireplace P.L.
_�
/
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath Drywall - Int. L2thIEW
Gam-
Final
Find
"D
POOLS ' SPAS
SLOCKV IAL,L
APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Find
Gas Piping
PLUM BHG APPROVALS
Gas Test
Waste Lines
%_ _ �
Electric Final
Heater Final
Water Piping
`'
Plumbing Final
Plumbing Top Out
. Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral �1�
Sir Connection �V'�—a��
Pool Cover
Encapsulation
Gals Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice
DE ��`-',.T,1`t`
(Gas)
[ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
�f=30 rc;,
Law Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)_
C�„ n
FEB -18-2002 14:14 WESTERN INSULATION 909 686 5766 P.12i24
WESTERN IN SLTLA TION O L.P.
4211 Lath= Street, Riverside, CaWomia 92501
'fel. (909)886-8760 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/P-HASE:_DUNA FAIRWAYS TR#24586 PHASE 4
LOT #k: 26
SITE ADDRESS: 78;316 CALLE LAS RAMBLAS, LA QUINTA , CA
EXTERIOR WALLS:
MANUFACTURER: JOHNS MANVILLE THICKNESS: 3 5/8 " R -VALUE: R-13
BA'(TS BLOW
MANUFACTURER: GREENFIRER 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: I 'e 4
TITLE: PRODUCTION WNAGER
DA7E: FEBRUARY 16, 2002