0106-237 (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 7 �^ % Signature of Contractor 4
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
() 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 by5Section 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 Policy No.
.LDE, KI' i AiI1�'ry INS. 1d`►tdC•��E?fSd ��
(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: Applicant ... t r -~ /ye, „
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 cyst 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.
1 ti I. A
Signature (Owner/Agent) r 1a } t •��=�A� 4 `t Date:! .
r
� ►�
BUILDING PERMIT PERMIT/1
DATE Jr 1 VALUATION LOT 01.06-137 TRACT
S200,45720 90 719596
JOB SITE
APN
ADDRESS
'LIS LAS R KUMAN
769 -MI -030
OWNER
CONTRACTOR / DESIGNER / ENGINEER
C.INCURY (TOWN -L OOMMDFIRI
VY- r CROWRIJ, COMMOWDIES
15315 00. S11 M. : % U3 710`200
1535 so, °A° S'TRELM am F. 0200
VAN BERNARDWO CA 92408
VAN B 'NARIVNTO CA 92408
(909)381-6007 E. ff 2120
USE OF PERMIT
40NOLF F,i :,Y DWFAIMG I
13900 WESTERLY PLACE.
.r •
SM . L rJT 30 PI -AN 311 � PERMIT L;1?ice NW 1N(;Lb0,,E B1/.1Ca; ` W w.,
PGO€ • Oil, l~?aif "'?, AY A.L'PWA04. -6% P.44.WCH' to ,: yttl?, ON mi:mna
ISSUAg3C9 OF moi+ k'S-.AH TYPE•APPIAl¢1).
CUSTOM. CON-,"T11U TICill pp;i00 BY
PORC 13I,P.Ai°TIO ,•t 383 �[i SP
i1,P,,MCATIPORT 364,003W
K`ON91RUCT1't' N PER 101-000418-000 $003,00
PLAN CHMK KEIT 101-000.139-318 $"1.95
MECRA.2d3CAL ME 101.000.421.000 $08,50
L 1/ €iO•t: ML V S 101 x000.420.00
PY,�'1ul.Y3i�;i1� . +�..�_ 1i�1��Jt)q�q19�t)Oi9 �;• S➢6�.3U
d a� a c� tOra r ?ru a i,�. sty -.101-OW-241-00LI
01f �1`i171 C1 Fka 101-10-423,,000 �Z6,9U
DEV'L1DPER, 3ltfl.PAi 4 t,' fDi1
AR T PR MIX P ;' ii:mr -1.000•-t5>000
IV
JUL
- 6 2001
PLA" CIMIC
CITY OF LA 01,11i TA �")° 1 �r1T11"Fits
FMAACE
MCI*
DEPT
~
RECEIPT
DATE l
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION'
DATE
INSPECTOR
BUILDING 'APPROVALS
MECHANICAL APPROVALS
Set Backs
�% /�/�
Underground Ducts
Forms & Footings
/
Ducts
Slab Grade
Steel_
�I O /�
!
Return Air
Combustion Air
Roof Deck
O.K. to Wrap
_
/ _ a 6'�
// s.�W �j�.
Exhaust Fans
F.A.U.
Framing
/G/L
Compressor
Insulation
Vents
Fireplace P.L.
Grills
_
/ f/
Fireplace T.O.
Fans & Controls
(/
Party Wall Insulation
Condensate Lines
Party Wail Firewall
Exterior Lath
Drywall - Int. Lath
J_ _
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
Gas Test
Waste Lines •
_
2- . -��.
Electric Final
Heater Final
Water Piping
C/
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
ewer Lateral
Pool Cover
ewer Connection
Encapsulation
Gas Piping
/Z-
Gas Test
4
Appliances
-
Final
_
COMMENTS:
Final
Al
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.
r;...
Smoke Detectors
'i r3
Temp. Use of Power
Final
Utility Notice (Perm)=�g�`y
FES -16-2002 14:15 WESTERN INSULATION 909 686 8766 P.14i24
WESTE INSULATION v L.P.
4211 Latha= Street, R2 vemide, California 92501
TeL (909) 686-8760 Fax (909) 686-8786
INSUIdATION CERTIFICATE
THIS 15 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/PH�ASE:—DUNA FAIRWAYS TR#29586 PHASE 4
LOT #: 30 .s• r,
SITE ADDRESS=71E�3-28 -�CALLE LAS RAMBLAS, LA QUINTA , CA
-------------- -----------------------------------------------
EXTERIOR WALLS:
MANUFACTURER: JOHNS MANVILLE THICKNESS: 3 518 " R -VALUE: R-13
CEIL1tVGSk BATTS BLOW
MANUFACTURER: GREENFISER 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: �•}1� u�
TITLE: PRODUCTION MANAGER
DATE; FEBRUARY 18, 2002