0106-238 (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 "l,�tt'� Signature of Contractor !y ,1 • ' 17 �`
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:
Carrier -- Policy No.
rrOLD.111
(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.) r.
Date: h r'a PtZ' Applicant -1'2',..
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 t&: 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) f� z , �� ''/ } Date>¢'%��
BUILDING PERMIT PERMIT#
't:
DATE VALUATION LOT 4i.i1684/'•l�ia.YCN TRACT
JOB SITE
APN
ADDRESS
'7&J434 C;ALLF.:IrAS )FW,`.�i3LA,V
76"21-db.v
OWNER
CONTRACTOR / DESIGNER / ENGINEER
C1 N TJR CR0W J..L _";OhAt�llit,C'.CZ:8
C"WrLiXy cRaWM L, CCyX*0fUN)T1F
15 3 5 30. pia' MIRI 1',r, XsI 01100
1335 so, IV TRETt'!", MT,1 #200
SAV BrK—JW.APXX1q0 CA 92408
N i31-12KARDINO CA 92409
k909Y381 �C,007, CP0T1d 2120
USE OF PERMIT
€Y �'f �9?; aaii�S(C.•'a' DWELLING
1 :1990 W"1'ERLY PLAC1-a:
,,YD ., LOT Si,PW01 1A - Pk,'RMIT DOES OT INC1r,t,1'DE PULL?CKAIA,
jaC3S:s.�: 01C �1�4�f�SiY.l3�'',�.4'P�t>�,41Fi. "93'€�r 3�1,�,.)!�Cf i�S"•Y 3��5 �?�+f �(1�,`1°i.}�1;:�:
ISSUAMC0.' OF SAME 'PLAN T YVIIK APP1.• M.
CUSTOM CONSTRUCTION 118031"SP
P09.C:;f•1r`I:'M10 199.00 SP
X921A . :.► COST OF1 C:ON&YRUC13110 T
152.961..40
Pla`.1�1'SInT Pyk, SUMMARY'
CONOTMIC17tION9 FEE 11/a.7_{3��1yq_�rk��ll��r.t3iq��La1
g�dan�16
19
1ti�tI.W1;6Ke4I,C?Al, ITE 101-000421-000
f,'LF,V.Tf C?Ai. FEE 101-000-420-OM�1af3,z;1 '
P1.1.IMBDgQ FOE 301.000.419.000 $14125
t
S!TR.CYNO NOTION FES - MID , 101-000-241 -000 $13.30
0RADING P9r? 101000-423400 420.00
MPKAS1'faiAl '11:iRS FM 225-000-414.3-249,
1
" f
8UY3-`l:(MAL Ce X%fftU AN .'�Q3-'Y�J{7 .eyrhp�L' -MCK.
$3,25 1. 1
_
/y .;{1 p
Tat`^7�ri�
RECEIPT
4({TE./
Bl
DATE FINALED
INSPECTOR
I SPECTIOO N RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings
Slab Grade
Q J
U_ d
Underground Ducts
Ducts
Return Air
,
Steel 6_/ v '
Roof Deck JQ//_
O.K. to Wrap
Framing
d
Combustion Air
Exhaust Fans
F.A.U.
c�
Compressor
I
Insulation /�
Fireplace P.L. /
Vents
Grills
Fire lace T.O.•
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
�/
/� fFWW
�y
Flaval
BLOCKNit ALL APPROVALS
Final
POOLS - SSPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
°
Underground Plbg. Test
�Inal
Gas Piping
PLUV o IHG APPROVALS
_
Gas Test
Electric Final
Waste Lines
�i /07
6
Heater Final
Plumbing Final
Water Piping %
Plumbing Top Out
Equipment Enclosure
Showar Pans
O.K. for Finish Plaster
Sewer Lateral "
Seaver Connection ��/��
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
-
Final
COMMENTS:
Flnml
j55
Utility Notice (Gas) 3_ / o 2— 1
[ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Lawn Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm) 22- d2__
FEB -18-2002 14:15 WESTERN INSULATION 909 686 8786 P.15i24
WESSTER- M IST SULATION 9 L.F.
4211 Latham Street, Riverside, California 92601
Tel. (909) 686-8760 Fax (909) 686-8786
INSULATION CERTIFICATE
THIS IS TO CERTIFY THAT INSULATION HAS BEEN INSTALLED IN CONFORMANCE WITH
THE CURRENT ENERGY REGULATION, CALIFORNIA ADMINISTRATIVE CODE, TITLE 24,
STATE'OF CALIFORNIA, IN THE BUILDING LOCATED AT:
TRACT/PHASE: DUNA-FAIRWAYS TR#29586 PHASE 4
L-OTF�31
SITE -ADDRESS. 78-334 CALLS LAS RAM$LAS, LA QUINTA, CA
..................................................................
EXTERIOR WALLS:
MANUFACTURER: JOHNS MANVILLE THICKNESS: 3 5/8' R -VALUE: R-13
BATTS BLOW
MANUFACTURER: GREENF/BER THICKNESS: 8.16 R -VALUE: R-30
CEILINGS: BATTS BLOW
S
MANUFACTURER: JOHNS MANVILLE THICKNESS: 1 1 " R -VALUE: R-30
GENERAL CONTRACTOR: CENTURY HOMES
BY: "
f. TITLE:
DATE:
INSULATION CONTRACTOR; WESTERN INSULATION, L.P.
LICENSE NUMBER: 794484
BY.
TITLE: PRODUCTION MANAGER
DATE: FEBRUARY 18. 2002 c