0106-239 (SFD)LICENSED CONTRACTOR DECLARATION
I here6affirm 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
1.0/31/2(
Date Signature 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:
( ) 11 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.
(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, a .
Date:.. Applicant
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a: permit subject' to the conditions and restrictions set forth on his
application.
i r
1. Each person upon whose behalf this application is made & each person at
whose request and for whose"benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above- mentioned, property
rffor inspection purposes. r'
Signature (Owner/Agent) h '�' X' �_7a•* Datea,
BUILDING PERMIT PERMITH
/.
DATE / VALUATION LOT�'.. TRACT
i'//�.�'�✓ �� ;4P.,' Y"r tZ 32 29596
JOB SITE '
APN
ADDRESS y�s +g:3Re[ii�� ���`�'�g;y �,t} ��ns 7}�( ��rr
re,340 �M9i.tt.R.f . L&I CGWY.ilIAF.�y.,196'!
f6$i+^�eah d.^V:
OWNER
CONTRACTOR/ DESIGNER/ EN INEER
CITIMT Y (VI Ownt .L 010bWW4"L21WA
CENTURY CR09001M , Cz,'Y.Ev (.3aUM
15 3 5 SO, -LV om .4, STE noo
1,535 90. pfJ'o BMW, UTZ 42,00 .
SAN 13.MINA90.1NO CA 92408
;SAM.f3EIZ.1.1ARD3T, O CA. 9 408
(905.))381-6007 ciaTif 2120
USE OF PERMIT
KNITTER aL ASSOCiAT95
SFD - LOT 32 PLAN 2A, . 1'Fj1�.1U T .1300:3 NCYP 114 ,1„ L 9 B1..K% X VSA L4, Y
ISSUAHCZ OF SAW, PLAN TYPZdW.PL-1ZD.
CWTOM C:Ca}1;1'i'11;'Ut;'1'iC N P,l 7,O0 2F
P01WiiIPRI110 206.0 SF
CIAPM RIC.A€MORT 444,00 9F
?.:CIv I' Al2D CQISU 01♦' C01.7MUMMOR
111615-57.50
i.ONSTItUC7'1ON FBI 101-000-418-000 S909.00
PLAN CHECK FEE 1131.000.439-3119
ELLYMf` AI, PEE R 01-210(1-Cft3Ct $1;'.1 S
PL.IUMB.1140 VA 101.000,419.000 � � SE8^UD
STA N0'M0T10N: F9 - f1T: 40 1-61-000-241 -€:00 ,$119.53
1431-000423.000 $20,04
SI+EPRASTR43t"I3. RS YM 225-000-443-342 sa,907.00
D
t
a�7C)B_ ( IF&R. ,°',�:OKIND , ; CHECK
$3,417.91
710 0 - NOW
RECEIPT
DATE�/
BY
DATE FINALED
INSPECTOR
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings
�_��
Underground Ducts
Ducts
Slab Grade
�$g /f�
Retum Air
Steel
Roof Deck
_ l
/O �%
�_
Combustion Air .
Exhaust Fans
O.K. to Wrap
Framing/
_
l?
_
�z ��
/
��.
l',�_
F.A.U.
Compressor
-
� � _ i
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
_
Drywall - Int. Lath
_
Final
2j— -�
Final
3-_/—oL
��
POOLS - SPAS
BLOCCZWALL APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMRING APPROVALS
Gas Test
_
�
Electric Final
Waste Lin es
6�
Heater Final
Water Piping
a
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
_
Pool Cover
Sewer Connection
/ v
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
-may
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;��
�T
Utility Notice (Perm)
FEB -i8-2032 14:16 WESTERN INSULATION 909 686 8786 P.16i24
WESTERN INSULATION, L*Po
4211 Latham Street, Riverside, California 92501
Tel. (909) 686-8760 Fwc (909) 686-6786
INSU'LA'TION 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
(LOT V: —3.
SITE -ADDRESS: 78.340 CALLS LAS RAMBLAS, LA QUINTA , CA
.................-....-------._----------........................
EXIFAIOR WALLS:
MANUFACTURER: JOHNS MANVILLE THICKNESS: 3 5/8 " R -VALUE: R-13
CEILINGS: BATTS BLOW
MANUFACTURER: CREENFIBER THICKNESS: 8.1 " R -VALUE: R-30
CEILi.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 MANAGER
DATE: FEBRUARY 18, 2002