0106-240 (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 yi'.A'f;'�f Signature of Contractorr�,�j'�' ✓ { _�,J
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 1 -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.
(This section need not be completed if the permit valuation is for $100.00 or less).
( ) .l 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: '"> a'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,,Idamages 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 condition's 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.
mployees: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. J .
Signature (Owner/Agent)�y1 ✓ '`.sera Date--
BUILDING PERMIT PERMIT#
/
DAT€� r J �/ VALUATION LOT 01i['f�p 2 4) TRACT
/: /6(/ b-00 .57.E 3:
JOB SITE
ADDRESS
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OWNER
CONTRACTOR / DESIGNER / EN (NEER
CEN Y' C , L C.�,%�� Mr=S
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1535 No, �1 iF3d'�.S:�i.re ��Juv 1F�Wila
7:3:1 .'�Y,;r�+MAY190 CA, 92,1
.3. Y �iMild''ARD190 C:!A. 9Z108
(909)381-6007 CRIB 212
USE OF PERMIT
KNITTER a ASS#iC:ZAJES
.SYWO3X IFfil-flLy IMM/1.11NO
3991) W&WERLY P IACF
I<, .T 33 PIAN 33..1 • P)TWAIT UDES NOT I;i+>f:.t« DIV, BLOCK t-VAt,,4
POOL OR DRIV1,MY4►PP.RO A+CH, 75% utt,.ANCHECK PER ON MULT.IPW
0113' l}.9.t CE OF a"'Ll Pl.;AI4 TYPE APPLIED.
f;.0 M'OM C 0143TRU,..' 100 $39 .69 SR
PORCHI ATIO/' 21;3.00 P
0.f1RAO.. CARPM 3"00 SR
.ki1%�iW.,u� IED CM,' OF, '6.°ON10,11MMON 200,457 rO
�y,:�W.FGUNWIRY
CONSTRUCTION ION RS 101-000-418-000 $99 C.op
Yyf,.KH afle Y FPS 101.400-439-319 $ZX$3
MECILANIM VER . 101m=-421-000 $9810
P'LECTRICrAL.",k ffa4-iJ4 2C 4 t;�..r- .•..- ^w'a"1�ti.fs2
J400.000,419 .10Welf �.91d
CRAM* PER
AkDiR:lTi�I"NIr�iPUluB9�IIIC1�' lP^�1,LfC!'ES REMIL
1
ryq R -2,55-004A
D .
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JUL 6
MM -TOTAL CON MAUM 1-11 AWD YLP.M'
"D 1 4 ! -Z' ., Moo
" FINANCE DEPP(
IYUB ROW
1 / �
RECEIPT
DATE ,�
f ,G,—+
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs_
Forms & Footings
Slab Grade
Steel
Roof Deck�`Q/��
Oto Wrap
.K.
Framing
�_��%
/_yam`
�
/jam
le—/XL.
Underground Ducts
Ducts
ReturnAir
Combustion Air
Exhaust Fans
F.A.U.
Compressor.
_
_
j -
Insulation
Fireplace P.L.
e
i �% �
r
��rJ
Vents
Grills
Fireplace T.O.
Fans & Controls
Party Wail Insulation
Condensate Lines
Party Wail Firewall
Exterior Lath
Drywall - Int. Lath
) %
Final
"�=2 / _ Z
��
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
Waste Lines7/,���� 6
Water Piping
Gas Test
Sect Final
Heater Final
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
7i�'
,A�_
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
a
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
Utility Notice (Perm)12-27 - e9 2
FEB -18-2002 14:16 WESTERN INSULATION 909 686 8786 P.17i24
WESTERN INSULATION o L. Po
4211 Latham street, Riverside, California 92501
Tel. (909) 686-8760 Fax (909) 68&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:—DUNAIFAIRWAYS TR#29586 PHASE 4
LOT #: X3.3 -�
SITE—ADD RESS-711,;346 -CALLE LAS RAMBLAS, LA QUINTA , CA
........... .............................................
EXTERIOR WALLS:
MANUFACTURER; JOHNS MANVILLE THICKNESS: 3 5/8' R -VALUE: R-13
CEILINGS: BATTS BLOW
MANUFACTURER: CREENFIBER THICKNESS: 8.1 " R -VALUE: R-30
CEILINGS: BATTS BLOW
MANUFACTURER: JOHNS MANVILLE THICKNESS: ill, R -VALUE: R-30
GENERA. CONTRACTOR: CENTURY HOMES
BY: - TITLE -
DATE:
INSULATION CONTRACTOR: WESTERN INSULATION, L.P.
LICENSE NUMBER: 794484
BY:
TITLE: PRODUCTION MXNAGER
DATE: FEBRUARY 16, 2002