0106-242 (SFD)LICENSED CONTRACTOR DECLARATION.
I hereby affirm under penalty of perjury that I am licensed under provisions of
Ch41er 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 / A, . 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:
li. Carrier Policy No.
IGOLDIN "OLE 110%
(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 `hose provisions-
Applicant—
Date:,
rovisions,r,Tr
Date:. -_.,� ✓'• rr Applicant �f °.i` t'f f .,,C
r t.. , -y.
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 application 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. ��
gSignature (Owner/Agent) -k� f ? .,Date .t.�e' /0i
BUILDING PERMIT PERMITk
DATE � VALUATION LOT TRACT
JOB SITE r � ^•+.__,
ADDRESS
APN
OWNER
CONTRACTOR/DESIGNER/EN (NEER
Mmk*tJtky MOV41ML Ct)MDf i, M
C"P-N-T'f71R.''.1' C✓ROWEU, COMM+LU1`3TINS
I ep35 tm s" mm, . #200
153.5 30. M" IrRM, SIM, 0200
B. 14��:p.�.�RTYINO CA 92408
�}33i+"�AitRi��C3 CA 92408
-(909p:181.6007 L'T 'if 2.120
Ae�AC
USE OF PERMIT
MN C019FCa7DWI�ML O 1
3!e9.U."YtTfa'LtC:L,.%p.M�.�.Va�M:
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em1�yy p (�,�p q F�7 ps1 �ftAt�y •� c.p. DO
el4'l{d r. y.�.l•A J5 ¢'�`ckN 3A, n.f'Cr7CRNH 6d�. &S 1.40T. 3AV0✓�rel:V HJXI7s K hY.&L14,
1*001, t 11D18.IVFV iiY�,PPROACK 75p/o P: 1'G1W1K FR ON W;,'1'1PIX,
I91M A XCE3 OF SAMS f LA.''M T YPR .APPL-1ED. .
CUSTOM CONSPR't CT101i VP -5.00 01'
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6 2001
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PERM, fTIC N11M m���,FiN:
;ct DEPT
:;�i1t��'E'k1:�i'`3�A1']t'1?l� •1�73�C0�s��JB�CIfi�O �9�I,R�
PLAN CHIMIC 3�3�",.� 101-000-430"318 $201,85
ItS✓M ?• i1'.l L, AL FEE, 101-000-420-000 3128161
'
P3,,t3kA'DINOFeS 101-00 -419"31-3(9 S102..91
MONa:t' MOTICIM FRE d "00 101-000-241-000 $20.03
ORAMN 101-000-42.4-000 $20.00
TIEVZLOPS111 IMPACT 79F, $1,90-400
.SRT rg PUBLIC PLACES - ME= 101.000.255 -MO $20,00
0'(M. -TOTAL Ct9NE"M.iFM014 AIM PIMT Cl*.VtC
RECEIPT
DATE/
BY
DATE FINALED
INSPECTOR
"I/<^ vl
INSPECTION RECORD
OPERATION
. DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set BacksUnderground
Forms & Footings
8 �� /U
Ducts
Ducts
Slab Grade
Steel
j
�_�v��
Return Air
Combustion Air
Roof Deck
%��
Exhaust Fans
_
O.K. to Wrap
F.A.U.
Framing
'0S ��L
Compressor
'
— -
Insulationi%Z��.�
6 f f�
////
Vents
.Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
-
Party Wail Firewall
Exterior Lath
Drywall - Int. Lath
Final_
/ --
Finalj/—
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%�3�
/
Electric Final
Heater Final
Water Piping
/
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
/-
�G�
Pool Cover
Sewer Connection
_
r Z/U�
Encapsulation
Gas Piping
Gas Test
Appliances
-
Final
COMMENTS:
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)
-aZ-�
FEE -1B-2002 14:17 WESTERN INSULATION 909 686 8786 P.19i24
WESTERN INSULATIONt L.P.
4211 Latham Street, Rivcreide, C Wornia 92601
Tel. (909) 686.8760 Fox (909) 686-8786
INSULATION OEIF'IGATE
THIS IS TO CERTIFY THAT INSULATION HAS BEEN INSTALLED IN CONFORMANCE WITH
THE CURRENT ENERGY RECULATION, CALIFORNIA ADMINISTRATIVE CODE, TITLE 24,
STATE OF CALIFORNIA, IN THE BUILDING LOCATED AT:
TRAC_TMHASE'DUNA FAIRWAYS TR#29586 PHASE 4
LOT #: --�,35
SITE-ADDRESS:'78-358 CALLE LAS RAMBLAS, LA QUINTA , CA
......-----1.=�
= ---- ....------ --------------------------
EXTERIOR.WALL5,
MANUFACTURER. JOHNS MANVILLE THICKNESS: 3 518 " R -VALUE: R-13
CEILIN Si BATTS BLOW
MANUFACTURER: GREENFISER THICKNESS: 8.1 " R -VALUE: R-30
CEIL1NGSi 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: oe 4't -e-
TITLE: PRODUCTION MP► AGER
DATE: FEBRUARY 18, 2002