0106-245 (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
`114188
Date -~ s,, A Signature of Contractor
a`,•^` orf ��f � t! ✓ . v',�;yRi.�n.Gs�' ,/
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.
• t'3G,1,P1� Fs�Cfl»la 13��. �i r"�d::•��!l��S�3�
(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.
i Date. -_ --- r Applicant ,•-1., ,.. ,
r`f'>
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, & 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){a'"1r1 Date's'
/tea
BUILDING PERMIT PERMIT#
`
DATE VALUATION LOT 45 TRACT
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`
JOB SITE f
APN
ADDRESS
78--376 C ALLE 1f.A.B:>raA,14MILAS'
769421-•030
OWNER
CONTRACTOR /DESIGNER / EN INEER
C%Mmy, Mcvwll co-WCIVrIM'I .
r"FAi' RY" CROVIM1. C OMMID3:flaiM
1 X35 SP. "D° n3'AIRTXA, STT. 4*200
1535 so, `,x wxa er, gla 07,00
(91,1)381-6007 CMIr' 2120
USE OF PERMIT
,"OWT'fP0. &A.SSOCI ATI?:S
,i!'i+QXY_ FAMILY DWIMM.,11~ O
3#90 W&S1'LRLV P.'LACE,
sn) • Lur 3a, �u.N -2w- kRMIT DOL`146'1' IINCL t.:IDY BLOC .. r ^
_
.Pot)b O1, DR.IV?�d`i' �` APPROACH. '�M �I�.F�I�'C�2 X 15 5 C�' I,'�����y �
F-_...
1S. 3'1F:tA C Z OF w E PE I 'I Y'PZ ADPL !rD. .,..( ' }
CUOTONS CONSTRU>w' RYN 7 oui, w -f J U L
—_ 6 2001
PORCHfF AT,1O 206.00 Str
GARA CI—M.PORT 01,00 OF
cilY
of LA OUINTA
FIM,NiCE
DEPT
M f`.0 ,,D COST 0117 C.`ON Wt MON
11161W,501
01-413'3'lZ,UCTI47N .€ PER 101-000-418-000 $909.00
PIAN C HLrC K FPX 101-0100-439.318 $186.13
MECHANIC" 11 11 101 -WO -421-000 S".50
I?L EC CRICAL ME 101-OOta-420.000 13
$sFfiiMB103. FEE 401.0004119.040 Wlso
S'l7'6 MIG k1t (YrION FEE r RESID 101-000-241-,'' 00
GRAMME 101-000-423.000 $20,00
}I FRASTfdilC` URF. PrIP 22.5-00".49.342 $1,907,00
1`jM WtTAX., OONVIRC1'MC)'A1'AND FLW CHEXIC
$3,417.91
TOTAL .h d%cE6.MW MES D.VX,{.4OW
iF
�gWA7a�ffi
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION (RECORD
OPERATION DATE INSPECTOR
BUILDING APPROVALS
Set Backs
Forms &Footings ( _
Slab Grade
Steel G
Roof Deck `�
O.K. to Wrap Ar,
Framing
Insulation
Fireplace P.L. l
Fireplace T.O. `
Party Wall Insulation
Party Wali Firewall
Exterior Lath
i nruwau _int i atn 7
OPERATION
BLOCKWALL APPROVALS
DATE
INSPECTOR
MECHANICAL APPROVALS
Underground Ducts
Footings
Ducts
Return Air
Bond Beam
Combustion Air
Exhaust Fans
F.A.U.
Underground Electric
Compressor
Underground Pibg. Test
Final
Vents
Grills
Gas Piping
Waste Lines�
PLUMBING APPROVALS
%
Fans 8 Controls
fi — _
Plumbing Final
POOLS - SPAS
Sewer Connection
Final
COMMENTS:
I Final
ELECTRICAL APPROVALS
Temp. Power Pole
Underaround Conduit
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
I
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
Waste Lines�
PLUMBING APPROVALS
%
Gas Test
Electric Final
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
, _ / , _ , . i
Pool Cover
Sewer Connection
Final
COMMENTS:
I Final
ELECTRICAL APPROVALS
Temp. Power Pole
Underaround Conduit
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
I
FEB -18-2002 14:19 WESTERN INSULATION 909 686 8786 P.22i24
WESTERN INSULATION, L.P.
4211 Latham Street, Riverside, California 92501
Tel, (9091686-8760 Fax (909) 686-8786
INSULATION CERTIFICATE
THIS 15 TO CERTIFY THAT INSULATION HAS BEEN INSTALLED IN CONFOZMANCE WITH
THE CURRENT ENERGY REGULATION, CALIFORNIA ADMINISTRATIVE CODE, TITLE 24,
STATE OF CALIFORNIA, IN THE BUILDING LOCATED AT:
TRACT/P_HASE:"DUAA FFAIRWAYS TR#29586 PHASE 4
LOT
SITE ADDRESS:" 78:376 CALLE LAS RAMBLAS, LA QUINTA , CA
------------------------------------------------------------------
Jjjgjj(QR WALLS:
MANUFACTURER: JOHNS MANVILLE THICKNESS: 3 5/8" R -VALUE: R-13
CELL BATTS BLOW
MANUFACTURER: GREENF18ER 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:
IN&LATION WNTRACfOR: WESTERN INSULATION, L.P.
LICENSE NUMBER: 794484
BY:/L,[.C..
TITLE: PRODUCTION MANAGER
DATE; FEBRUARY 18, 2002