0106-246 (SFD)+ LICENSED CONTRACTOR DECLARATION v
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
i141 11 3: t ,:� f 'iNJ1/2(
Date P v � „ 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:
Carrier Policy No.
kI:1P.i3' YSIaF 9 lar 2ff 3{:- 3�#43�Yt-!?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,
Date: "� ,¢/ � Applicant c ,�' `) , A I& 77`e%�7
r d trn f c. v ,
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 asprovided 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),!� , C.'b^! �������= Date 7•�- �.�
BUILDING PERMIT PERMIT#
r
DATE VALUATION LOT OUM ,246 TRACT
39 79386
JOB SITE -'
APN
ADDRESS
OWNER
CONTRACTOR/ DESIGNER/ EN INEER
1535 By, T* T, .," , 0200
1535 = "xX ITIMT, cddZ ##200
SAN M. -N TA MM•O CA 09
$AX BERINTAR.i INO CA. 9.24.08
i
(909)381.60m ML4 23.20
USE OF PERMIT
I::k;Y I"'9 rR i ASSOCtA'F EV
'T z : Ya P�3 3� • ] .i..l4�+J
3990, WESTERLY PL&CE
STr1C3 r LOT 39 .PLAN 15 r PH.R IT DMS MW YNCLUD , BLOCK VIAU,
POOL, ORDRIVEWAYAPPROACH, 715% P11MMIN"FICK RIE UK MULTYPLY-1
T=1AI;1CLO; OF SAME rd,9OW TYPE APPLI'€ D. R f;�
C17OTOM CONS'TRUC TION Z305. Do
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(110,0T1 RUCTION AKS; 10111000-4-1111f -000 3993.00
1a3.,,OIN C i."r.ICK MY. 101-000-439-318 $701.83
MEK, HAN WAL FEE 101-000-421.000 $99.50
)MCMIM ITS 101-000-420-000 :129.61
PL•tYiUiL1M0 Yet 111-0M419v000
S°fiRt5Ho MO TIO14 ME . MID s
CYRRrlDMO FEF 101-000-423-000 $20.ACt
DEVZLOM", IMPACT FER no
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LESS
$0.00
. 1KY-. a8.e •5.7'rA9.C!'d,'i14 IRM DITY.e NOW
RECEIPT
DATE' //
!�' 1r/ -
BY
DATE FINALED
INSPECTOR
r,
INSPECTION RECORD
OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR
BUILDING APPROVALS MECHANICAL APPROVALS
Set Backs — _ / Underground Ducts — — —
Forms &Footings � �YD � Ducts
Slab Grade �/� Retum Air
Steel / Combustion Air G
Roof Deck / Exhaust Fans
O.K. to Wrap _. s6 F.A.U.
Framing _ / f Compressor
Insulation l ;e'//�/( Vents
Fireplace P.L. Grills
Fireplace T.O. Fans & Controls
Party Wali Insulation Condensate Lines
Party Wall Firewall
Exterior Lath �V
r)rvwall _ Int I ath
Final 1 �5 -Za - 2
BLOCKWALL APPROVALS
Set Backs
Footings
Bond Beam
PLUMBING APPROVALS
Waste Lines /
Water Piping
Plumbing Top Out
Shower Pans
(/ Sewer Lateral
Sewer Connection
_�
6 7 0-( I
Gas Piping
Gas Test
Appliances
/— —
-LZ-I_
Utility Notice (Gas) �_� –p
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
��a
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility
L —ZG G
POOLS - SPAS
Steel
Electric Bond
Main Drain
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Gas Piping
Gas Test
Electric Final
Heater Final
Plumbing Final
Equipment Enclosure
O.K for Finish Plaster
Pool Cover
Final
COMMENTS:
FEB -18-2002 14:19 WESTERN INSULATION 909 686 8786 P.23i24
WESTERN INSULATION, L.P.
4211 Latham Street, Riverside, California 92501
Tel. (909) 686-8760 Fox (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-DUNAIRWAYS TR#29586 PHASE 4
SITE ADDRESS -78=382 CALLE LAS RAMBLAS, LA QUINTA, CA
5
EXTERROR, WALLS:
MANUFACTURER: JOHNS MANVILLE THICKNESS: 35/8' R -VALUE: R-13
CEILINGS: BATTS BLOW
MANUFACTURER: CREENFIBER 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:
INSULATION CONTRACTOR: WESTERN INSULATION, L.P.
LICENSE NUMBER: 794484
BY, �.
TITLE: PRODUCTION MA AGER
DATE:
FEBRUARY 18, 2002