0106-247 (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
7y41� ., i41pl✓;tC
Date ,1 Signature of Contractor
Nr Y 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.
(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: 7 A Applicant
:Csrc"sX"^'ya['-.r�.i`�:.,r, .
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, n
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents,and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction; and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent)`^' -, Date A7 1'A ,
d Me <..aP4�%v Lar° rA ..:.,✓, . !/
BUILDING PERMIT PERMIT#
,-
DATE ,'��lj VALUATION LOTTRACT
iii.3el
JOB SITE
APN
ADDRESS
OWNER
CONTRACTOR / DESIGNER / EN (NEER
;:i IT11Cmly, CROW 'i L CCaYMUAiT, E3
UIT MY M—OWELL cd-wWTIM IS
1:515),1.01. ,: MST, > 3'rK 0-200
1535 a). D. a�`�":4°R', U3."C . 420 a
SA F ,3:, CS Ce'� 92468
1
SAWBEIRMARDINO CA, 92408
(909pal."CC 07 MIX 2120
USE OF PERMIT
399f)WESTERLY !'LACE
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_511 1 , sy.4..;?'DRIVEWAY
POOL OR 1.�RI J WAY Y4II"PROAb.K 75% PIJ.Pt1.lV4�r•SFl;R PER 0n��3'liv, Gl l5
ISE:E6sat.IC90? RA$PJH Pl„P.?J TYPE.APPLIED.
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CUSTOM t.�7:1�f1°i it.LiC`!'�ON . r ,1, 0 x 00 OF
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PORMPATIO 199.00 SF
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M. 11131Y UCTION Fri E 101 -000.418-000 ���.€►il
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K.AN CHFXX Fa?R 101••000-435-318
MW41AXICkIL, ME 101 -000-01 "000 $161 S0
X1.11C'i ICA L VXX $106.91
y Atl gi3t�v113.000a419•000 $141425
TeCrryV,Op 014 1W, 4MSIy 101-000-24.1-000 S1.3.30
QW01NORE101r0c0-C.13-M U0y100
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i♦2rSMRUCTURPP8. 225-0-00-449-342
00.1401tiMIXT.1,014 AND YLAN MERCK
LMS PRE -PAID TWS
$0.00
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS'
Set Backs
Forms & Footings
��/�
�p /
/�!/!�
Underground Ducts
Ducts
Slab Grade_
Retum Air
Steel
Roof DeckExhaust
O.K. to Wrap
Combustion Air .
Fans
F.A.U.
Framing
, �� "(
Compressor
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'
I
Final
3—zz—Z
POOLS - SPAS
BLOCKWALL APPROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
-
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Waste Lines
�l al
-Electric Final
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure "
Shower Pans
O.K. for Finish Plaster
Sewer Lateral_�
�6 Q (
Pool Cover
Sewer Connection
>
Encapsulation
Gas Piping
/
Gas Test
—� t�_, �,
`!,`Q/�,:�
•
Appliances
Final
COMMENTS:
Final
y'
_
Utility Notice (Gas)
�_ 2 141i -vim
' c5
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
-��✓-�
Fbdures
Main Service
Sub Panels
Exterior Receptacles
_
G.F.I.
Smoke Detectors
Temp. Use of Power
r
'
Final
f ��'
Utility Notice (Perm)
FEB -18-2002 14:20 WESTERN INSULATION 909 686 8786 P.24i24
STE INSULATION! L! P.
4211 Latham Street, Riverside, California 92501
Tei, (909) 686-8760 Fags (909) 686.8786
INSULATION CERTEFICATE
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 #: 40-
SITE -ADDRESS: 78-388�CALLE LAS RAMBLAS, LA QUINTA , CA
------------------------------------------------------------------
EXTERIOR WALLS:
MANUFACTURER: JOHNS MANVILLE THICKNESS: 3 5/8' R -VALUE: R-13
CEILINGS- BAT75 BLOW
MANUFACTURER: GREENFISER THICKNESS: 8.1 " R -VALUE: R-30
C EI LIbIGS: BATTS BLOW
MANUFACTURER: JOHNS MANVILLE THICKNESS: 1 t " R -VALUE: R-30
GENERAL CONTRACTORS CENTURY DOMES
BY:
TITLE:
DATE:
INSULATION CONTRACTOR: WESTERN INSULATION, L.P.
LICENSE NUMBER: 794484
BY: !!��
TITLE: PRODUCTION MANAGER
DATE: FEBRUARY 18, 2002
TOTAL P.24