0101-141 (SFD)'' LICENSED CONTRACTOR DECLARATION
� hereby affirm under penalty of perjury that I amilicensed under provisions of
„ 6,tiapter 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 Signature of Contractors . Al
r#: OWNER -BUILDER DECLARATIO
i'I'hereby affirm under penalty of perjury that.l 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 providedfore 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.
STATE FUND 1614112
(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 ttbQse provsi on
Date: %f Applicant
Warning; Failure to secure Workers' Compensaton coverage is unlawful and
-shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
."of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on. his.
application. 3
1. Each person upon whose behalf this application is made & each person "'At
whose request and•for whose benefit work is performed under or pursuant.to
any permit issued as a result of this appllicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees...
2. Any permit issued as a result of this application becomes null and void.if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. -I agree to comply.with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
q
y ) r1 f
Si nature [Owner/Anent' ¢ " 1 ' Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT (gj TRACT
It 91
JOB SI E
APN
ADDRESS
OWNER
CONTRACTOR/DESIGNER/EN (NEER
29395 A.GOURAROAD 9204 "
29395 AiaOURAROAD #204
hG0UX.A-F4Y= CA 91301
A.CKAYRAIMIS CA 91301
'(818)€794WO CLAi_,
t
USE OFF
Pr�E//RAA'YlMII'T.
gqy q M DEy yq
SJwP,IAA$OFLOT 11PERMIT U01,t'3NOT 1INCL1DY,
. ..
JWKW+}LSI 0\Q/RI CAI LU)i efl,!WE
RZOUL`3')ON POV, M'Lai. TJ!P.Lr WSW MgCE OF SAME, PLA14 TYPE
CUM, M C:ONSTRU CT7,ON 2,2xpo 3i?
,
PORCki/PA,'tTtO W00 sit
FiT'ltex"M Coif 01.1, 4"ORMUC'A10H
1190,743.20
,
P�.�cg•iWp E S1y"pL�3���y,yy:�i�ARY
�gg'ry /yt y��, q p��p �q � }p
101-000-018-000
Fi��1�Y'f��'. `.+SIY.Ce�t.'ION b".L;.. Y•IJJ.s��00-018-00 ' $0 .00
PLAN CHF -CIT WE 101-000-439-318 M, $.92
KiuCHA'MCA101TE 101-000-421-000 '$98.0
I;?UIC.'i TRI CAL M% 101-000-42"G $121.39
PLUM BIHO rir.;
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings
Slab Grade
/
Underground Ducts
Ducts
Return Air
Steel
Roof Deck
O.K. to Wrap
Framing
Insulation
_
3�9�D/
of_ _
T ��
Combustion Air
Exhaust Fans
F.A.U.
Compressor
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wali Insulation
Condensate Lines
Party Wall Firewall
;
Exterior Lath
Drywall - Int. Lath
Final'
Final
��03
POOLS - SPAS
BLOCKWALL
APPROVA Ls
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
Waste Lines
Water Piping
Gas Test
Electric Final
Heater Final
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection 3/ifi3/?��
Gas Piping _
Gas Test 7)—V fly/?f1j �O� i/d/
Appliances v (/f`
Pool Cover
Encapsulation
Final
COMMENTS:
�� v/�•
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).-
WESTERN INSULATION, L.P.V.
4211 Latham Street, Riverside, California 92501
r Tel. (909) 686-8760 Fax (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: THE LAURELS @ PGA WEST/MODELS
`LOT # : 15
SITE ADDRESS: 54899 WINGED FOOT. LA QUINTA, CA
EXTERIOR WALLS @ 2X6 FRAMING:
MANUFACTURER: JOHNS MANVILLE, THICKNESS:6 3/4 " R -VALUE: R-19
EXTERIOR WALLS @ 2X4 FRAMING: 1 ,
` MANUFACTURER: JOHNS MANVILLE THICKNESS: 3 5/8 R -VALUE R-13
:a CEILINGS: BATTS BL"0
MANUFACTURER: GREENSTONE THICKNESS: 8.'1 R -VALUE: R-30
CEILINGS:BATTS BLOW
MANUFACTURER: JOHNS MANVILLE THICKNESS: 11 R -VALUE: R-30
GENERAL CONTRACTOR: GREENEWAY DEVELOPMENT, INC.
BY:
TITLE:
DATE:
INSULATION CONTRACTOR: WESTERN INSULATION, L.P.
LICENSE NUMBER: 794484
BY:
-TITLE: P D CTION MANAGER
DATE
JLXY 11, 2001
Ce'rt�fica
te f,-
o Occu ancy
,1� acs. -
0
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. ty
of �La , Quntar
Builditigand,SaM �Dpplattmen
Y.
This Certificate issued pursuant to, the requirements, of Section 109 of the Uniform Bui/a/ing Code;
certifying that, ` 1 the time of isstiance, this, structure_,was in comp/lance with the various ordinances
of. the City regu/sting bui/ding construction`or use. ;For tfie fo/%wing;Da
� BUILDING, ADDRESS: 5449 'WINGED FOOT
.; Y - ` I , "
Use Classification:, SINGLE FAMILY DWELLING'" :Bldg. Permit No.: 0101-141.
Occupancy Group: s. R-3 Type of Construction:. VN T. Land, Use Zone: RL ` _ s
t
� • J ` _ y 1f- f 1t -. f . '.. y S. L` � j }. ]R .i ✓ ter' = r, '.
Owner -of Building: = LA QUINTA VILLAS LLC`-, " ''r Address: '-293.95 AGOURA ROAD.#204'
City AGOURA HILLS, CA 91301
y , , By DANIEL P. CRAWFORD JR, .
�r, � �-? y.• ,Y -rte � ��%. - _ `' t • � (+
Date: 1'/9/03
_ r Building,Official
` rr POST INA CONSPICUOUS PLACE 'f' .�