0101-140 (SFD)LICENSED CONTRACTOR DECLARATION
Ihereby 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.
(Lic6nse # Lic. Class Exp. Date
Date '�.% Signature of. Contractor d.r
OWNER -BUILDER DECLARATION
DECLARATION
d 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+projecf (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 maintaiWa•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 Sectiow370,9 of the Labor
Code, h• II f rthwith "comply with th, ro tons'
Applicant 2"!,,,Z '�� x ��
I
Warning: Failure to secure Workers' Compensafion 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 I
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.
1 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.
Si nature (Owner/A ent) 14. , 1 Date
BUILDING PERMIT PERMIT#
DATEI VALUATION LOT% - TRACT
wp
JOB S11
APN
ADDRESS / + —
OWNER
CONTRACTOR / DESIGNER / EN (NEER
LAQ}:1'tPTITAVI11;:L�►�`4N-.0
4� �ti�J�.� ll�"ifk7L.0 'EW.1"311'C
2.9.395Ai:�cSUR4R.O} 4.20
29-395.AGOURAROAD 0204
Sa:30!JD?'t` MLLS (!A 91301
ADOURA MALS A 91301
(31 S)V 94W MW
USE OF PERMIT
SING ,ILcg71 AMA Y 1`�'diT.Es�'.�r1�'d�'1'
5n)1J:1,A,'0:3:A. I.,0T 14 F'E:fWT f)0>v:i'htOT INCLUDE ,
8,LOCX-,W.AICA.nS'dl'GSC).l.,MRIVY.'W.AYAPPROACH.?%PLAN ;HECK"'YER
RXDf,ICTION FOR .15F;U.t•~.NC161 CSP PJ:iME PLAN TYPE,
CLlS'1OM CON TRi)G:'t; 915 71422100 8f
PORCHIPATIO, A2.00 SP,
i' ARAGWCARPORT(IN) %133,09
X2`17A1: IND C'08T OF C':£3XSr"�°RVC"1';I0H
�:ruA2 "� ". IG''J`iO ' f�: s 1t13.�11ZiZ1-�A3 �OCgI) $996, 'J
-FIL H CHECIC FK'E 101-000439-1318
439-•318
ECI IANIC,AL 101-0410-421.000
IL]ed+DO RICi.1tl.1.FEE1Cil-CJ00-420-d'i0�2' $Iri.-+D
KAN"81N O FEV, 1.01-(KIO- i 1.9.00® SIX 50
V rP,,0N0 MOTION FFY_ - I n81'.� 101-,000-24.1-000
0PADING FFIE, 101 _0004V3.0%) $20+00 •
l: t''SVIrI�L:))< ER. IMPACT FEE
INVIN -PUBLIC PIACHS - RESir i01-oowss-oJ0 $2+57
"M 1:2T+t' bsi'1' 101-000-439-319 45U0.60
1•1M I Ai:. 00
JAN 1:2
V IA
PITY
RECEIPT
DATE Y` i..DAT
FIN L
INSPE O
�� 4
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings
_
Underground Ducts
Ducts
Slab Grade
/fi- 6�
_
Return Air
Steel
Roof Deck
_
��3/
Combustion Air
Exhaust Fans
O.K. to Wrap
3� ! 0 j
—_ –
F.A.U.
Framing
�/_
Compressor
Insulation
T Joy
/�,,¢,�
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
-Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
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
/0�f/7 /
Electric Final
Heater Final
Water Piping
IT
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
_
3%3�ai
Pool Cover
Encapsulation
Gas Piping
Gas Test�3/Q(
_
Appliances
r
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL
APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
y
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)=Q
WESTERN INSULATION, L.P..-
4.211 Latham Street, Riverside, California 92501
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 #: 14.
SITE ADDRESS: 55927 WINGED FOOT. LA QUINTA, CA
EXTERIOR WALLS @ 2X6 FRAMING:
MANUFACTURER: JOHNS MANVILLE, THICKNESS: 6 314 " R -VALUE: R-19
'EXTERIOR WALLS @ 2X4 FRAMING:
MANUFACTURER: JOHNS MANVILLE THICKNESS: 3 518 R -VALUE: R-13'
CEILINGS: BATTS BLOW
MANUFACTURER: GREENSTONE THICKNESS: 81 -R-VALUE: R-30
CEILINGS: BATTS BLOW
MANUFACTURER: JOHNS MANVILLE THICKNESS: i 1 R -VALUE: R-30
GENERAL CONTRACTOR: GREENEWAY DEVELOPMENT,. INC.
" BY:
TITLE: t
DATE:
INSULATION CONTRACTOR: WESTERN INSULATION, L.P.
LICENSE NUMBER: 794484
BY: .
TITLE: AAUatION MANAGER
DATE JUIX 11, 2001 r
Certificate .of 06d'u'panpy
� ' ..
City,of La,Qudnta.'
Baildingand Safetj(-De "ar-tment �� -OF-p
This Certificate issued pursuant to the requirements of Section 109 of the Uniform Building Code,
certifying that, at the time of issuance, this structure was in compliance' with the various ordinances,
of the City regulating building construction or use. For the following:
BUILDING ADDRESS: ;,54-927 WINGED FOOT
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: , 0101-140
Occupancy Group: R-3, Type,of Construction: VN Land Use Zone: RL
Owner of Building: LA QUINTA VILLAS LLC -Address: 29395 AGOURA ROAD #204• `
City:- AGOURA HILLS, CA 91301
By: DANIEL P. CRAWFORD JR.
• 1. '. r. .. ,
Date: 1/29/03
Building Official
- POST IN A CONSPICUOUS PLACE