0101-131 (SFD)ti LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
�U Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
CN tJ,. Professionals Code, and my License is in full force and "effect.
;1 License # Lic: Class Exp. Date
O.; M
tiui
�e
C:) Z r— Date Signature of Contractor
CD U C:) OWNER -BUILDER DECLARATION
HWW I hereby affirm under penalty of perjury that l am exempt from the C'ontractor's
N License Law for the following reason:
Z ( ) 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 constructtthe project' (Sec. 7044, Business & *Professionals
Code).
�
() I am exempt under Section B&P.C. for this reason
a Date Signature of Owner
CL UJ
z WORKER'S COMPENSATION DECLARATION
C:) •� Cc: •I 'hereby affirm under penalty of perjury one of the following declarations:
U-) H O (') I have and will maintain a certificate of consent to self -insure for workers'
x W. compensation, as provided for.by Section 3700 of the Labor Code, for the
O � Q ' performance of the work for which this permit is issued. '
C0 Q U ( ) I have and will maintain workers' compensation insurance, as required by
O U Q Section 3700 of the Labor Code, for the performance of the work for which this
':•d. U') 1 permit is issued. My workers' compensation insurance carrier & policy no. are:
'Carrier Policy No.
�' • 0 ?NATE ,FUND 1614122
J
(This section need not be completed if the permit valuation is for $100.00 or less).
O I certify that in the performance of the work for which this permit is issued,
I shall not employ any person in any manner so as to become subject to the
workers' compensation laws of California, and agree that if I should become
1
-subject to the workers' compensation provisions of Section 700 of the Labor
a� Code, I shall forthwith comply with thos'$ pro isi s.
Date: .lp Applicant
Warning: Failure to secure Workers' Compensr'tion 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 ate
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, indemniNii
&, hold harmless the City of La Quinta, its officers, agents and employees ,
2. Any permit'is`sued as a •result of this application becomes null and void 4P,
` :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 four inspection purposes., ,0
Signature (Owner/Agent)aQ Date./ t✓Q
BUILDING PERMIT PERMIT#
DATEVALUATION -LOT TRACT
t
JOB SITE
APN
ADDRESS _ _
1 K0—R1) Ij'8J_
'i69 4824*9
OWNER
CONTRACTOR /DES,rNERIEN61NEER
y y�y--
1 .
tLMMK1YyANsIOMINT 1
39595 AOCYTURAM011-2:04
_79395 Aa.�C.�Y' i OAT) 4204
.s�GOUR�.1C',CS�.+.rk..8 CA 91301
yRA
.����5.9SSqq.� 1
i ';Ara�py,9p!7
y0.n�../1y"ia.tbq:[1��.. �.��u�
I.
USE OF PERMIT
APPR0ACH15% PIAN CH WK FIRE.
�►.;�;i5i�'�;;�i�� �T�9� n�tux`k �'L� I��i�.a�%t�.n�, t�;;r' ;��� I}x..�.:�; �-��,•tr
S'C31ti:Y�ifB�a'I;i�? t K4.00 �P
MOAA` DRD COW OF CONS RUMON
190-17143.120
CONST UMON FaM 101-000-419-000
i i„k't'N C;lilr 1 ,PI91t. 141_00043?? -31£3
1V1#LC"1it'b3d1CJ^ , Y°' 141.000-421.000 �.
MId,iM; INGd�' t 101wt2w=-41 9-11X0
S9'RC}NOMt7VON KYX, RE ID 101-000-241-000
ORADINO WE 101-000-423-000 520.00
OVE9. P.€ ft IMPACT PRE $1,907.00
SM.=MTN f,�' RUCIDON ANT7.✓pa€e'�tATW^efCq`
3,aeJF?.r�i�
Y�,..C7K rxy�
TOTAIPIOMMUMMOD
tow
JAN'V 2001 •
RECEIPT",.'
DATE j !
BY
DAT LED
INSPECTOR
n
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings Spovw_ Q -!S 1
Underground Ducts
Ducts
_
Slab Grade y�/
Return Air
Steel 3
Combustion Air
Roof Deck _ ��
Exhaust Fans
_
O.K. to Wrap�// ,�
F.A.U.
Framing s -Q
Compressor
Insulation S 7 �b/
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall /
Exterior Lath
Dryurall - Int. Lath
Final
_ _�
Final I—lul _��8 f73
POOLS -SPAS
BLOCKWALL APPROVA
—S
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
_
Waste Lines /�30/e T�
Electric final
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection j�y$�p�
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS;
Final
if
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 INSULA'TION.,
L.P.
4211 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 #29121/PHASE 1,
LOT #.: 5
SITE ADDRESS: 55179 WINGED FOOT. LA QUINTA, CA
-------------------------------------
EXTERIOR WALLS @ 2X6 FRAMING: '•
+:�
MANUFACTURER: JOHNS MANVILLE THICKNESS: 6 3/4 "
R -VALUE: R-19
EXTERIOR WALLS Co 2X4 FRAMING:
MANUFACTURER: JOHNS MANVILLE THICKNESS: 3 5/8 "
R -VALUE: R-13
CEILINGS: BATTS r'-BLO
,. MANUFACTURER: GREENSTONE THICKNESS: 8.1
R-VALUE:.'R-30
CEILINGS: (:::::BATTS BLOW r
•'� •
MANUFACTURER:, JOHNS MANVILLE THICKNESS: 11
R -VALUE: 13-30
GENERAL CONTRACTOR: GREENEWAY DEVELOPMENT, INC.
BY:
TITLE: ,
DATE
- INSULATION CONTRACTOR: WESTERN INSULATIC-N,,L.P.
LICENSE NUMBER: 794484
BY:
:.TITLE:' PRbi6VtION MANAGER
;
',,'DATE JUL 11, 2001
j � F y +
Cer ifanT _ .
t Hca to of
Occur
pc.
-Ci of La - Q Won t6T...
., .Buildihg � _�and &ifet �De artm Y p en t �� OF
-This Certificate, issued pursuant tot the requirements of Section 109 of the Uniform Bui/ding Code,.
certifying that, at the time of issuance, this structure, was in comp/lance with the various ordinances
of the. City regulating building construction or use. = For the fol%wing:
;BUILDING ADDRESS: 55-179 WINGED FOOT '.
Use Classification: SINGLE FAMILY- DWELLING Bldg. Permit,No.: 0101-131
Occupancy..Group: `R-3 Type -of Construction: VN- Land, Use Zone: RL
N Owner of .Building; LA QUINTA VILLAS LLC ` Address: 29395 AGOURA ;ROAD #204
'City. - AGOURA HILLS, CA., 91301
By:. DANIEL';P. CRAWFORD JR.
Date: 1/8j03
Building Official -
{ '. - .. .. _ ,.. ,- �;_ - , • J ,i :. Jam' ..
POST IN A CONSPICUOUS. PLACE