0101-133 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
,.,ChapttY 9•(commencing with Section 7000) of Division 3 of the Business and
*"Professionals Code, and my License is in full force and effect.
License # Lia Class Exp. Date
Date's Signature of Contractor ;✓
OWNER -BUILDER DECLARATION
].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).
( ) 1, as owner -of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
O 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.
0FA'19 RUA1'D 16141'a
(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 prove,s ions of Section 700 of the Labor
Codesh�l forthwith comply with t fdse �'oSisl5ns. ..._ ...
Date:: %9 Applicant .�'� ✓1 -�
Warning: Failure to secure Workers' CompeFsation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety'
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person"aty
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for igspection purposes.
,r.
Si nature {Owner/A ent) Date�I �
BUILDING PERMIT PERMTJI
DATE VALUATION LOT,�� ��Q3 TRACT
!t
JOB SITE f
APN
ADDRESS r
7469-442,-)6.9
OWNER _
CONTRACTOR/ / EN ]NEER
LA. QUMCA, V1.1.1IL
52,545 AUKICTRAROAD 4-204
7,9395 AGOURA ROAD ft,04
A.00TIRr'i6:k1;1't. S ;;:A ?1M1.
AGOUZ£u'+.M1..US CSS :944301
(618)8-19-4800 (ISI.At$
USE OF PERMIT
SIM -FLAX 2013 LOT4 PERMT E)OES NOT 1NC'fXIDE'
X: ; I 'G'r)�k .�N'1I�S t l fry)�i3�,"Ij 'l'fi.l'�w2�k�«�rAhwi�.'! 'f�• l'd..4?N C'I.1.RCK FRE
F',fa 0U'CT10'N '*XX1 MU1.31PLA ;9 SSU I" E TYPU
CUSTOM CONSTRUCTION Z25s," OF
1Ar)RMgATIO BF
(MRAOFiCA° RPORT p)
R•y�r'��4,f3,'1?ED COST OF Ct(�NS"I,7��1�'��. 014
1981x.510:11}
y{,� +� p�V}�{j, p�r�•q ,{{p p'
PET-4y,Y�.$� FRE 67 S1S71Al�.fli R 8.
CICANS'1'RUCTIal 1M': 101-000-418-000 $951.00
PLAN «,1•lf?'CK FER, 1011-060-439-318 $191AX
lidWHAIN:[CAi.r 1 VY, 101-000,421-000 - M. AI
1AUVr,.MaMI,Ifitt�ti1»t:i1,0-4x.0-000
P1611M � O FE 101 n000-•19-t3W
00,
S TRO3401 0TIOA11r`EE . REMD 101-000-241-000,
SAADINO FEE 1,01-000-423-000 Vkap
e:dYt'+V'Pu'LY1:Y�ry..Il�JYlA0,3',d M1'l:ct'E.��QV
i 1�;�'iION aA`9D PLAN
L,R 33 1"Re•;i ,� U k s
�i1.6b�9
_.. JAN 12.2001-
2.2001 `
40171
RECEIPT
DATE, +1
DATE.FINALED
INSPECTOR
INSPECTION RECORD
l
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
- BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms &Footings �p�R
Slab Grade/ll�
/yI
f 6�
Ducts
Return Air
Steel
_
Combustion Air
Roof Deck
or
Exhaust Fans
O.K. to Wrap
L10/ (p
%1
F.A.U.
Framing
ressor
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
Final
6/�
POOLS -SPAS
BLOCKWALL APPROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
FinalI
Gas Piping
PLUMBING APPROVALS
Gas Test
Waste Lines
_
��3o�d% ��
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
?�(
Encapsulation
Gas Piping _
Gas Test
Appliances
Final
COMMENTS:
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 INSULA'T'ION, L.P.
4211 Latham Street, Riverside, California 92501
Tel. (909) 686-8760 Fax (909) 68678786
F 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#: 4
SITE ADDRESS: 55207 WINGED FOOT. LA QUINTA, CA
EXTERIOR WALLS @ 2X6 FRAMING:
MANUFACTURER: JOHNS MANVILLE THICKNESS: 6 3/4 " R-VALUE: ; R-19
EXTERIOR WALLS @ 2X4 FRAMING:
`0,;MANUFACTURER: JOHNS MANVILLE THICKNESS: 3 5/3 R-VALUE: +'R-13
CEILINGS: BATTS BLOW
MANUFACTURER: GREENSTONE THICKNESS: 8.( R-VALUE: `R-30
CEILINGS:BATTS BLOW
MANUFACTURER:-, JOHNS MANVILLE THICKNESS: 1 R-VALUE: R-30
GENERAL CONTRACTOR: GREENEWAY DEVELOPMErJT; INC.
5
BY:
TITLE:
DATE: ,
INSULATION CONTRACTOR: WESTERN INSULATIOR L.P.
LICENSE NUMBER: 794484
BY:
TITLE: POD&TION MANAGER
f'
..DATE JUIfY 11, 2001
a ,
0
f
Ocertificatd.occupanc-r-
�, .�
a
City o I L a Quinta -
V
Building and SafetyDeartment ��F-
l�7.'.
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
ollowing;BUILDING ADDRESS: 55-207 WINGED FOOT
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0101-133
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., 92301
By: GARY HARTMAN i • ^
Date: 11/11/01
Building Official
POST IN A CONSPICUOUS, PLACE,