0101-130 (SFD)LICENSED CONTRACTOR DECLARATION
,J, hereby affirm under penalty of perjury that I am licensed under provisions of
wChapter 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
Yo
,f Date Signature of Contractor
. OWNER -BUILDER DECLARATION
4`hhereby affirm under penalty of. perjury that I am exempt from the Contractor's
License Law for the following reason:
( J 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 (Sed. 704,4, Business & Professionals
Code).
( ) ' I am exempt under Section B&RC. for this reason
Date. -,Signature of Owner
WORKER'S COMPENSATION DECLARATION'
`,I - hereby• affirm under penalty'.of perjury one of'the following declarations:
O Ihave,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
s. -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).
certify that in the performance of the work for which this permit is issued,
(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, l s all forthwith''comply with tho,,se pro rsio s. , 9
Date. r Applicant-- - ���
Warning: Failure to secure Workers' Compenid ion coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, iri
addition to the cost of compensation, damages as provided for in Section 3706
of the Latior`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,?yoid!if
work is not commenced .within 180 days from date sof issuance of such
permit, or cessation of work for 180 days will subject permit to cancellati6n.
I certify that. 1, 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)' r<''' Date
BUILDING PERMIT PERMIT#
DATE VALUATION 1' LOT TRACT t
JOB SITE
APN
ADDRES? _
OWNER —
CONTRACTOR / DESIGNER / EN (NEER y
LA. QUM& VILLAS 1.14!
2939.','' M0UNA:ROA1D 02N.
29395 AC#OURA.ROAD -0204
Lfa i:E A1I '1 CA 91301
.t9COURAIM .S11 CA 91301.
(818)W19.4800 CIBLff
USE OF PERMIT
[' t
M 3+r
MJ,07014 0-0149 fo;i1 S:'F'IO ;i' rX, 90 SF
t s � 'r 194.as SIP
0;ltai'd.At3.i"sK,'!iRPORT {ak? t%a99i5. +
ENDOWED C09r0,' 6:ONSMU ICIN
1%),74320
♦gy�y �t �i, Twp Yq� {
16'ECw`p!1:�3}~dl:D3 G9C',YS`Y.A..�i88.P.4. E'.'
MP10"114 ,ALFA( 101.000.421-C 00, $98.50
t1.t+,C'l`1U=1 FT111r, 101 _000420-00.0
P3.,1tMUNG PUP 301-000-41.9=000
N
r��'p�u F • R M 1/01-pt�l�si�_=,��95,�1-000.
rt
�giy�^yJ
g�z��pr
Gxf{':A:l..'SE O R �Y01-000 423.000 $/� 6W
d'
lA J. t a k�trB IMPACT PES
} '"s 11313B °f` fAt%aCON'S'' )C;.'h M-AAb1:>PLA C-1DZax
LESS Pxr_%�PAW TEM
301M
M1
4,1.,MAWPEe.tY+sDOE N4!"YY -
�4h�ens77Wo
JAN 12100
QV_
SIT
RECEIPT.
DATE
BY' "i,
DAT ALED
(NSP OR
u
I
11
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
dPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
2�lS pt s T'
Ducts
_
Slab Grade
Steel
Roof Deck
O.K. to Wrap
�il�%p!
3�Q ��
//2 4
Return Air
Combustion Air
Exhaust Fans
F.A.U.
-
Framing
Insulation��1Q73AC�
Fireplace P.L.
s6.3 01
Vents
Grills .
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall /
Exterior Lath
Drywall - Int. Lath !o b
Final
BLOCKWALL APPROVALS
Final,
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
I
Gas Piping
PLUMBING APPROVALS'
Waste Lines /���` '�
Gas Test
Electric Final
Heater Final
Water Piping
N
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sew�e�r Connection
��f Q�d�
Pool Cover
Encapsulation
Gas Piping
Gas Test
0/f/ aj
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) v7 �3
' � • WESTERN INSULATION, L. P
4211 Latham Street, Riverside, California 92501
` Tel. (909) 686-8760 Fax (909) 686-8786
•INSULATION CERTIFICATE
f.
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#: 2
SITE ADDRESS: 55263 WINGED FOOT. LA QUINTA, CA
EXTERIOR WALLS @ 2X6 FRAMING:
• MANUFACTURER: JOHNS MANVILLE THICKNESS: 6 3/4 " 'R -VALUE: R-19
EXTERIOR WALLS @ 2X4 FRAMING:
MANUFACTURER: JOHNS MANVILLE THICKNESS: 35/81, R -VALUE: R-13
CEILINGS: BATTS BLOW
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 TION MANAGER
DATE JULY 11, 2001 '
Certificate of �Occup anPy - .
0j
- L
City of La Quin.ta,Building and Safety Department OF
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: 55-263 WINGED FOOT
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.:~" 0101-130
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL
Owner'of Building: ` -LA QUINTA VILLAS LLC Address: -'29395 AGOURA ROAD #204 y ti
City: AGOURA HILLS, CA 91301
By: DANIEL P. CRAWFORD`JR. ,
Date: 4/29/03
_ Building Official Y ,