0101-137 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that |amlicahso under provisions of
C (commencing with Section 7000) of Diviuiph o of the Business and
Professionals Code, and m�,License ioinfull force and effect.
uoonoo�uo.o/uuo Exp. Date
4, signature of
OWNER -BUILDER DECLARATIeN
I hereby affirm under penalty of.perjury that I am exempt from the Contractor's
License Law fortoe following reason:
( ) 1, 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
uat� signature 61. owner
WORKER'S COMPENSATION'DECLARATION
I hereby affirm'under penalty' of perjury one of the following declarations:
I have and will maintain a 6ertificate 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. -
STAU MID 1624.122,
(This section need not be
' completed 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 tho4e provis . ons.
Warning: Failure to secure Workers' Compengtion coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $1 00,000� 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 �mooi��,�oui��mmG��
m, o ponnh subject m the conditions *and ,omhctinnu ag forth on his
application. .
1 Eachwxo�benoxm�appmaonnmmade&oau person atwhose `
,request. and forperformed under or pursuantltb �.
any ponn��euaUaoamouuo/m� shall,i .
& hold harmless the City ofLaOuima.its officers, agents and, emp|uyoos'.
3.Any permit issued aaa 'eou|t of thisapplication becomes null and void i[
*o,x is not uummannoU within days'from data of issuance of such
pannu, or cessation nfwork for 1oVdays will subject permit mcancellation.
|oertify that | have read this application and state that the above information io
correct. | agree moomp|y'with all City, and Stam laws relating to the building
oonmmnUon, and hereby authorize representatives o/this City to enter upon
the above-mentioned property for inspection pu,p0000.!
Gignamm(Ownr/Agmt)
BUILDING PERMIT PERMIT#
DATE VALUATION LOT TRACT
ADDRESS
OWNER
CONTRACTOR/ 61NEER
CA 94�1,101
A HIMB CA 943301
(818)879-4800' C11"Us.
USE OF PERMIT
31 PER OP -4L
RE
(MNPRUCTION FEE 101-000-413-000 .$901644
MAN CHECK FEE W.53
mec-PINNIC, AL WEE 1014=421_000. 198,110
PUUMSTWI ME 101-000-419-000
ORADINO FRE 1011-000-423-000 $20,00
DWELOPM IMPACT MB
js
10
IYUS PRI
$0.00
JAN 1 Z 2001
RECEIPTDATE BY
(INSPECTOR
_0
,
Date �
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Slab Grade2�Zp1
Steel
Roof Deck
O.K. to Wrap�///"�/0/
FramingCompressorInsulation
Fireplace P.L.
Fireplace T.O.
Party Wall Insulation
/f,
p(
fs/ �F
b�_
Ducts
Return Air
Combustion Air
Exhaust Fans
F.A.U.
Vents
Grills
Fans & Controls
Condensate Lines
L7,
Party Wall Firewall
Exterior Lath
_
J
D II - Int. Lath
Final
./b ✓
POOLS - SPAS
Final
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
_
Waste Lines /�30�( T�
Gas Test
Electric Final
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for -Finish Plaster
Sewer Lateral
Sewer Connection/sem/�
Gas Piping
(GG
Pool Cover
Encapsulation
Gas Test
Appliances
Final
COMMENTS:
Final IJA
Utility Notice (Gas) � l�JI
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 2/ijlD 3
Final–
Utility Notice (Perm) vdl p�l/L
r
WESTERN INSULATION, 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 N 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 #:: 3
SITE ADDRESS: 55235 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: 3 5'8 " R -VALUE: , R-13
CEILINGS: BATTS
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 NUMB R: 79944484
TITLE: P, CTION MANAGER
DATE MLY 11, 2001
i