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LICENSED CONTRACTOR'DECLARATION ; 'r
I hereby affirm under penalty of perjury that I am licensed and;r'provisions bf
Chapter 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 '
�, r �•. deifl! �•��
Date' ` = �'f' Signature' of Contractor
f ''OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that l,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 project (Sec. 7044, Business & Professionals
Code).
�) I AM enmpt under Section B&P.C. for this reason
Date Signature of Owner
r 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:
CarrierPolicy. No.
(This section need not be completed if the permit valuation is for $100.00 or less).
() 1 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 th'k
workers' compensation laws of California, and agree that if I should.become
subject to the workers' compensation provisions of Section 3700 of th6,L abor
r
-Code, I shall forthwith comply with those provisions:
Date 421,/1 .` 'Applicant
Warning: Failure to secure Workers' Compensation 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
any permit issued asa 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.,l 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 )s ��` ' ��'j1 ! Date"i {'
' BUILDING PERMIT PERMIT#
DATE VALUATION LOT 0101 _J. . TRACT
JOB SITE
ADDRESS
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74_8615 Z.F.M710 WAY
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OWNER - CONTRACTOR / DESIGNER / EN (NEER
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(909-)381- ,3"l mut :.;17:d"'.
USE OF PERMIT
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RECEIPT
DATE
DATE FINALED
INSPECTOR +
k )
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck '
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
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
BLOCKWALL APPROVALS
POOLS -SPAS
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
Electric Final
Waste Lines
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
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)
COMMENTS: ti
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JUNI-13-2001 1522 WESTERN INSULATION• 909 686 6736 P.12/21',
1� I �J]LAT l, Lo' P®
4211 Latham Street, Riverside, Canlbr la 92501.
Tel. (909) 686-8760 Fix (909) 686-8786 ,
IN'SU;A'T'ION CERTIFICATE
THIS IS TO CERTIFY THAT INSULATION HAS BEEN INSTALLED IN ZCNFORMANCE WITH
THE CURRENT ENERGY REGULATION, CALIFORNIA ADMINISTRATIVE CODE, TITLE 24,
STATE OF CALIFORNIA, IN THE BUILDING LOCATED AT:
TRACT / PHASE: STARLIGHT DUNES #23773-6/PHASE 4
-
LOT #
'
SITE ADDRESS: 78-866 ZENITH WAY. LA QUINTA, CA y
--------------------------------
.EXTERIOR
W LS s:
MANUFACTURER: 'JOHNS MANVILLE THICKNESS: 3 5/8 ' P-VALUE;.R-13
`
GEf GS• BATTS _.
MANUFACTURER: GREEN STONE THICKNESS: 10.3 m R-VALUE: R-38 a
CEIUN4i BAITS BLOW
MANUFACTURER: JOHNS MANVILLE THICKNESS: 13." R-VALUE: R48
. %GENERAL
GQNTRACT—Q CENTURY HOMES -
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BY: -
TITLE:
l
DATE:
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0N$ LABON CONTRACTOR: WESTERN INSULATION, L.P.
LICENSE NUMBER: 794484 -
BY: ;
TITLE: P CTION M GER
DATE JUNE 13,2001