0101-312 (SFD)I LICENSED CONTRACTOR DECLARATION
�I hereby affirm under penalty of perjury that I am licensed under provisions of
1=111
Chapter -9 (commencing with Section 7000) of Division 3 of the Business and
cv W Professionals Code, and my License is in full force and effect.
p =) ch License # Lic. Class Exp. Date
C) u7
oZ r— /"' �� r�� Signature of Contractor-t_::
J U coo OWNER -BUILDER DECLARATION
W W I hereby affirm under penalty of perjury that I am exempt from the Contractor's
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 construct the project (Sec. 7044, Business & Professionals
Code).
( ) I am exempt under Section , B&P.C. for this reason
LO
O N Date Signature of Owner
rn
Q WORKER'S COMPENSATION DECLARATION
o cc I hereby affirm under penalty of perjury one of the following declarations:
Lo <O () 1 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.
m Q C) ( ) I have and will maintain workers' compensation insurance, as required by
p U Q Section 3700 of the Labor Code, for the performance of the work for which this
li Im9 permit i§ issued. My workers' compensation insurance carrier & policy no. are:
Z Carrier . Policy No.
O h>zAR.S11 UVA MC C001294102
J(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
3 subject to the workers' compensation provisions of Section 3700 of the Labor
Code I shall forthwith comply with those provisions.
mate: Applicant
Warning: Failure to secure Wor rs' Compen tioeCoverage 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 r
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 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 )f 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 -inspection purposes.
tignature (Owner/Agent) �""� �� - "' Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 0101-31, TRACT
i1ibYL i"fdld; 1=1,441= 13
JOB SITE
APN
ADDRESS lC��
OWNER - --
CONTRACTOR t DESIGNER / EN (NEER
'ST.IA..R. OF MUMMA 1HC
M°TLR 0F CAUFORNIA, WC
23 CORPORATE TE PIA7A GUITE 245'
2.3 WRa'ORAT., IP:6.. —A SU11" R 245
NEWPOR'P REAM CA, 9266 0
WE"C`M DEAC"N. Chi 92660
(349)719.4975 CPU, 03(A
USE OF PERMIT
bflwa1,l'? FAMILY DwMiNG
'.'M:1-P1..A.T3:SAR WPIGe+I,MTA. 1,M55 T.UMMiT DOES N01 %Nt':S.UDE
t
OWMM MA1S•TRUC:' IaN :1:nao Sr.
PORC:1-IIP TIO `? YO.09 41r
0AR&O'1+,3t'•.A,R:1'ORT W.00 Sri
tyy� p `q ggp�3�L�+f,7,•�^ y.�r �,r
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Es ir'iinxaAX 1) i�n'h.++IT r �6.°4,l.AQPi'X.CSM.i�..�•itO.4�'
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a 81 .0.e�i'�F•a2uc�C 0
0%18TR11C1'10N fi' 101440.418-DOO st, 76.4p1
PLAN CHECK. 11901 301-000439-318 $1;040.69
til..4.+i•D',ANICIA1,FEE 101.060-4a.1- iiD $1114,00
2 f YRICALPTIV, 101.000--420-000 $1822
C):.T. MtBING1RP; 1.01-1 0419.000 S20S123
3T'k13 40 MOTION � d MAD 101-000-241-000 $29.16
ta113t"G 1ti�R 101-000.423.104 136,40
F,,VV24A)13.ZR IMPACT 1?1F 91,�07.Gt3
MT IA PUBLIC PLACES - U+51'L `, 01-fItJ0-2554ft $2,03,61
DAB B-TafL ClJAF I C'°',�OM ARD MAN C.'.4:1M-K
$4,95'7.1`x9
J U L 2 2001 TV. 3�:� YM DUE NOW
$4,%7.13P
re
CITY OF LA UUINTA j
FINANCE DFiPT Ii
RECEIPT
DATE
BY I /
DATE FIN ED
-7
INSPECT
-A.
_ J
Q
u
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms &Footings
Underground Ducts
Ducts
���
_
Slab Grade
/�/��
Return Air
Steel/
Roof Deck
_
9/��
Combustion Air
Exhaust Fans
O.K. to Wrap
f6� I
F.A.U.
Framing
_
Compressor
Insulation
���
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lanes
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
'Z�/%���—
POOLS - SPAS
BLOCKWALL APPROVAL 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
11%r-
Electric Final
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Piaster
Sewer Lateral
Sewer Connection
_
/�d�
Pool Cover
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 INSULATION, L.P.
4211 Latham Street, Riverside, California 92501
Tel. (909) 686-8760 Pax (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 LEGENDS @ PGA WEST #28838-1I-2, PHASE 1
LOT #: 1055
SITE ADDRESS: 81-185'GOLF VIEW DR. LA QUINTA, CA
----------------------------------------------- -------------------
EXTERIOR WALLS:
MANUFACTURER:
CEILINGS:
JOHNS MANVILLE
BATT
THICKNESS: 3 5/8 " R -VALUE: R-13
BLOW
MANUFACTURER: JOHNS MANVILLE THICKNESS: 11 " R -VALUE: R-30
GENERAL CONTRACTOR: WESTERN PACIFIC HOUSING
BY:
TITLE:
DATE:
INSULATION CONTRACTOR: WESTERN INSULATION; L.P.
LICENSE NUMBER: 794484
BY: `�< ta
TITLE: OD TION MANAGER
DATE: J�ARY 28, 2002
Certificate of Occupancy
City of La Quinta
Building and Safety Department
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:
Use Classification:
Occupancy Group:
SINGLE FAMILY DWELLING
81-185 GOLF VIEW DRIVE
R-3 Type of Construction: VN
Owner of Building: SHLR OF CALIFORNIA INC
Building Official
Bldg. Permit No.: 0101-312
Land Use Zone: RL
Address: 23 CORPORATE PLAZA STE 245
City: NEWPORT BEACH, CA., 92660
By: DANIEL P. CRAWFORD JR.
Date: 7/11/02
POST IN A CONSPICUOUS PLACE