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LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
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
7�VW B 11 O 4i r
ate_ °) Signature of Contractor ° - �•
OWNER -BUILDER DECLARATIO
I 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 tN� 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
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.
MAWS'13 USA 040 C00 I M, SO2
(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 provisions of Section 3700 of the Labor
,ode, I shall forthwith comply with those provisions.
49 Date: = Al ZA, Applicant - �-
Warning: Failure to secure Workers' Comperisaion coverage is GnTawnni6d
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless, ttie City of La Quinta, its officers, agents and employees.
2. Any permit issLie�d as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection pur oses.
Ignature (Owner/Agent) r �• r'f --� Date f
BUILDING PERMIT PERMIT#
DATE VALUATION LOT ;IF�f'�a�F i3�� TRACT
JOB SITE
APN
ADDRESS �- — —
OWNER --
CONTRACTOR/DESIGNER/EN INEER
SUEL O9 CIALDX)M A1STC
SH . OF TFC)MLlkW
23 C.'('IRC1;yGRAXE PLVA =7 245
lS C0TaK)r4Ar s' ?A k1't.71'1S W
art'•�0 wr BI.gA(2 CA 92660
N;vWPOPT IMAM CA. 92660
(945)719ASY7; M-4 6304
USE IT
X jjggy M
Sf+<). PLsAlM:9.&'b ICAW A L4'1..36 PERN117'' ODS NOT DICLCiDE
FlBc19i; b"d :9wfll' `+ , f�14r tj$ APk°RO.6iCH,
8:'1.1.x'1 Ohq. CCAWSi"RUd:' I -OW Iks16.DO Sly
WFLCHIPATIO 81.7.00 fly
0AXA00CARPOIRT CM) 1,060100
1 'rg"."11M IDOIs' COMMU ON
3.24,72.6.0
OOMMICTION FE' 101.000-41:,000 VAMO
VLAH CHECK VWX 101-000-439-319
M 11CHANICA1, PS 7e. 101-000.421-000 $124.00
31=TRXAL EWE 101-000-420-M) $20.06
:P'1A'13MF3TNO F`F;1~+ 101.000.419-000 %+190.7$
STR.01140 MOT101\1 M , .RESID 101-000-241-000 `32.47
101.-OnO 423.0 90 :t�c�0y.aID
0116 7IN0 @)F1annWf
of tvt
%J.6��'d+iJOP QiY7YACT YZE
ART M PUBLIC VI.,AC'r - REO 301-000455 000 52.1.1182
KtRUL"'i�'!. ON I&D:�LAM CHEM
3A -,S 1:3.10
.1X33 iPPM-PA1:i�. O
D�Ilr
$0,00
JUL 2 2001 PERMXr M- SW POW
CiTY OF LA OUINTA
FINANCE DEPT
421RECEIPT
DATE .i
BY j j
DATE FI ALED
INSPE O
INSPECTION RECORD .,
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings �` �/L
Slab Grade `y
_
Q�
d(
Underground Ducts
Ducts
Return Air
Steel_
Combustion Air
Roof Deck
_
9/1� i 4
Exhaust Fans
O.K. to Wrap
Framing
Insulation
_
���/-�
G, 6�
F.A.U.
Compressor
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wail Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
_
Final �b�
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
Gas Piping
PLUMBING APPROVALS
Waste Lines ����
Water Piping
Gas Test
Electric Final
Heater Final
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
/I/
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp, Power Pole
Underground Conduit
Rough Wiring
Loan Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm) MOV
K -AY -06.2002 03:51 176023340S1 MAYER k00FTNG '2543 7.002!003
Corporate Office:
(76U) 737-8838
P.U, t34x 462590
Fscnrldido, CA 01046 INco P TED FAX: (760) 737-0350
L1CC11CC p 663581
b1 al--3ts
WESTERN PACIFIC HOUSING
l:.A QUINTA
760-564-7022 (FAX)
05-6-02
Attn: JOHN -
Roofing on "LEGENDS (a, P-G.A. UST" Ph 1 LOT #36
Mayer Roofing has supplied and installed "15" O'haiin cloaked roof vents , on lot #36
at 81-225 GOLF V1F,W DR1V.F•Tile vents have been installed per manufacturers specifications.
Note: Exact vent locations are determined by builder
RESP.IECT LILLY SUBMITTED
SCOTT BEECHAM
OPERATIONS MANAGER
Mayer Roofing, Inc.
Page 1 of I
558 Library &treat . San Frwmdo, CA 91340 193 Orange Street . Riverside, CA 925022
(81.8) 83 K-(5064 . FAX ('$1$) 838-4493(90 ) 7$2'-0601 . FAX (909) 783-0SO4
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 #28838-1/-2, PHASE 1
LOT #: 2036
SITE ADDRESS: 81-225 GOLF VIEW DR. LA QUINTA, CA
------------------------------------------------------------------
EXTERIOR WALLS:
MANUFACTURER: JOHNS MANVILLE THICKNESS: 3 5/8 " R -VALUE: R-13
CEILINGS:
MANUFACTURER
CfE>
JOHNS MANVILLE
BLOW
THICKNESS: 11 "
GENERAL CONTRACTOR: WESTERN PACIFIC HOUSING
BY:
TITLE:
DATE:
INSULATION CONTRACTOR: WESTERN INSULATION, L.P.
LICENSE NUMBER: 794484
BY:
TITLE: RO CTION MANAGER
DATE: J UARY 28, 2002
R -VALUE: R-30
0
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
R-3
81-225 GOLF VIEW DRIVE
Type of Construction: VN
Bldg. Permit No.: 0101-315
Land Use Zone: RL
Owner of Building: SHLR OF CALIFORNIA INC Address: 23 CORPORATE PLAZA STE 245
Building Official
City: NEWPORT BEACH, CA., 92660
By: DANIEL P. CRAWFORD JR.
Date: 6/28/02
POST IN A CONSPICUOUS PLACE