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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
Date '' Signature•of Contractor"
'�-�
OWNER -BUILDER. DECLARATION
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 the structure is not intended or offered for
sale (Sec. 7044, Business & Professionals Code). .
( ) I, as owner of the property, Am 6ktiusiveiy contracting wlin licansea
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.
()4' 1 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:
Cartier. FUND Policy No.
(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
Code, I shad forthwith comply with thosa`p) i�v scions. ,..-.�
r;:*Date: -•9 t' 7 ... y` Applicant— J
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject _an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions;:set forth -on his
application.
Each person.upon whose behalf this application -is made &.each person at
whose request and for whose benefit work Is performed under or pursuant, to
any permit issued as a result of.this appllcaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced''within 180 days from date of issuance of such
permit, or cessation of work for 180•days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for jns ection purposes.
Signature .(Owner/Agent) Date
BUILDING PERMIT PERMITk`
TRACT
DATE VALUATION,I LOT
JOB SITE
ADDRESS 44-4224VIAV1Y,LSOL
APN
OWNER,
CONTRACTOR DESIGNER ENGINEER
.
(g:ryUTpJp NldpN �C FLAME®2, c
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70.57.0 VIA tSE1'ILLA
7$-520111A. NEVI]:JA
LAe UNTA (,IA.. 2x5
1AQI.IRIM Ck 9217M
i
USE OF PERMIT
iii' T 'LIME 1hE3.!]YWALL, POOL OR
TAA1tAGE1CAAMMT 441.00 SIR
4154.00 EW .
�Q.�� ,+..9 fx', G d.. fs�C:1"AA�I�s`s�9 )d.-"'�
148;31430
7. yI�{{,�( y�y((p (p'�y{'ap p•�q,
L' FiYAV.'EA�H.L..� .6�1>P..�.� 17471?L'il:fLL3C.sE3
PTAH LVIRCK PER 1014W-439-319
COM'Y'RUC-now F1
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: CFi� ZTC� L« SrQL ata.!*i Sf $' 1.128,46
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MAJURNO PRE
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I'M FRE -PAID PEES
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WAY JI H
CITY OF LAQUINTA
FINANCEDEPT
RECEIPT
DATEBY
C
DA E FINALED
INSPECTOR
PIP
.10
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
-_ g,
Underground Ducts
Forms & Footings
✓
Ducts
Slab Grade
_
Return Air -
Steel�-�'�
.
Combustion Air
Roof Deck
Exhaust Fans
0. K. to Wrap
7- D
F.A.U.
Framing
p
Compressor
Insulation
-
Vents
Fireplace P.L.
unils
Fireplace T.O.
Fans & Controls
Party Wail Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final 6127
BLOCKWALL PP OVALS
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
- —Z
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
ow
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
- Z—
Encapsulation
Gas Piping
Gas Test_
O L
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) • j .d p/
COMMENTS:
Desert Sands Unified School District
47-950. Dune Palms Road
At the . present time, the Desert Sands Unified School District does not, collect fees on garages/carports, covered
patios/walkways, residential additions under 500, 'square feet, detached accessory structures or replacement mobilehomes: 'It
has been determined the above-named owner is, exempt from paying school fees at this time due to the following reason'. '
EXEMPTION:NOT APPLICABLE
This.certifies that school facility fees imposed pursuant to Government Code 53080 in -he amount of
2.14- X 2,461 or $ 5,266.54 the property listed above and that b iilding`
permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued
Fees Paid By OC PriVest Bank - JR Mauro t Telephone 760/427-9480 F
Name on the check
By Dr. Doris Wilson
Superintendent a
Fee collected /exem ted b , Crystal'. Scott Pa ment Received. ;;
Check No. 210748086'-'
Signature-
NOTICE:
ignature NOTICE: Pursuant to Assembly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90 -day approval period in which you may protes<the fees or other payment identified
above will begin 4o run from'the date on which the building orinstallation permit for this project is sssued or on which they are paid to the District(s) or to another public entity authorized to
collect them an the Distrid('s)(s') behalf, whichever is earlier.' -
Collector: Attach a copy of county or city plan check application form to district copy for all waivers.
Embossed Original- Building Dept:/Applicant Copy- Applicant/Receipt Copy- Accounting
DEC -11-2002 15:04. WESTERN INSULATION 909 686 8786 P.02iO4
s
WESTERN I SOLATION
. , 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 IN CONFORMANCE WITH
THE CURRENT ENERGY REGULATION, CALIFORNIA ADMINISTRATIVE CODE, TITLE 24,
STATE OF CALIFORNIA, IN THE BUILDING LOCATED AT.
TRACT/PHASE: SANTIAGO /PHASE 3
SITE#ADDRESS �..
25 VIA.flEL SOL LA IUNTA, CA.
-------- -------------------�-_ .:�--------------
E ERIO S• BATTS
MANUFACTURER: KNAUF THICKNESS: ' ., 3 1/2" R- VALUE: R-13
CEILINGS:
--__ BLOWN FIBERGLASS
MANUFACTURER: KNAUF THICKNESS: 15.50" R- VALUE: R-38
CEILINGS: BA TTS
MANUFACTURER: JOHNS MANVILLE THICKNESS: 13" R- VALUE: R=38`
GENERAL CONTRACTOR: R.C. HOBBS COMPANY
BY:
.TITLE:
'DATE:
INSULAIION C N RACTOR: WESTERN INSULATION, L.P.
LICENSE NUMBER: 4484
BY: F
TITLE: PRODUCTION ER
DATE: DECEMBER
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.Certificate - ofOccu a c • n -r
City afLa-Quinta
Bdilding.,and SafetyDepatotment. 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:. `
r BUILDING 'ADDRESS: 44-425 VIA DEL SOL
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No:: - 0203-006
Occupancy Group: R-3 Type of Construction: ,VN Land Use Zone: RL
Owner of Building: CENTURY AMERICAN DEV. Address: 78-520 VIA SEVILLA-
City.: LA. QUINTA, CA. 92251
r - By: STEVE TRAXEL
A
Date: 12-13-2002 .
Building Official`
POST IN A CONSPICUOUS PLACE
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