0112-084 (SFD)LICENSED CONTRACTOR DECLARATION
Ihereby affirm under penalty of perjury that I am licensed under'provisions of
Cnapter 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
47W9 r1 3/1102
.SP1 ^XlrC^'".'{�„•"j,,,,,,�...e.-'r""'�....
Dater 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 exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & -Professionals
Code).
O 'I am exempt under Section B&P.C. for this reason
Date Signature of Owner
WORKER'S COMPENSATION DECLARATION
t
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.
(( f) 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 C3(.)LZAN- KAGLE Policy No. WVC 94710111401.
(This section need not be completed if the permit valuation is for $1.00.00 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 thosevisions.�r„
Date: r?~� Applicant
Warning: Failure. to secure Workers' Compensation coverage is unlawful and
shall subject anjemployer 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 the City of La Quinta, `its officers, agents and employees
2..Any permit issued as a result of this application tiecomes 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.
Signature (Owner/Agent) M � Date -3_1—' ^
M
•_s
BUILDING PERMIT PERM
DATE VALUATION 1.1:6.971, LOT . 4 j TRACT 4'1971. -1
JOB SITE 4443'S AIJA AE'L a`rO t
ADDRESS
APN wdi_701404
OWNER
CONTRACTOR /DESIGNER EN(NEER.t
,
(IERII..A ky 1dp T)E �'0P1Y ,
W, CEiAT!qyA1yTCQp
118_57tiVIA aTEVI
78-5 2 0't hSEAUTA
1AA.,QX)INIA CA 9.2253
L AQT:tV.-XA CA92253
(750)5r64-54,'12 'LAT , 54f.%7
USE OF PERMIT
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PL" G; ZCK F+BE 1'01-QZ}'<,k 4' 3'9••388 $167.45
Ai" CH.A�s`ICAL FEE 101.00€ .4,11 •t300
F r,1 P� Ir FtIF 101-000-420-000 11121.22
PF..iMI1YHO FEE 101.000 -419 -ON $160.50
STROW0 MOTION F - i MID 101..()0.24,1-010 $1430
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RECEIPT 3;55
DATE, y T.N>f 'BY /�
DATE FINALED
INSPECTOR
k
V"
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
2---
Exhaust Fans
O.K. to Wrap
_ Z
F.A.U.
Framing
Compressor
Insulation
—p
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 o Z
BLOCKWALL APPkOVALS
steel
POOLS - SPAS
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
3 —
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
=�
Pool Cover
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:
DEC -11-2002 1E:=04 WESTERN INSULATION 909:686 8786 P.03iO4
WE 'TEX -1
INSULATION, Ls P•
_ 4211 Lat6m street, %verside, Califomia 92501
t, 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,
STATEIOF CALIFORNIA, IN THE BUILDING LOCATED AT.:
TRACTIPHASE: SANTIAGO / PHASE 3
PLOT#; 4
k L
43-
5 VIA=DEISOLS LA QIUNTA", CASADDRESITE 44 .
-- - TS ------------- ------
EXTER40RWALLS: BAT
MANUFACTURER: CNAUF THICKNESS: 31/2- R VALUE: R-13
CEILINGS: BLOWN FIBERGLASS
MANUFACTURER: KNAUF THICKNESS: 15.50" R- VALUE: R-38
CEILINGS: BAITS
. MANUFACTURER:. JOHNS MANVILLE THICKNESS: 13"+R- VALUE: R-38 .
GENERAL CONTRACTOR: R.C. HOBBS COMPANY
BY:
TITLE:
DATE:
INSULATION COT CTOR: WESTERN INSULATION, L.P.
LICENSE NUMBER: 79"84
BY:
TITLE: PRODUCTION AN G R
DATE: DECEMBER 1 , 200
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.Certificate of'Oecupancy
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a.
Cityof La Quinta...,
Building and Safety Department- Fey OFSc.
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 Cit-y regulating building construction or use. For the following:
BUILDING ADDRESS: 44-435 VIA DEL SOL
.Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0112-084
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 92253
By: STEVE TRAXEL
Date: 12-20-2002
Building Official .
POST IN A CONSPICUOUS PLACE