0002-348 (SFD)LICENSED CONTRACTOR DECLARATION
li{ereby affirm under penalty of perjury that I am licensed under provisions of
i,napter 9 (commencing with Section 7000) of Division 3 of the Business and
Professionals Code, and my License, is in full force and effect.
License #t'sq, {�;{� ��tL}ic. Class Exp. Date/ f, }J/��
f1..0/3V-20f
Dater}
, i 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 -
compensa4ion, will do the work, and the structure is not intended or offered for
-Sale (Sec. 2044;' Business & Professionals Code).
(,) 1, as owner of the property, am exclusively contracting with licensed'
contractors,to constrocit,the project (Sec. 7044, Business & Professionals .
Code).
O I am exempt under'Section" ' B&P.C. for this reason
Date's Signatuie of Owner
Y • .¢
WORKER'S COMPENSATION DECLARATION
4•r
I hereby affirm. under penalty of -perjury one of 'the following declarations:
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
perfor pence of the work for'which this permit is issued. _ -
(1<1 have and will maintain workers' compensation insurance, as required by
Section'3700 of the Labor. Code, afor the performance of the work for which this
permit is issued. My, workers'. compensation insurance' carrier & policy no. are:
Cartier Policy No.
(This section need not be completed if the permit valuation is for $100:00 or less).
. r O 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 those provisions./� -
Date:'Applicant' :�,1. .K ?i1i1,✓
l/
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 he 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 re.sult'of.this applicaton agrees to, &,shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Anypermit 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 in(s�pection purposes.
Signature (Owner/Agent) TV- 1 Date
BUILDING PERMIT PERMT#
'�
DATE rJ i VALUATION LOT TRACT
$13"
JOB SITE y
ADDRESS ,. a C `l��t# �i k �.E' �I E
�h� —
APN
Q�ii�i '040 �y4�i
OWNER
CONTRACTOR / DESIGNER / ENGINEER
` C';;.N"MMLY C-0,13WELL
C -1:t `1 .,',''."COM" LI ,,N�iTIrs ,.
_35 SO. ".0" 5":CMSET, S'i'd. 2tX?
.B
SAN R,2� APLEANO J.A. 92408
SAN BERNARDWO O CA. 9240$
' r
�
USE OF PERMIT
�U'�I�i1,.fs.F��•tf��.US..�`:i�t+U'�liLi�fi.i
•- _ �- -- 1- __.--
SIT- LO i6 ?LAN 4D- Z-RMiT DOEZ NOT i1d>;;'UDE BLOCK WALL
P00.6. F0R N1W;1'.l's7LE ISSUANCE OF ;
VOW PLAN TYK. r
• r.S w.n•.. •�..••.• n•r.•.vrv: r•.ns �.�'`� VV fit'
.l L\!'i1+3 4V11.1� .[Ctl4 A 1L1.tV E.r a
,
PORCI-YPATIO 42.00 SF
. r
OeA+:tA�3fJC R1t�rfa.4cA` _ 635.191 SF
ESTI MIN Tr1:11 rly-W ' OF �;ONIS IRI'li ric-IN
�.�.3211018.64 ..
�y r a
,�•yy JIMMIT FRE
CONSTRUC'TIGN' FEE 101-000-418.0100 5753.00
PLAN C-TC"i FEE _ GO, JR�-
WX-C'1IAld1CAL I:RE, ltitai3fl�- �:?2-{3J0 � X43 `stt
L'" .
SLE,GrR1CAL s EC. 101-000-420-000-. 733:w0 _
S *1
t
;: `d
PLUN4BING FEF 101-000-419.000 $198.56
141
STRONO _A10TION KE Rr'.'M ? O1. -CM -243 •t3(e<) ?"
M +` -
CI AD-ING its ; 101-000-423-000 Sa.L+.L'fi
ri I
4
DEWEL PES IMIPACT t EE suiaoo
•
ART IN PUBLIC PLACES - RESLr, '101-1000-255-000 SSt�►.50
�t
F
s�,
SURYT(,)TaJ..C( N-501-11CITI ►.N AIv!�PG.A�!.CT�:��x
���?fi� $j
LESS PREv-PAi'L)FEES'
,�.OAN
TOTMT, FTi_'R1%.11T FEES DIX NOW
13, 261.r52
RECEIPT
DATE
B'� 1'; �4`',
DATE FINALED
INSPECTOR "
t ,1
.2
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
_ 't,^I _94
Ducts
Slab Grade
Is- k(k . '
Return Air
Steel
_-0 _dQ
Combustion Air
Roof Deck
�.-W_
Exhaust Fans
OX to Wrapf-�
F.A.U.
Framing
Insulation
t g
Compressor
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
_
Exterior Lath
,ere 7L
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 I
I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
4-%(, • dw
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
D
Appliances
Final
Final a
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) qL
COMMENTS:
k
DEC -19-2000, 16:21 WESTERN INSULATION 909 6%-97% P.02/04
ERN INS-0LATION, Il i.
�Ii�ES
4211 Latham Street, Riverside, Californla 92501
- Tel. (Wg) 686-8760Fax (409) 686-8786'
ENSMAION CERTIFI AT :
• THIS IS TO CERTIFY THAT INSULATION HAS BEEN INSTALLED IN CONFORMANCE Wll H
THE CURRENT ENERGY REGULATION, CALIFORNIA ADMINISTRATIVE CODE?' TITLE
STATE OF CALIFORNIA, IN THE BUILDING LOCATED AT:. "
TRACT I PHASE: MARBELLA PHASE 3
< LOT # : 16
SITE ADDRESS: 78766 WAKEFIELD CIRCLE LA QUINTA, GA = • : - -
---- -•-
------- ---- - -• -• ......
EXTERIOR WALLS,
MANUFACTURER: JOHNS MANVILLE THICKNESS: 3 6/8 " F�-VALUE; R-13
CEILI BATT SLOW
MANUFACTURER: JOHNS MANVILLE THICKNESS: 11 F VALUE: R-30
GENERAL CONTCTOR: CENTURY HOMES
BY.
TITLE:
DATE:
iNSULATIQN CONTRACT WESTERN INSULATION, INC.
LICENSE NUMB • 481278 ,
BY:' 1 _
TITLE: PRODUCTION M GER '
DATE DECEMBER 19, 2000