0002-346 (SFD)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
14188' d 10;'-! 1, i2c"
y �
Date `° Signature of Contractor's
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).
( ) 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.
CR)LDk L!,WV_ W& t4rtjlr:' 4'I 100-01
(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 shall forthwith comply with those provisions. ,
Date: I Applicant . ,,`v*t �"+ ,, ///
'� a
Warning: Fal ure o 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.
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 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.
Signature (Owner/Agent)'11a / 1 / ; -, Date
I-— A -749- -t
BUILDING PERMIT PERMIT#
0002.346
DATE r.,j VALUATION S1131.198.60
LOT TRACT
JOB SITE r APN
ADDRESS -7&, 7:�"h%'�ixi'eS:1 i_ B C 1,RC.LE 01044;l+a0_0161
OWNER
{Nit.thin, +isr-C
1335 80. 4)" ST'C-I;El, S"U'. #200
SA1VNO 1',A a1408
USE OF PERMIT
i 1 MR1111..Y 1_XW.'l,T:ING
CONTRACTOR / DESIGNER / ENGINEER
nJ^ra .D Y `.'T�,!') 4')`.'!_,1. r1, 411 1%trtn
li
1533 SO. " C'i""S'i e�1?1''1', aE �1=200
SAN i�l t`tL+4ARi)1Nt) ('A 91408
t409')391-600',1 t1€11,;'E
1'00L. ;` iJlo PLAN [>HHCX3 Fh;U l:.i l)i.1(."I' ON t't!,iR MlJ1.'i7I3LE tSSI fAivt;la 0F
SAJ�16 P1,AN l`Y NF-.
��,•. R
ZR.NL.,' �:CiN 1"UCJON] 2,20Y.00 Sig
PORc;,'1i/PAi'iO 1206 SF
QARAGUK'1A.tt}jt R:r 633.(Rl SV
1.STIMAT'ED °.OST OF CON-MiUCTIO—N
PERVIlt f FEE, SUA'IMAIt Y
CON STRUC''i'10N'FEE
10J.-000-418-13Uti
$155.011
Pf.aN'('frK'N')T F
1011-400-4119-318
60
.NtECi1.";NWfyL Jill
.101 -01MIC 421-000r
ie4:.C~:Viti.tY•r L r&i
101-000-420-600
PLUMB fNO EEJ.01-0010.41`4ft
$1+8'so
11TV:`A40 ?140`7TJON 11 F - T F3YT;
1411-ftflftU2al.006
51,311,
(IR,,''i ING ITIL
SZ000
A,'t`P IN Pt.3f3Lit-, PLACES - kf~SW0.1° 000-255-0 0
S84_50
St iR-"Y AT. C0NX'1'f I IM -10N AN 1) Tit,AN S11f'f:'K
LE'S'S M"TAID
DATE
'1,3 lf".A.1,.PERMIT i+E.E'S 10lV,180MY,
DATE FINALED I INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Main Drain
Underground Ducts
Forms &Footings
-1
Ducts
Slab Grade
g `_�
Retum Air
Steel
_L4
Combustion Air
Roof Deck
b . ZV ,LA
Exhaust Fans
O.K to Wrap
GQ
F.A.U.
Framing
Insulation
Gt �1 vo
Compressor
Vents
Fireplace P.L.
Heater Final
Grills
Fireplace T.O.
Plumbing Final
Fans & Controls
Party Wall Insulation
Equipment Enclosure
_
Condensate Lines
Party Wall Firewall
O.K. for Finish Plaster
Sewer Lateral
Exterior Lath
Pool Cover
Sewer Connection
Drvwall - Int. Lath
R I I q I
Gas Piping
Final
COMMENTS:
Final
ELECTRICAL APPROVALS
Temp. Power Pole
Underaround Conduit
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temo. Use of Power ..1 ui I i .r
Final
Utility Notice
Final
Final 9"z --
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
Gas Piping
PLUMBING
APPROVALS
Gas Test
Electric Final
Waste Lines
-ZSR AA
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
IBM
Encapsulation
Gas Piping
Gas Test
it two
Final
COMMENTS:
Final
ELECTRICAL APPROVALS
Temp. Power Pole
Underaround Conduit
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temo. Use of Power ..1 ui I i .r
Final
Utility Notice
WESTERN INSULATION, INC.
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:, MARBELLA II - 23995-8
LOT # 14,
SITE ADDRESS: 78-785 WAKEFIELD CIRCLE, LA QUINTA, CA
EXTERIOR WALLS:
MANUFACTURER: JOHNS MANVILLE „THICKNESS: 3 5/8 " R -VALUE: R-13
.CEILINGS: BATT BLOW
MANUFACTURER: GREENSTONE THICKNESS: 10.3" R -VALUE: R-38
CEILINGS: BATTS BLOW
MANUFACTURER: JOHNS MANVILLE THICK 13" R -VALUE: R-38
GENERAL CONTRACTOR: CENTURY HOMES
LICENSE NUMBER:
BY:
TITLE:
DATE:
INSULATION CONTRACTOR: WESTERN INSULATION, INC.
LICENSE NUMBER: 481278
BY:
TITLE: PRODUCTION MANAGE
- DATE NOVEMBER 6, 2000