0002-354 (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
i14HIS >~5 1013V=
Date C3 �'rs}1 Signature of Contractor r ti` f. � O.A !
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 in or offered for
sale (Sec. 7044, Business & Professionals Code). -
( ) I, as owner•of .th6.property, am exclusively contracting with licensed
contractors to. construct the project (Sec': 7044, Business & Professionals
Code).
() I am exempt under Section. --.f B&P.C. for this reason
Date, t Signature of Owner a
WORKER'S COMPENSATION DECLARATION
1. hereby affirm Linden penalty of perjury one sof'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
perfaormnce 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 Policv No.
CO?7 ��,'4:8ACL81 RN 3.
NWC 54.4t758-01
(This section need not be'completed if the permit valuation is for $100.00 or less).
O I certify that in the performance of the work for which1this permit is issued, '.
I shallnot 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: `7 f��r1 1 Applicant
Warning: Failure to secure Workers' Compensation coverages unlawful and -
shall subject an employer to criminal,penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages'as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1.,Each person upon whose behalf this application is made & each person at
whose request and4or whose benefit work is performed under or pursuant to
any permit issued as a result of this'applicaton agrees to, & shall, indemnity
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days, from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is.
correct. I agree to comply with all City, and State laws relating•to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection (purposes. }'
Signature (Owner/Agent;'. F—b� Dater`"-�i
..«�.y�. N•a..+•x. .n..�>.�.....•s-+.N..^+e.+•>. rAwwv�.-,tires �.-,-3-�_.-•t. - -.T-Via"... .L.4a.A
PERMIT k
:. BUILDING PERMIT
r .
DATE VALUATION LOT
TRACT
7 �gs1K,
G�+ 99 W
JOB SITE�`yg�� YS
ADDRESS.1 '.Y:0051i1_'K :.UE11+G >s.>I. >iMY,.,
APN
• '
OWNER
CONTRACTOR / DESIGNER / ENGINEER
ICEN'I'isIPYCR..0VRLL:C0iN41YL. 11, YF
1535, SO. -D'SIMM- Be% STE ir:2a0 •
1.535 SO. -D' S"; 'REE
, STF. #200
SAN BERNAR2,Ut`I40 CA 92408
SAty :t"3ERNAP'.T)DIO CA.
92408 ,•, :'1
.()007
: 1'I1; 2120
USE OF PERMIT
��i4::"LT.� 1�1�3.I1.,i' Ue;k�:Ll.ilvc�
-
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SIVD- LOT 74 PLAN 3F1312 FERMI—f DOES NOT INCLUDE BLOCK'WALLS
OP. POOL. 756/o PLAN C:e `K kME t RUC T ION FOR WtLil.`i.1PLE ISSIJANCE
Op SANIT.s' PLAN 1—I M. r
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V�11�..�•l,`J$•el.P1AA["01( - •_ ? J.UU JF ,`
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03SA9MD COST OF CONSTRUCTION
,.s
1^005-50'.1
fife,RM-IT FEE SUMMARY
C 10148T}1W111. N :Ptd 101-000-418.000 S748AW
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PM1141BrNGYIM 101-000-419-000 $434,75
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A-Wf T.AI PUBLIC PLACES - FE-S1L) 701000-295-000 � 575.01
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TOTAT PER I IiiEES Mil±,
S3:244.2:27' .~
RECEIPT
DATE
BYr�Y yt
DATE FINALED
INSPECTOR
, ,
tiS ;
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
4 - f Pi -610
Ducts
Slab Grade
5. 1 - 00
Return Air
Steel
q .0
Combustion Air
Roof Deck
Zz
Exhaust Fans
O.K to Wrap
Vs _Q0
F.A.U.
Framing
_00 l=Q i.
Compressor
Insulation
,S)a CO FAL
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
61 IH I fap
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
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
3 -. i _00
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
_
8 t bo
Pool Cover
Sewer Connection
(QF;(
Encapsulation
Gas Piping
Gas Test
1Lp
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power. Pole
Underground Conduit
Rough Wiring
Law Voltage Wiring
FbQures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power o gyp
Final /ZZUW rfz�
Utility Notice (Perm) 1"(5(-t-)
COMMENTS:
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 IL- 23995-8
LOT # 74
SITE ADDRESS: 78-820 WAKEFIELD CIRCLE, LA QUINTA, CA
EXTERIOR WALLS:
MANUFACTURER: JOHNS MANVILLE THICKNESS: 3 5/8'" R-VALUE: R,-13
CEILINGS: BATTS, BLOW
MANUFACTURER: GREENSTONE THICKNESS: 10.3" R-VALUE: R-38
CEILINGS: BATTS BLOW
MANUFACTURER: JOHNS MANVILLE THICKN 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