0002-357 (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 #y t bs Lic. Class Exp. D7atie�p 1 t�V
I HAf?C� 1013it201
i 1
Date 149-' Signature of Contractor
i to.
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.
G(11 -11"N 1.'.: CU tib;. IV 111,• .5311066 ()?
(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,.l shall forthwith comply with those provisions. 11 ,
Date::.' t l i Applicant—
Warning:
pplicant h{ r` y:l if
r`
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.
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 applicator 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.
/ti
Signature (Owner/Agent) d l . )tet G_.1J Dates -1 6-
BUILDING PERMIT PERMIT#
0"0092-357
DATE VALUATION LOT TRACT
JOB SITE _ APN
ADDRESS -&4'-D -VJ UfL- LI) CIRC L 6+4-040 -016
OWNER
s'r9R!���r);T r �!�l11�11tkl[ "i£S,
a -r v.,i+x I— a _11. u
.1s3«5 SCS, "D" tWREET, SM. 0200
SAN BEi NAIWI NO CA 32409
USE OF PERMIT
�lt+i'131.,11~'AMIi.."t l�W,r•.it.L.itVc.i
CONTRACTOR / DESIGNER / ENGINEER
,�jjpp � ! TAr���r�r t !»! sit UTTrr S
. +..1v.�. .r. ♦. +.�� r erg. r..• rcr ar •. i. e.<._
1533 SO. "D" S'1i'.EET, STE.4,20
SAN BERNAK13iNO (:'A 4211104
009)"49 CIRi.#f 2120
SIA)- U f 76 Psllnai al it PLttMIf DOE6 NOV IiI C -L fol- b '.?X: k, WikLLS c lk
int X)L, l * 0 PLAN (;FllrC K I I -X ICE13►U t ON FOR AM.LJ1. I.IPLr 18SUAINt_ E r F .
S AIME PLAN 7YACE.
1l:Ni i —t __11 ',V.3 X N�vOOV S
P0:Tit;tl& TIO :2 06 Sa<
UAiZACTFJCAIkV(,A 6' 6,15.00 SF
FSTIt�rlIid3.•4.AED ICOS.i, �+N;i' �iT+.1a �.u,llC�CFLN
A:-2 R.v0
C(11148T.Rtf'CTION 1 FI 1(11-000-y118•000 S755910
P1ANf"*WTZ:Ff-01 TSS t,A
,
tiIL-t. 41CAL S•l, 105`00?00-14�f11z�11--.0�0t0fd
C, 1.Ci0
ISLEC>: tti:AL.Fhk 101.000-420-000
PL.T3N?F3P401+ 101 -OW -419-000
cr ^, A N0 TIM,
D6 Vh-,L0JPFR bWAC.T 0:11
ART 1N PUBLIC PLAC; S - RESIL 701 -000 -255 -Hilt) SN0,50 >
STTK-T TAT. roNs-,re TICTION ANT) Pf.AW t�1417CK
�A1`61,5?
LFSS PRE PAID FEES
WOO
I OT At, P[+ RMt f' K1+:.,-% ME 1tiQ3W
$3,26'1,52
RECEIPT DATE DATE FINALED
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
j -Z-OO
Return Air
Steel
(� —@Q
Combustion Air
Roof Deck
(ft �-� �j
Exhaust Fans
O.K to Wrap
, �,3 oQ�
F.A.U.
Framing
so
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final 12 QCo ,fl0
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
—(Q -40
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
$ (cdv4c
Encapsulation
Gas Piping
Gas Test
( �y
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 p oa
Final
Utility Notice (Perm) O
COMMENTS:
NOV-06-2030 •15:35, WESTERN INSULATION 909 666 8796 P.14/ -Y?
TINGESTERN IN
` CeUm" 92501
4211 LethAm , Street, Riverside.
" f
TeL (9091686.8760 FOX (909) 686.8786
r .
WS
THIS IS TO CERTIFY THAT INSULATION HAS BEEN INSTALLED IMCONFORMANGE`WITH
THE CURRENT ENERGY REGULATION, 'CALIFORNIA ADMINISTRATIVE CODE, TITLE 24,
STAGE OF CALIFORNIA, IN THE BUILDING LOCATED AT-
•~MARBELLA 11 — 23996-8 y ' • t
• TRACT I PHASE
LOT # 76- lV
7B=840 WAKEFIELD`CIRCLE, LA QU NTA; CA. ,
SITE ADDRESS: x *; `
i TERIOR'VI AUa:
` . JOHNS. MANVILLE
THICKNESS: 3 5.8 " FI -VALUE,., R-13
MANUFACTURER'
' EI S. BATT9 BLOW • µ n
MANUFACTURER: GREENS NE THICKNESS: 10.3" R -VALUE: 13-38 .
OW s
x; ► r BATTS' ,
* . • f,, 1 1 - �. R -VALUE: �R 38
MANUFACTURER: JOHNS MANVILLE THICK _ S: -13"+'- - - - - - ,
- HOMES
rE °��i/4L OIOIT A TOR: CENTURY
LICENSE NUMBER:
'TITLE. .. � IV -
DATE; *- ,
� T ON C NTS R: WESTERN INgULATION, INC. ;
n, LICENSE PIUMB¢R: 481278
BY:
.PRODUCTION MANAGER
- TITLE' .� .
DATE. NOVEMBER 8; 2000