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0002-340 (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 a � � Date b a lf" Signature of Contractor ,' 14_,j,"/^� 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 Ddie 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. ( t,)4 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: CarriertPolicy No. NW514063-101J.y i rr SL yy J. (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: h , s Applicant 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 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) %° %t Date / gq BUILDING PERMIT PERMIT# tit#i,�na<a.tt DATE VALUATIONltl43'"11[ LOT TRACT JOB EAPN ADDRESS 6,04-640-16 OWNER CONTRACTOR / DESIGNERENGINEER ( �i� PITjl�1"4 i� :::�i♦l �'iri°6 . f��4i l�. i�v*37 i i. gib? // r a l. f�y�e�i �+.! a�� k..�y1�:e�1of J' (7 ..}.p v1T.�1��iei lr-• ,1533 SO. "M ���'PP..4+:�"T', wC _ ,`i.A 1:35 S,0. "L'" S �f:E iT, Sf.F', 6100 SAN BERNARDINU (A. 9240k SAtI 1'ERNAILUM0 CA 92408 Cilt,# 2120 USE OF PERMIT w :u� tkii-n . j �P.I.AN t-HL-;Ch.r'.I~E FOR i+,Itli,`fY LH, SSUA,14(1Of T j M /.�r.91i9�ttiM1'Y. \ '� `L>t\a��:.t �>u�e�t.�a.t.il�."�tUiJ .,,i 5.is6 PO.RE.`.k:f;Pk iO t �•AttAt.7k.{�,`At2t'i,ixi'!' �.�5:i7u �if� F SUMI.XT ED COST OF t'ONSMUiC'!° 011, FWlU)-QtX( _41844tH ! Telfi eKl P1 AN VFFr %` ri-T i tt f �ltlltl-�3- i i R %; 54 IQ E JJLCT IdCAL;AX I01-000-420-6 tl) i ±i tSFi f3F ilAillj?qf,> Mkt; 101101 A!14_tWt) Sl►;,ONQ INIOV )74 FEY - f PSM' 1014Y10 -?4!-000 St. S 04 OR 1ADR FEE 101-000,423-000 �3�fl.i>t1 L)EiVI.-L ;PEIZ1iViPA.(:T E` -' at,17�'9f?t? Akt' !N P'OF3LIC iLriM - RLSW'70.11-©00.25',5 }00) Ci FE;.'Y %f I: i'! iN 5"tT tt ^ fi(`JN A NI) P± A N CsH ff"K i, E 215 RIt LESS PRE -PAID FITS' 0-00 RECEIPT DATE BY I DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Sewer Lateral Pool Cover Underground Ducts Forms & Footings Ei-vi Re Ducts Slab Grade Return Air Steel q-ZZ-QO Combustion Air Roof Deck V -'1.f. - co Exhaust Fans OX to Wrap -7. Ii, oo hA F.A.U. Framing Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath ! $ zz � - Drywall - Int. Lath Q I11I 06 POOLS - SPAS BLOCKWALL APPROVALS steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underaround Plba. Test PLUMBING APPROVALS Gas Test Electric Final Waste Lines T Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection g Encapsulation Gas Piping Gas Test t. Qo en�bia- Notice (Gas) I -aw—(JD G�� - ELECTRICAL APPROVALS Power Pole ground Conduit Low Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power ll1-Y Notice (Perm) t y (Gm COMMENTS: , DEC-19-2000 1622 WESTERN INSULATION 909 686 8786 , P.04f04 W' ERN INSULATIONi INC*' EST 4211 Latham Snaat, `RiVeMde, COMrnla 92301 'Cel. (909) 686.8760 Foix (909)686-8786 µ ��T_1QX CN '-YFICATE THIS 1S 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 PHASE 3 LOTV: •: 8 m SITE ADDRESS: 78845 WAKEFIELD CIRCLE LA OUINTA, CA, r EXTERiOR_WALLS: MANUFACTURER: JOHNS MANVILLE THICKNESS: 3518- ` R-VALUE: "R-13, . BATTS SLOW ' CEILINGS- MANUFACTURER: J ILLE THICKNESS: 11 " Fl- VALUE., R-30' - 91EjNERL%L CONTRACTOR: CENTURY HOMES , -BY: TITLE: r DATE: t` INSULATION CONTRAC'TO.fl, WESTERN INSULATION, INC. :LICENSE NUMBE71278 BY: TITLE: PRODUCT ON MANA ER` DATE DECEMBER 18,. 2000 Y 'TOTAL P.04.