0002-358 (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
Date! ITNignature of Contractor
OWNER -BUILDER. DECLARATION
I hereby affirm under penalty of perjury that l,am exempt from the Contractor's
License Law for the following reason:
( ) 1, 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
u6d6).
O I am exempt under SectionB&P.C. for this reason
Date ° J " •Signature' of Owner
WORKER'S COMPENSATION DECLARATION'
~1 hereby affirm under penalty of.perjury one of the -following declarations:
O 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 i§sued �>
(�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. '
r riitvr^s,-. ��nrr'r, •n.r� �rartvrr'• a.JenFo iia .
i. �_!:.s'l,.�d'..i? L' ryvS..�'.1 1! V •3 � � -d'4 CY V `..�Y`! V •N)"V
(This section need not be completed if the permit valuation is for $100.00 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 fokhwitl comply with. those provisions: '
Applicant _
Warning: Failure t6secure 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, Js 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) '-1 °-# d —f r l /1 'A Date
BUILDING PERMIT PERMIT#
BUILDING
;
(98i£tt�••:t15�
DAT�E-;,} C VALUATION 513916,397°60 LOT
TRACTJOB
SITE
ADDRESS. J .�A- >t9 +; 9 CS\E.A. F °:
OWNER
CONTRACTOR/ DESIGNER/ ENGINEER.
-
�.
RJiwe � i:, CA di*�:5
LfCyN1'dTTEs�S
rpY1t1
�Vn
1, 535 SCS: P'13 " 5 .REEL. :'r1'Zr.40
1535 SFJ. "1�" i'QE.E'z , SI°. Y260
AN £it .ii �'�i.A� R li l"IVO 92408
SANT2ir�tl>!Al'9�1NO CA
92443"
1911913 1.-eiQO"'
C}3
M 21.20.,
USE OF PERMIT
SjINGL% FAMILY DV2 1:NG
�.
U'D� ;LOT 77 PUN 2& f-EiUvRT DOES NOT iivC'T,irurz ani ocx wAbLs O
�t,�at:. 7S"✓o.�':f..A:ial .t,"F.I:ti:Gf�, �'E.E.t2:E.UitC"i'll,�Iti.E�i�k�tvf(f1..7'£t'1.�;1�sU.tlTyf;k: C)h' :
•
SANt 4E PLAN TYPE
ZJs �CiS
M1RQ4JPAT10 l oo sr.
GA1KiV.'r.1C;AR:ljC7t" r . 420.00 SF'
s,+at�sa.g,a raaaa ams rix r rnar� n r+sr�s"a%,FL q
7l. �..°7.' VL+sY!.fi il�,.M,t a. &:B°.6d♦
g�xp .pts:,+gJ�?dL4sll2
,�•��y. y g•,�SUMMARY
CONSTRUCTM, FKh 101-000-418-000
PLAN CHECK "113 '101 () O-4`19-:310 g1 i^ 7A
4
All, C.111t NWAL rEE ... 101--000-4.21.,000 $47.00
EL sCi Rli:fta, FEE . 901-000-420-1200 $I.7'::9t3
'� ��
IM I'
LIJ'1vLB Nt3 FES 101-000-419-000 _ S IV.255
'
3_7.01,* NfOTIOW REST -1) 101 -000 -?41-011 ! bTt).�4
t #�, °; r4 .. '.
GRADING ADINGFPIC 101-000-423-11011
Dt~°irEl.,t?P" k LW, ACTFEE
A?2.•1' iN PUBLic PLikCES - PESiD 701-000-255-000
Cr-10TA_L t;0NSTtt X.I1101N AND FLAN C1%1TC-•IC
LESS pp r
41v v
RECEIPT.
DATE
By i -
DATE FINALED
INSPECTOR
INSPECTION (RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
C
Ducts
Slab Grade
Z
Return Air
Steel
��_
Combustion Air
Roof Deck
t _
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Qj
Compressor
Insulation
fj o,, V;z4_
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
F�
Final
Final tL_-
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
—(A t4a
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
bli loo
Pool Cover
Sewer Connection
8 t pfl
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final /z
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) en
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 II - 23995-8
LOT # 77
SITE ADDRESS: 78-850 WAKEFIELD CIRCLE, LA QUINTA, CA.
EXTERIOR WALLS:
MANUFACTURER: JOHNS MANVILLE THICKNESS 3 5/8 " R-VALUE: R-13
CEILINGS: BATTS` BLOW
MANUFACTURER: GREENSTOI_ THICKNESS: 8.1" IR-VALUE: R-30
CEILINGS: BATTSBLOW
MANUFACTURER: JOHNS MANVILLE THTC SS: 11" R-VALUE:.R-30
GENERAL CONTRACTOR: CENTURY HOMES
LICENSE NUMBER:
BY:
TITLE: '
DATE:
INSULATION CONTRACTOR: WESTERN INSULATION, INC.
LICENSE NUMBER: 481278
-BY.
TITLE: PRODUCTION MANAG
DATE NOVEMBER 6, 2000
L,