0002-359 (SFD)LICENSED CONTRACTORDECLARATION
I hereby affirm under penalty of perjury that.1 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
Wil I ki. OE
'6 Date Signature ofContracto 4-1
1- 7
OWNER -BUILDER DECLARATION
I hereby affirm under
nder pen'6 , Ity of perjury that I am exempt from the Contractor's
License Law for the foll6wing 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).
11 as owner -of-the property, am exclusively contracting with licensed
contractors
ontractors to construct the.project (Sec. 7044,'Business & Professionals
Code).
am exempt under Section, B&P.C.. for this reason -
Date Signature of Owner
WORKER'S COMPENSATION DECLARATION
I 'hereby affirm-16nder penalty of'perjury one o ' f the following declarations:
)-I have and -Will, niaintiiin a certificate of consent to self -insure for Workers!
compensation, 'as,provid6d for by Section 3700 of .the Labor Code, for the
1perfor/Eance of the work for which this permit is issued.
.a (V 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' rkers, compensation insurance carrier & policy no. are:
.Carrier Policy No.
GOILDENUAGIXt NS-.' .,_1,qWC544 W-01
(This -section need not be completed if,the . permit valuation is for $100.00 or less).
I certify that in the perf6rmance 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'ag I ree that if I should become
p .
subject to the workers' compensation provigions-of Section 3700 of the Labor
I shall f6rthwith comply with.th'ose'provisions-,
Date: � Appli6ant
Warning: Failure to secure Workers'.Compensation coverage is unlawful and
shall s6bject an employer'to'crimind penbCities and civil fines up to $100,000,* in-.'f
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees. sr
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit , subject to the; conditionsand r restrictions, ,§et forth on his
application.
1. Each person upon whose, behalf this'application is mad . e & 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 160 days will subject permit to cancellation.
I certify that I have read this application and state that'the above informatioh is
.correct. I agree to comply with all City, and, State laws relating to the he building,
construction, and hereby authorize representatives of this City to enter upon
,the above' -mentioned property f6r inspection 'purposes.
Signature (Owner/Agent) Date bpw
, IT#.1
.BPERM
PERMIT
—
.BUILDING ojilt,)
-
DATE VALUATION LOT, TRACT.
—
JOB SITE'
ADDRESS"; %V
[APN'
OWNER
CONTRACTOR DESIGNER ENGINEER
07'M' "I%Wylty CRCAVISU
CENrA. Y
1535 so. -'1)" SrPoe e -r, sm 11-200
1535 SO. T" STREET,.'�Ft.
#200
SAN'.6MINARDMID 'CA. 92408
SAW BEKNARDINO
CA
92408
(900)381 -0007,
CE141
-!I i-20 -
USE OF PERMIT
SINGLE FAMILY MT.LLING
9PD- LOT 71 PLAIN 44- MUM 60ES N& NUMB DL60K, WALLS OR
POOL. -75% FOR M.ULTIPLE ISSUANM OF
GAWE PLAN T-YPE,.
PE RMIT ITCE SbAffvt�RY
COMSITRUCITHM -Flu. 101-000-4*18-000 91755.00
RAN C_WCK.FW,:, 101:-005-4 9-31,5 i 5114. 6f)
E N 20
LF. 'URICAL M-7 $138
Y'LuNiBING FE. -E. 101.-000 419-000 8138,14)
_R,1_R$M 101-OW-241.ft!
X14
-S
ClUIDINCY FM
DZ M-WPOk MPAC 9 FRE
AWF PL0LIC PL -ACES - RESU0701-0004,55-000
i�Y ,
u
SUB-TUFAL CONSIRUGTION MID PLAN CHECK
PRX-PAID FEES
LESS I
$
-10TAL PEWMIT FEWSOUE NOW
S. 3,2 6 CS: 2
RECEIPT
DATE
B
DATE FINALED
INSPECTOR
';A -
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
_at
Ducts
Slab Grade
9r - I, .00
Return Air
Steel
14 T o
Combustion Air
Roof Deck
`p- it -00— I
Exhaust Fans
OX to Wrap
Eid
F.A.U.
Framing
QlI jzX0 cd':04
Compressor
Insulation
•$ ��Y�,L
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
o0
Drywall - Int. Lath
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
t�� , x,00
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
L3
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APOROVALS
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)
COMMENTS:
WESTERN INSULATION,, INC.,'.'
4211 Latham Street, Riverside, California 92501
Tela (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 # 78
SITE ADDRESS: 78-860 WAKEFIELD CIRCLE, LA QUINTA, CA
EXTERIOR WALLS:
MANUFACTURER: JOHNS MANVILLE THICKNESS: 3 5/6 " R -VALUE: R-13
CEILINGS: BATT 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, IVC.
LICENSE NUMBER: 481278
BY:
TITLE: PRODUCTION MANAGER
DATE NOVEMBER 6, 2000