0002-338 (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
r9 tib 1-`31�2Ut
4
Date. � � '�/% Signature of Contractor ° r e"',
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:pf the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code),
( ) I am exempt under Section , B&RC. 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 a a61� 1 1 d ePr-'!€ 11. 1;3`; Policy No. "Wr• "1.1061 (I't
(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: 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, 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.
lL4Si9nature (Owner/Agent) Date L�!
_ BUILDING PERMIT PERMITT'C"i"X3
DATE `, �; VALUATION 5132..11,98.61 LOT Xh TRACT 1�}Uabt °i
JOB SITE '11- 651VV1 lA:(�il'�cAvle D �.17:�.�d..a E,
APN �r�'Rs ��1�—�l) i>
ADDRESS
OWNER
CONTRACTOR / DESIGNER / ENGINEER
f".3iM71,TRY 'f ;i1' i,l C:C1.11't?w1'IMI' ES
CYN IURYA C111.0izSEI. L t'0h§NIM IFtlU,
1333 SO, `D" S'I RL ks i , tiT ., 020
1.535 Sid. ".11)" ! I REET, 4,22(}5',
SAN BERNARDINO CA '92408
SAN BERNAR[ INO CA 92408
USE OF PERMIT
Si;+UL.i°,PIVrIIL, 111AVi?1LW4
Nl1 b- iA'i j' 6 PLAN 413•• i°h it i DOLS NO'l R4;OOI diWOa vJ lltj6 U(
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3 A A,A;N 11. PIi,
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ti�1l2HCSkiY>;Ak.4'�)lt'I` cii�a,Ut! ;;8°'
t3IIMA'TD COST OY CON3TRCIOI
I32119A
iiu, agTFEE, JVMA- AR
CON:4'1"R.lfi 71 oro (4-Y 101-000-41!i-000 `S 75h iK)
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ii.,i:t"R 1214 r41. i°t�{ 1014JCit 420-u0G 3f ;E . •fr
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V11t 1W+J -1;4 P Eb, 101-8410-414-000 S 08, So
' �I tt1Nc: rust frTON WFb' , VF RTI) 101 43t1f 1-141 -000 �t �
AXVIN P(►.t'.WC PLACi N - kU Sil. i01-000-255-000 $9220"*)
R1 TB-RYT.Ai.. CONK-FRUCIT) AND PT.NN, ('1<';i t'K
i;1
LESS PRE -'RAID FF `T
$10.0fi
!°t)'!ALbtil?,NOVL"
4,2h1. s Z
4
RECEIPT
DATE
BY ,..
DATE FINALED
INSPECTOR
L
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
4. 1
Ducts
Slab Grade
. Y—oo
Return Air
Steel
, "'0p
Combustion Air
Roof Deck
4(y. (7
Exhaust Fans
O.K. to Wrap
. 1'5 .OD
F.A.U.
Framing
_6 Cz
Compressor
Insulation
8 3 F
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
4 ($
Drywall - Int. Lath
Final
Final _ _ .on
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 I
I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
1
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
3
Pool Cover
Sewer Connection
g
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas) .9D
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 ItC"t
Final 12A'2s—C-00 Ca
Utility Notice (Perm)
COMMENTS:
WESTERN INSULATIONS 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 # 6
'SITE ADDRESS: 78-865 WAKEFIELD CIRCLE, LA QUINTA, CA'
------------------------------------------------------------------
EXTERIOR WALLS:
MANUFACTURER: JOHNS MANVILLE THICKNESS: 3 5/8 " R -VALUE: R-13
CEILINGS: ATTS BLOW
MANUFACTURER: GREENSTONE THICKNESS: 10.3" R -VALUE: R-38
CEILINGS: BATTS BLOW
MANUFACTURER: JOHNS MANVILLE THICKNESS: 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 MANAGER „
DATE NOVEMBER 6, 2000
♦-51