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a LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I•am licensed under provisions ofi6.4
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 # - „.._, ;'+ r Lic. Class '�' - Exp Date:
Date 'G Ll Signature Of Contractor
OWNER -BUILDER. DECLARATION '
Thereby affirm under penalty of perjury that Tam exempt from the Contractor's
License Law for the following 'reason: ' "
(-)• l,'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). _
O, I am exempt under Section B&P.C. fog this reason
Date rSignat.ure 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) 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. NWC `rj�fai3�132
'(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.'� �r
Date:, 11'';q/6!,, , Applicant—
Warning:
pplicant 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 provides] for in Sectio_ n 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)' ' 4,/7/ Date"
1.
PERMIT #
PERMIT-
jBUILDING
J .%j1'1 t {% LOT' TRACT
2 f'
DATE ;;i 7,( -�- `
f tJ� fI { VALUATION
�3�'i p••S
JOB ADDRESS �T�%=ftir 'Q'1i1K�ckE[L�Er�rAPN
-C RMEM-.
ADDRESS -A KAI JEW-
APN
ft
OWNER
CONTRACTOR/DESIGNER/ENGINEER
In Tc.'rFav -
L �+. V b .rl\ r ♦ ,. ,I irS.!2� 19A ld.• ,I L,�
r^w�•i�r x,�r(9 Snte: j T
� 1. 1 ��. .1 � \+. it �...d.
rina'��r' r�,�1x 3 :'
�JOH! VU i{ .L.
o. '01,i #tFIt" ', Si k , {k200
1535 SO. T" S'1`fcr3 ;
SIE. 4200
SM 6E.R14A1t.i:).lN0 CA- 92408
Sh6i E3ERNARD.INO
CA .92408 t:
afif.te.
2120
USE OF PERMIT
WED- LOT N ;r-L.ALV a'?'k3- NOT ,Ii+6CWDR, B1,Ci4:K MALLS OR-
POOL. 75% PLAN C%►iLkfo FEE REt U(7 .[ON FM h9E11,'t'11IILE:i;NWANCS 01'
5.s-ifil..i Lr'•.JjV.J 1.[Ctic—, 101.4
PClRCris'PA:HO 32.00;. Si
fJt3!'if1E1 fGAEt!'U12i' 4.20.60 S
PERA sT Vtali SUMMARY
101 -OW -41 £t -NO $664.00
30N664.00
"P1,A:fd Q!T �C � FFF,.. --101-t1t1{_439-318 _ _ $137.70
ivt1sC[`,t.i14, CALrrL*Y,, 1.01-000-421--00t?
f.EC:` LUICAL fad 101-000--420.1060 $119.90
-
MI UAI1 NOr ME 101-UOO-•419-000 X 13'.2.5
�3 t Rli lC Mfg t tC�i� x 1Sf . - F,85 i its (_1()0 : 41-0(!{l 2 4
?
µyd
G• INC FEE 10Is_000-921•000 $MU.0-0
s"
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DEVELOPER V"Nff'AC'I:' 1 I:;£�
A11 k' 1N VLFIILIC PL :Ris f13 '` 014) W - 2 S5-000
•
Y "-t!
rot
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+:w
a'7 ' rn . rte se rrtl TC "�C3 T 41ND MAN C!4FCX
1,ESS PI?.0=i'AID FEES
..
$0.00
RECEIPT
DATEBY
IN
DATE FINALED
INSPECTOR
ra.
INSPECTION RECORD
OPERATION
DATE
I INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
•% Lt _ @d
Ducts
Slab Grade
Return Air
Steel
Z/ . 00
Combustion Air
Roof Deck
, t
Exhaust Fans
O.K to Wrap
7• f 1.Om AJ
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
_
Drywall - Int. Lath
Final
Final
_
t_Z_!41�
POOLS - SPAS
BLOCKWALL
APPROVALS
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
. i 7-
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
$
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final Z �•j ('p,
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 D
Final 121u�
Utility Notice (Perm) o
DEC-18-2000 11:12 WESTERN INSULATION F 909'696-87%P.02=02
T I u 9i o
4211 Iatbram Str"to RiVcaoide, Catffomia 92501
TeL (909) 6W-87760 Fax (909) 6w-wa6
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 11 , - 23995-8 PHASE 3
LOT # a
SITE ADDRESS 78886 WAKEFIELD CIRCLE LA QUINTA, CA
MANUFACTURER: .!QHNS MANVILLE THICKNESS: 3.5/8 " R-VALUE: R-13
CEIUNft FBA:T:T:S BLOW -
MANUFACTURER: GREENSTONE THICKNESS.: 8,1 " Ft- VALUE: R-30
>cFjuNrs. BATTS BLOW
MANUFACTURER:JOHNS MANVILLE THICKNESS: 11 " -R•- VALUE: R-30
GENERAL_ CONTRACTOR: CENTURY HOMES
BY:
TITLE:
DATE:.
INSULAII®N QQNJWESTERN INSULATION, INC.
LICENSgE NUM 481278 �.
BY:' k�n
f TITLE: PRODUCTION MAdVf,
DATE DECEMBER 18, 2000
TOTAL P.02