0002-362 (SFD)�^4
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.
t License # - Lic. Class Exp., Date
B 1.sU,tli;(
Date ��`� Signature of Contractor in 4-4,
r t r J —
ti.
OWNER BOLDER 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'ezclusively contracting with Iic8llsed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
Q I am exempt under Section • B&P.C..for this reason
Date Signature of Owner
WORKER'S COMPENSATION DECLARATION'
1 hereby affirm -Linder 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 issued.
(t,)/ 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.
I1nT VNrTA, , rt r, s4Ya -oi' ?t"e CA,M6Ci A/
V,70.IA•Q/Fi'! . i:1i�r!.r✓ aSre�. .t`i 'Vy 4: .'f •r+lV74-V 1
(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,
1 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 provlslons.J " , 0 '
Date:->!� f Applicant ` '`s' ''t a%�"I it ��//l Jf
r •N 4
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. ., s
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 Quints, Its officers, agents and employees.,
2. Any permit Issued as a:result of this appllcaiion=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 Ihave read this application and state that the above information is
correct. I agree to comply with all Gity, 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. t
Signature (Owrer/Agent) •� ti4d��� Date �
PERMIT #
BUILDING PERMIT
.
DATE VALUATION' 5130 �1�,Li.51D LOT TRACT 239w5.,s
JOB SITE ' sew. �
ADDRESSIliVY�'..3'Yi;OiB�R.s
APN
-C1i?••ii'�3SD-�.9ECD y'
OWNER •
CONTRACTOR / DESIGNER / ENGINEER
C1. D. C1',MVEL':. COMIAMUNITiES,
1535 SO 'W I;FR.9101' • 9FE. #200 y
�
, 1 535 ;;,O- "b" STREET, , SIMI, 9-200 +
•;�'StlN
,5 AN ;i3F.F NAk.1�:INO Gt1. 4240'
F1t"_.RN'A:RDrN0 CiA. 9240A
i:'6f"# '2120 •Zw
USE OF PERMIT
SFD- LOT 81 P i,AN 3FA PETWOT HOES INOT NC;LUIDE. TI.00K TS�As".0- Ott:
:FOOL. 75/0 -PLAIN C.k[EC -f-E-8 .R"UC'I ON ! ol2.lbl.Lf1, t It%Lie :tSSUA!tNC E OP
SAM MAN TWIE.r
Mt1CT CGINSTRIUCI ION • 2,1.65.00 SF-
4APAGf1CA1U10RF 635.00 SF
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. 1
Y 1*'r;1AA A'a•rrn e'1n1*•r Cres+
L'>`9.8 SSl.Ak•±�S•L' kl lw'Si`�9s i!!r.' 4'69.C'!tP3..S+,-'4.E 51.r1'!
I W s►f1G CA
4..*3aFPt3w•.Jt7'.• .
PERMU FEE SIAM—Mt W11
CONS`1aRUG1.10.t4 FEE 101-000.418-W0 $798.0
PLAIN C-MCK1;13F 101-000-439-31 S -- $154..03
MAECHANICAI FIE; 1011- � �'�1-??00 05
tLEC.TRI AL ZEE101-000-420-000. "a336.SJ8
-
PILUMB NG HE 101-000-419-000
",,". RON<t MOTION RM-RE311,1 1€11 4. 1-241-000
�t
C.o12ADJ,NTC rte+ 101-000-423.00oS 5120.00 As�
{ M.•
ART .IN PUBLIC, PLACES 1aUSID 701-W 255.000 $73.01
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AI t n>v t'r N A?1')?'L�^N'ti3 L?t_'. '. `
."" $,3,24217
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vinr� �f1(�
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O AL.4?ERMF "WEIES YDa,1E NOW
$3;' 42027 r
RECEIPT
DATE •�
Bye r
DATE FINALED .
INSPECTOR
"'A ti
0
A.,
4
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
..
Ducts
Slab Grade
- 2
Return Air
Steel
e [
Combustion Air
Roof Deck
(i
Exhaust Fans
O.K. to Wrap
7 -'T —MO
F.A.U.
Framing
3kCompressor
Insulationo
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
tf teo �6bG
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
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
t5
Pool Cover
Sewer Connection
jam
Encapsulation
Gas Piping
Gas Test
1 (p
Appliances
Final
Final IVAMICD
Utility Notice (Gas) 1) 11
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Law Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power c $
Final
Utility Notice (Perm)
COMMENTS:
WES'T'ERN�INSULA�' �
. I®lv, , INC*I1vC;
4211 Latham Street, Riverside, California'92501
Tela (909) .686-8760 Fax (909) 686-8786
INSULATION CERTIFICATE
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 II - 23995-8
LOT # 81
SITE ADDRESS: 78-890 WAKEFIELD CIRCLE, LA QUINTA, CA
EXTERIOR WALLS:
MANUFACTURER: JOHNS MANVILLE THICKNESS: 3 5/8 " R -VALUE: 'R-13
CEILINGS: BAT BLOW
MANUFACTURER: GREENSTONE THICKNESS: 10.3" R -VALUE: R-38
CEILINGS: BATTS LOW "
MANUFACTURER: JOHNS MANVILLE THICKNESS: 137- . R-,/ALUE: 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