0002-334 (SFD)t
LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that.l 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 # Lica Class Exp. Date
71 Pi•glg, t+j {Al,/ 111U1f
Dater�t� /" fl Signature of Contractor����"'"j
6 . o
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I -am exempt from the Contractor's
License Law for the following season: a
( ) '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 exclusively contracting with'lid6hMsd
contractors to construct the project (Sec. 7044,•Busi6ess &'Professionals
Code). t ,
(), I am exempt under Section =', B&P.C. for this reason
Date r + +Signature of Owner.
WORKER'S COMPENSATION DECLARATION
I hereby affirm,•under penalty of- perjury one of the -following declarations:
( ) I have an -d 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. ,
(fie) 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:
Carrierr, f A.c; Policy No. 24WC e440ex6-01.
OL.t t:4N rsLIL Ito,
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(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. q - - • -
Date: Applicant
7 W i
Warning: Failure to secure: Workers' Compensation coverage is unlawful and ,
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions' and restrictions set forth on his
application.. ,
1. Each person upon whose behalf this application is made & each person at
whose request and for whose -benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless. the City of La Quinta, its, officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work -is not commenced within .180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify�that I,have read this application and state.that the above information is
`correct. I agree to comply with all City, and State'laws relating to the building
construction, and, hereby authorize representatives of,this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) �'=t<l% Date��!r��l
_ ,
BUILDING PERMIT PERMITk
DATEP,• j XX VALUATION S„ ,1'T�, %) LOT i--
TACT
JOB SITE
L31�'IP�1wi(ibr�k3iY�418r.iU
APN
C94��-f��$l�T
ADDRESS
OWNER -.
CONTRACTOR / DESIGNER / ENGINEER
(,.Q,Krr�r uvr,?�,t�r1;T r+nn,s�a r.rt�trV
.. a,,,j., 1. 1 1•S u A+F�!LYI,.r1
r,r1KvPUrtf+rrr�R10, V E f O�,innL'rii�rrt;c
O.(. \.rl ♦{• I.: J ..r
I �;* a5 130 ".v" �t l VEFF, STE. #200.
i 515 5v. "u" S.a i;:4�T, Sam— w2w
SAN C3i ftN.eittt'11.NU • C.A 92408
SAN B.FS4iNA DI:NO
CA
.92AX8
f909PRI-6007
31.. 'I.20., y
USE OF PERMIT
f;4;.testi WT 2 MAN 3AP&WIT DGESI NOTe T14C% VDZ BLOCR -�WJ Ls OR.
�.'iCE\l4 t• .ry:[a
•
USS I~ ATE, D COS Of' CONI S. RU A iON
C:l"�iQJ&'�'igUL"11C?h'T•'IM !f);i:�()E3(}-•LtllS•Uf)!? $ifi�S.Ut.!
'
ni_ra11T+;i+IFCK. K' I _ tQl-!lflf)-d�Q_�I�i _ �fiffi:75
TANICA1. FEE 101.-„W;4A..i-V4n
_LL tltdi`.r?1; L's li%4 t?U- :Z(3 G tr S:i3o.5�
ljLUNIMIN'G FIFE 01 -000 -4:19 -WO
,rru-0U12-((100l t fW1
y
00423-000 NJ0.vu
c�1 i
�)Ir'VELOP .ZL'Ii PACT'1” G :f,�JU%t)t)
i` • f
;,.:,
'
11�t�'' !:N PUBLIC 1�9�AGa~S �?dk»ti:tl� ^tUl-pt1(1-2$S-e�Ui? $755 Is
,
d _3
RI l 4 `t't1'('a4i. (;(,1Nfi�'filiC��,?ifhl !'t!1iY) �`•.P�.f�I (,liF(;iC
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<t�)
��1LUS
— _ t� !a r� ! l7
1) rdy�ffw
+�•'9S
TOTAL PKWHIVVEY's OUE]NOW
33,708.40
RECEIPT
DATE
BY r` it `'
DATE FINALED
INSPECTOR'
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
4 -'LL -az 141
Ducts
Slab Grade
Return Air
SteelL(
_{a®
Combustion Air
Roof Deck
4. j G - QD
Exhaust Fans
O.K to Wrap
i --z--dZ
F.A.U.
Framing
Insulation
a ks
1
Compressor
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final '�� � C,��'
BLOCKWALL APPROVALS
Final
POOLS -SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain _
Bernd Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
t k -OD
Heater Final
Water Piping
_
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
g
Pool Cover
Sewer Connection
•
Encapsulation
Gas Piping
+
Gas Test
L3�
Appliances
Final
Final
Utility Notice (Gas) IWAG
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G. F.1.
Smoke Detectors
Temp. Use of Power v
Final
Utility Notice (Perm) o
COMMENTS:
t
NOU-06-2000 1415:291- ,'� WESTERN 'INSULATION 909 686' 8786 P. 03/2?'
s WESTERN IfIrSULATIOiNgI C:
,
- - 42 l 1 Lath= street, Riverside, Cs Wornia 92501
Tel, (909) 686.8760 Fmx (909) 486-6786
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•
' BEEN INSTALLED IN•CONFORMANCE WITH
THIS IS TO CERTIFY THAT, INSULATION HAS
THE CURRENT ENERGY REGULATION, CALIFORNIA ADMINISTRATIVE CODE, TITLE 24,
. V
f STATE OF CALIFORNIA, IN THE BUILDING LOCATED AT: "
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O
'TRACT /PHASE: MARBELLA II - 23995-6 ;'
LOT IF - .2 "
y .: ,
SITE ADDRESS: 78-905 WAKEFIELD CIRCLE, LA QUINTA, CA
`
- ---•-------- . ... ...---- .'•-----------.------•
• EXTERIOR�L&'
_ .
, MANUFACTURER: JOHNS MANVILLE THICKNESS: 3 5/8 " R-VALUE: R-13
e - � -
•
.
, . BA BLOW •-
MANUFACTURER: GIREENS l 'THICKNESS: 8.1" R-VALUE: R-30,
BATTS BLOW .
- MANUFACTURER: JOHNS MANVILLE THTC. SS: 11 R-VALUE:'R-30
GENEB L CONI C1'Qi�: CENTURY HOMES
LICENSE NUMBER: ,
s
BY: ;
TITLE: —
DATE:
'• .
I-NOULATION CONT'i�4CiA : WESTERN INSULATION, INC."
LICENSE NUMBER: 481278
.:
BY:
TITLE:' PRODUCTION MANA
DATE NOVEMBER 6, 2000
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