0002-333 (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 Ad
f Professionals Code, and my License'.is in full force and effect.
License # • Lic. Class Exp.. Date
74189'
Date. 1'�� ar' " h Signature. -of Contractor
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).
( ) 1, AS 6Wn6r 6f M6 pr6p6fty, AM 6XGIU9IV6Iy 66ftitrAbtlhg WIM li68fised
contractors to construct the projeot-(Sec. 7044, -Business & Professionals
Code).
O I am exempt under Section B&P.C. 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
e
performance of thwork for'which this permit is•issued.
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 issued2 My workers' compensation insurance carrier & policy no. are:
Carrier - f Policy No.
i•vr1 1a.1 r, A n e• rn, - �,ri env �'di:t'f
Hary r+,S�+ f. a �ti ._ �✓ e
(This section'need not be completed if the permit valuation Js for $100.00 or• less).
( ) 1 certify that in the performance.of the work for which this permit is issued;
- I shall not employ'any person iri any manner so as to become subject to the
workers' compensation laws of California, and agree that if l should become
subject to the workers', compensation -provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions.-.
Date: l - 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.
Al
I certify that I have mad.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.
%Si nature (Owner/AnentDate*.fi �c•1 A
BUILDING PERMIT :' PERMIT#
M ,
r
DAT ;. � �((t VALUATION Ss146,39, 60 LOT e-111-
TRACT
2399"L
T``
-
J OBS ITE
ADDRESS YtiF�tH ! L/ i�fliR?a �i��
APNp1
91F �.�)
OWNER
CONTRACTOR / DESIGNER I ENGINEER
`CSN 1"Lkyt '1ZC')WELL CM;lle'ITJNMES
t":�`�lt RMIRY i.;ROANtl• LL.G'L i1 RZiJN3' ,iLS . .
1535 SO. ."D' STRELf';, &M..11200
1535 SCS. T" ..1STUl.T, $IT. ;1200
S.Al i BER- AR1:aINO CA 92408
SAN .�iBFWA1iD1\10 CA
92409. '
•(909,I .0-6007 _
C
BLf# ' 21,2g .
USE OF PERMIT
11'ft 'rF.,i N 1a�1t.L. lr VE.i1NQ
.b
S'f7D- LIOVf lWsi re -1,101W. .0035,8b✓dJTiL/iB;LOiR.WiV : LS CIA.
POOL..
vv,cl' CaINTaTsii3i""f°fol" 1,600.00 SF .
• I�vR���'.A.TI:O � 32 ft0 S.F' "�
,
_ UARA:sFaGARl7i>Wf 420.00 aF _
✓.&TO9'VEER CONT Of.,11-10I-�TRU"'7.11rON
.t ^!i.ti
P:ii:RMI1jr F EE SIfYAAAR`s'
CONXIA2)t;" 01N FRE 101.40041'.000
1.11; AW r, fit}} 7K FU-, ,, ;-
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n ?r�• .� r" . f•^e•-tz t (� l �t11► +''! 1 7� a An AGO
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�J":P;A'?pb�ltf t;.;.�, , ' . fji-±?00-�.'��«(A00 - $nt1.Og .
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�lc'F !N PUBLIC f'LAd3lr�i - Its 3!L' 701 -WO -155-000 $3s'.y°l
'4,,'•
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DUE NO -
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,R3,472 -5>'e
RECEIPT 7
DATE
BYi // �`+`� ,
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
14-14
Ducts
Slab Grade
.-dD
Return Air
Steel
Z (-
Combustion Air
Roof Deck
ip -I G - e0
Exhaust Fans
O.K. to Wrap
IL, 00
F.A.U.
Framing
3.1
Compressor
Insulation
Ed
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
ep C�tr
Drywall - Int. Lath
-�( C__V3
Final
Final
IZ I AO
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
I I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
, t
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 I fi
Utility Notice (Gas) ly ry �p
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
Final IL74(�
Utility Notice (Perm) o
WESTERN INSULA'T'ION9 INC..'
421.1 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 {ODE, TITLE 24,
STATE OF CALIFORNIA, IN THE BUILDING LOCATED AT:
TRACT / PHASE MARBELLA 11 - 23995-8
LOT
SITE ADDRESS: 78-915 WAKEFIELD CIRCLE,, LA QUINTA, ,CA
EXTERIOR WALLS:
MANUFACTURER: JOHNS MANVILLE THICKNESS: 3 5/8 " R -VALUE: R-13
f CEILINGS: BATTS' BLOW
MANUFACTURER: GREENSTONE THICKNESS: 8.1 " RA"ALUE: R-30 '
CEILINGS: BATTS BLOW
MANUFACTURER: JOHNS MANVILLE.. THI KNESS: 11" RNALUE: R-30
GENERAL CONTRACTOR: CENTURY HOMES
LICENSE NUMBER:,
BY:
TITLE:
i DATE:
INSULATION CONTRACTOR:WESTERN INSULATION, INC.
LICENSE NUMBER: 48.1278
BY:
TITLE: PRODUCTION MA
DATE NOVEMBER 6, 2000