9911-085 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions ;.f
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
Date ` ` f ` Signature of Contractor'• ? �• a ''
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 6w6e"r 6t the pr6peity, am exclusively contracting with licensed
contractors to construci'the project (Sec. 7044, Business & Professionals
Code).
() 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
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 Policy No.
GOLDEN SMILE MS, . . NWC 'M4068-01
(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: ,�':/,;.t• Applicant
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject'an employer to criminal penalties and civil fines up to $100,006, 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) ' Date
PERMIT#
BUILDING PERMIT
i�
4
DATE S VALUATION TRACT
? � 23W5-7•
JOB
ADDRESSr8—%, * *%,'A3iC 1X: 0 CHIME
APN
OWNER
CONTRACTOR / DESIGNER / ENGINEER
-'k-44i�j iti j.*'� y4YrLL,',. i.`1lii"i 41AIlieii.'a'.A.",V
I.t,&, i�+J'l:iji'yiiAiii,4tii�
155-i W, "U" STREET, .TE. Y200
SAN j3i`slt.tdARDINO CIA 91408
SAN klj-W.Nr 1NO is"A VNW,
(90YA 1 -Am _7 CSIA 2120
USE OF PERMIT
��r�•>;i;_t,.jr .i?lta�liia�.' iIWE4i�ildci
.
,kD-LOT fd, is .A -4U2 P K;41 :t' s (XN i-46f`1tiCLU1X1,' t>k(,fY�.K WAU `. R
P(.*Q_ 7YN- 101)LICTION TO PI.A.K (AA C K FIX VO4A MULTIPLE IS St.IANGIS
(*-'SAMJi PLAIN '17YPE:.
A 14'1\y� 1�1J7Y'.�,,i«4'14��•di'��V i, MIR�S.P.t�i .,��a
1�t+i21�.Ifi1„11'I'i�a 2200 ui'
;.Ak'
� TEM -CON'.`' 0, F C±�NSn �R�JCTION
132,198.60
``''��,�r)�;;qq��•t� �^ •� yip , � 9;T11M
E6�.iti.� II 6, 6`EE �S16Y.1���MI ST
<.70N:w'rXLTC-_r10N FEE 1131-tK00418-01W $?55,tNJ
Px ,AN C$YrrK ETir:
itl.Lit'�13ta�ail 1"L F
A"t`R0140INV 111,'101411;-FM-R_(?9Xn i0f-V(NO-;ti4)4)0 $13 ^",,
C°iif2.t DII.7CS C kir 101 -OW -423-000
DJEYW)PER 'l+iCT f+fists $ L,sq)'71W
ART IN PUBLIC 3ff liCHS - 3tI•d.= 701-ONJ -25:5-t)titl �x�l.5fa
1. 'ji>rt'�*,d,t`1 7�!•'irr+YFG"1`jt3 1 AM,) MAN
LESS 1'K#:'i AIV IITES
S000
TOW, PERMIT FEES 011E, NOW
RECEIPT
DATE
By\,
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
- Z • op (
Ducts
Slab Grade
-L, Po o04 ka
Return Air
Steel
2• z, -&b pay
Combustion Air
Roof Deck
- ?Z
Exhaust Fans
O.K. to Wrap
4-H-60
F.A.U.
Framing
5-1-0-0 ,
Compressor
Insulation
_ r t - o@
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wali Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
S- t•( - 0,0
Drywall - Int. Lath
Final IS I �
BLOCKWALL APPROVALS
Final
POOLS - SPAS
Steel
Set Hacks
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
1-,. -.0-0 r
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for.Finish Plaster .
Sewer Lateral .
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
G ov
Appliances
Final
COMMENTS:
"
Final
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
Final
Utility Notice (Perm) �� -
JUL-25-2000 15:09 WESTERN INSULATION 909 686 8786 P.06i11
t
WSTERR INSULATIONINC..
4211 Latham SUOet, Rivcraide, Cdi%rnia 92501
> TeL (909) 686-8760 Fax (909) 686-8786 -
F 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 y
TRACT / PHASE: 23995-7 Phase 1
LOT # : 14
SITE ADDRESS: 78-965 Wakefield Circle
La Quints, CA
---------------------------------------
----------------------------
'EXTERIOR WO►LLS:
MANUFACTURER: John Manville THICKNESS: 3614 R -VALUE: R•13
CEILINGS: BATTS BLOW
MANUFACTURER: Greenstone (CKNESS: - 10.3 R -VALUE: R-38
CEILINGS:
CATTSBLOMANUFACTURER: Johnv//le THICKNESS: 13" R -VALUE: R-38
GENERALCONTRA CTOR: Century Homes ,
a. LICENSE NUMBER:
BY:
TITLE: Sy�O
DATES
INS UtAONTONTRACTOR: -WESTERN INSULATION, INC.
" LICE MBER: 81278
TI CE MANAGER
DATE JULY 25, 2000 ;