0009-165 (SFD)LICENSED CONTRACTOR DECLARATION
I h�,eby affirm under penalty of perjury that l am licensed under provisions of
Cha$ter 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
�7141 $S "L3
Date> Signature of Contra
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 owner of the property, am exclusively contracting with licensed
contractors to construct 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:
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.
( ), 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 0OL DEN F -,A012, M;% Policy No. NWC-544008-02
(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 to workers' compensation �islonsl Se tion 3700 of the Labor
Cod all fo �y';v'I h comply wi ho, a proves ons.,
Date:/ t G-'�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.
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 properL, t, spection-purposes.
Signature (Owner/Agent)''' �/ Date /�/tAbell
BUILDING PERMIT PERMIT#
DATE VALUATION LOT-�
TRACT
4
23773.5
JOB SITE �r,yyr.
ADDRESS >.�i.�1I� A;i° � l7/.An cox i�
'
APN
60 -OW 26
OWNER
CONTRACTOR / DESIGNER / ENGINEER
S`A.r1%UMV DMX- 9 LLC
CENTURY CRCf`UIi3.,LL CONWUNTIMS
PC} T3C?Y 5140
1,535 SC?, "13" OT3 . ;' , S'l7_ 0200
A3 UT',or-,T BVACH CA 92662
SA14 W-MWOM0
CA 92 408
(909)381.6007
MR
21120
USE OF PERMIT
SVINPLAN:" L.OTA PERMIT tJOL;1d0T INCLUDE BLOCK
WAMWOOLMMVEWAYAPPROACO,
TRACT CO?3SSTRUCTION 21023.00 Sig
I?OTi.CFi PATIO 48.00 SP
CAARAMICARPORT (SP) 3,232,00
1. S'mum COST or C>Ctl]VymTTG"i'EGN
r �
c..1118,71soo
ONSTR.UCTION FEE 101.000.418.000 S7i16.0tt
� -14
PLAN C HECK PEE 201 e000-4. 9-31
ti4:?
IJ1EC�tAPIICAL PEE 101-000-421-000 $47.002
# 3 3
y
9L,L FPJCaA1,, PCE 101-000-420-000
PLUMBINO FEE 101-000.419.000 $1:34.75
ST:tCSNO MOTION FET: ° R.ESID 101-000-241-000 $11.87
GRAWHO PRE 101.000.423000 $20.00
�..,
1DWELOPER IMPACT FEE
OUIb-T.OTAL CON g1' IRTMION AWD PT...W CHECK
$3,517.74
Lig 33 PRF-RATD MO
'�°C3" A3� 1�11,t2id ff 1i ns ut1:�; Now
$3�'�2'1��74
RECEIPT
DATE
Ll
BY:
k
DAk FS
INSPECTOR
-1-1%
i
a
INSPECTION RECORD
OPERATION
:A.
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
2 _
Underground Ducts
Forms & Footings
01
Ducts
Slab GradeRetum
Air
Steel
Combustion Air
Roof Deck
Z �-O cgKExhaust
Fans
O. K. to Wrap
L x
F.A.U.
Framing
g $ CeVz�b _�4_
Compressor
Insulation
2 (p
Vents
Fireplace P.L.
v
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
_l(1OF
Drywall - Int. Lath
�l
Final
Final
POOLS - SPAS
BLOCKWALf A PROVALS
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
,��'l
Heater Final
Water Piping
. Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
IZ,� 7.—
7 Encapsulation
Gas Piping
Gas Test
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)
JUN -13-2001 15:19
WESTERN INSULATION
909 686 8766 P.05 �1
j
w
ERSTE I LTL ,
LoPe.
'4211 Letham Stzwt, Riverside, CaHloniia 92501
Tel. (909) 686-8760 Fax (909) 666-8786
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: STARLIGHT DUNES #23773-51PHASE 4
LOT #: 4
SITE ADDRESS:. 437560 MORNING STAR CT. LA QUINTA, CA
EXTERIOR WALLSU
MANUFACTURER: JOHNS MANVILLE THICKNESS: 3 618 ,"
R -VALUE=: R-13
BATTS BLOV�l.
MANUFACTURED. GREENSTONE THICKNESS: . 10.3 "
R -VALUE: R-38
CEILINGS: BATTS BLOW '
MANUFACTURER: JOHNS MANVILLE THICKNESS: 13 "
R -VALUE: R-38
gENERAL CONTRACTOR: CENTURY HOMES
BY:
TITLE:
DATE:
INSULATION CONTRAC:T®R: WESTERN INSULATION, L.P.
LICENSE NUMBER: 794484
BY:
TITLE: CT10N ItAAGER
DATE JUNE 13, 20 (11