0009-166 (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 and
Professionals Code, and my License is in full force. and effect.
License #q y pp �jLic. Class. Exp. Date 'y /.,P
•P141,8� B y i. o/3 ma.
Date's 6YPSignature 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). r
( ) 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:
(. ) 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 OOLDX14 01,E INNS Policy No. . NWC,-,944002-.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 the workers' compensation provisions of Section 3700 of the Labor
Code, I shall Virthwith comply wit -th0,provisiv.
Date: % ���// %f pplicant /��
Warning: Failure to secure Workers' Compensation coverage is unlawful and
40
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, indemnity
& 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 pu poses.
Signature (Owner/Agent)-! Date
BUILDING PERMIT PERMIT#
a9_g
DATE VALUATION LOT
/6) . i( - f�r> Ax€3,7�9..30 3
TRACT
231 35
JOB SITE
APN
ADDRESS 4XWO MOMING STAR COURT
609_08t1; -Q26
OWNER
CONTRACTOR / DESIGNER / ENGINEER
.��i.'.fiFi.LIC H,r DU ES LLC
.• '..!.'i.BRY CR.OWELL C(;iMMM1' IFeS
PO BOX 5140
15:35 30. "D` 'RM, 9M, 4200
NEWORT BEACH CA 92662
SAN 13EP ATti INO
Cly, 92108
(909):381-600'i
M.41 1120
USE OryF,PERMIT
�
l7S.f:,Y ��."ate"l'd•9J.YdiJJS .L1 YVrJKL+1.rJSYV
,
S:IPDPtAd:2HlAT:55F.EPIMIfDOES NOT MCLUE-il.]CC
6,V9}aO1JDR V7WA Tf`PAOAH, g0/. PLAN /fIECK pE19 REDUCTION , •r
FOR MUTAIPLE ISSU.At3CE OF SAME PLAN TYPE
TRACT CONSTRUCTION 2.9p .00 SF
PORCi;fP.EiTIO 48.60 9F
t /
OARAOFJ"RPORT (Sl� 0232,00
EMKXrFD COSrC O.F.+ CON17CRUCliox.
1181719-30
PLWWf FEE StIrAWARY
CONSTRUCTION 1'FP 101.040.418.000 VMS
PLAN CHECK FEE 101.000-439.318
MECHANICAL FRE 101=000.421 -Opti X4'1'.00
91,IXTPdC.AL FEE 161-000-.4120-000 $112.71_
PLUMBING F11L� 101.000-419-000 S134,'7�
r"
STRONC1.1t1IOTION FEF - MID 101-;000-241-000 $11.87
"'� 4
ORADINOF'RE $20,00
-
37IaVLrWPI�.It imp.1kCIT FEE $007.00
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:lCIB40` AL COMSTRUCTIOM AND PLAN alWX
IMS PRE .,PAM F�
$0.00
+
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1P 'a aV4Te7a�.�.1
RECEIPT
DATE
l C.3 %� %(/ ....�
BY
fir,"
DATE FINALED
INSPECTOR
OW
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
f�of
Underground Ducts
Forms & Footings
r'z of C�?
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof DeckCA(s'��,
Exhaust Fans
O.K to Wrap
� �'� �
F.A.U.
Framing
Compressor
Insulation
�13 �(�`'%�
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
/
Final4
Final
_ _
%`1 13
1
POC7LS SPAS
BLOCKWAI,L 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
I��� ,p0
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
I�j
Pool Cover
Sewer Connection
��}-
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
J ��
Temp. Use of Power
Final/
Utility Notice (Perm)
JUN -13-2001 15!19 WESTERN INSULATION_ 909 686 8786 P.06/1
� r
rd
°aj0dRN I ULATI , L.
4711 Tatham street, Riverside, CaLlfbmia 42501
Tel. (909) 686-8760 Fax (949) 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 i PHASE: STARLIGHT DUNES #23773.5/PHASE 4 `
LOT #: 5
SITE ADDRESS: 43-580 MORNING STAR CT. LA CIUINTA, CA
EXTERIOR MLLE:
MANUFACTURER; JOHNS MANVILLE THICKNESS: 3 5/8 " R -VALUE: R-13
c L NsaS:. BA7rs CBLo
MANUFACTURER: GREENSTONE THICKNESS: 10.3 " R -VALUE: R-38
CE_.,IUN-S- BAITS SLOW
�f
MANUFACTURER: JOHNS MANVILLE THICKNESS: 1310 R -VALUE: R•38
GENERAL. ONTRACTOR: CENTURY HOMES
x'
BY:
TITLE:
DATE;
INSULATI®BI Q- NTRACTQR: WESTERN INSULATION, L.P.
LICENSE NUMBER: 794484
BY: '
TITLE: PR CT -16N AGER
DATE JUNE 13, 206-1
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