0012-106 (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 # Lic. Class Exp. Date
714188 ! -1(%M 1111(
bate
f �- Signature of Contractor
j
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).
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
performance of the work:for which this permit is.issued.
04 1 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 t30i.'D1??3 i3l1,�31,if 13d . Policy' No: ° A1t tY• �d40tS�f its
(This section need not be completed if the permit valuation is for $100.60 or less).
O 1, 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.
ate: t) { ziirr 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. n .
1. Each person upon whose behalf this application is made, & each person at,, M
Whose request and for whose benefit work is performed under, or pursuant toz;
any permit issued as a result of this applicator 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 a11•City, and State laws relating to the building
construction, and hereby authorizerepresentatives of this City to enter upon
the above-mentioned property for inspection purposes. 1
signature .(Owner/Agent) jr? ��y%— Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT �" TRACT
s, y t y C
JOB SITE
ADDRESS _ 78^965 WC,y RMG STAR WAY
APN
^E "26 '
OWNER
CONT/RRA,C}T7OwR� /yyD�ESIIGfNjE�Ro�/ ENGINEER
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4.+.CsRI JL IAig.k'6�W1'41JrQV,CZlr ��.!'.!<W.4YAt..�dTiJ.dAS'�S
PO BQX 5 140
NEWPORT-BRAMI CA 92662
S"DEMARDINO CA 92408
4ti905;i sl.a,6R(Y", CSIA 2120
USE OF PERMIT
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5171) 1'1.r3.1dCS LOT 554w LPR>t IT DOES NOT 113Cl.,iHM;
BLL KWALINPOOIA i1MEWAY,i►.1RAA.O14.CH
93TRUCTION
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R',11':C'WPATIO "4941°a'it'
0ARAz:33MARPORT (810 01406.99
ED COST
173,679JO
4:�N 'J'fiU 'r1i�11 YPS 3 01 e(00-410,000 $"905.50
PLAN (:-}1ECK Fid
MEC%iANICA L dSr3 113. � �P(�� 1 r 0(3iS if .9S►
1wH:.>°:+Cnu+C44.11 FEE_, 1,01-000-420-0(M $131.16
1'LUMBP101�i� .. 1"(f1m(1(3t3 @�3� :7 e�62.S(►
STROWO MOTION F18B ;1ESYU 10.1-000-241-000 X1'9.3
OPLADINO WX,
DEVELOPER IMPACT FZF: $l,a7fr7.fl#?
- !' AL codivwt ' NL14 Il}.aX9iLV LJ."lry" 1%
$3A4.2.94
7 F.%1`9 PR PAM'PM
$0,00
1 g 2001 �"
JRA Fxm, . Fm DATE NOW - :.: -
"P,441.94
au�
aB� 0 Ul.
RECEIPT
DATE �f( BY.
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
�Zg�
Underground Ducts
Forms & Footings
1
Ducts
Slab Grade
�—i
Return Air
Steel
�F�el�
Combustion Air
Roof Deck
Exhaust Fans
0. K. to Wrap
6�
F.A.U.
_� _
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final Z d(
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
2 ZO
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral2
�
Pool Cover
Sewer Connection
` _"
�j
Encapsulation
Gas Piping
Gas Test
Q�
Appliances
01
Final
COMMENTS:
Final
Utility Notice
'�99
(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)
C „
AUG -20-2001 15:13 WESTERN INSULATION .909 G8G 8786 P•12%14 }�
WimmocISTERN IN64ULATION9 LmP*
4211 Lathom Street, Rivamide, California 92501
TCL (909) 686-8760 Fax (909) 684-87&8
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 #23773-5/PHASE 5
LOT #:
55
SITE ADDRESS:
.
78-865 MORNING STAR WAY. LA OUINTA, CA
E_F# W ALL.BI.
MANUFACTURER:
JOHNS MANVILLE THICKNESS: 3 5/8 " R -VALUE: R-13
CEILINGS!
BATTS . 3LU W
1
MANUFACTURER:
GREENSTONIE THICKNESS: 10.3 " R -VALUE: R-38
BATT BLOW
CE[UNG-S.,
MANUFACTURER:
JOHNS MANVILLE THICKNESS: 13 " R -VALUE: R-38
GENERAL CONTRACT
-0-83--1 CENTURY HOMES
BY:
TITLE:
DATE:
INSULATION
ONTRA R: WESTERN INSULATION, L.P.
LICENSE NUMBER: 794484
BY: �--
TITLE: PV5 U
ION MANAGER
DATE AU ST 20, 2001