0012-095 (SFD)LICENSED CONTRACTOR DECLARATION
1 .rreby affirm under penalty of perjury that I am licensed under provisions of
H Chapter 9 (commencing with Section 7000) of _Division 3 of the Business and
3 N W • ' Professionals Code, and my License is in full force and effect.
O =) C0 F ",r License # Lic. Class Exp. Date
__r_-0 LID
LLJ
o ZZ V ate Signature of Contractor
co,
I,- V o co OWNER -BUILDER DECLARATION
H a I hereby affirm under penalty of perjury. that I am exempt from the Contractor's
U) License Law for the following reason:
Z ( ) 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
bode): ,
co O I am exempt under Section B&P.C. for this reason
LO
N Date Signature *of Owner
0. rn
Q WORKER'S COMPENSATION DECLARATION-
O Z 1 hereby affirm under penalty of perjury one of the following declarations:
Lo <,p cr
( ) I have and -will maintain a certificate of consent to self -insure for workers'
LIL compensation, as provided for by Section 3700 of,the Labor Code; for the
O J- Q performance of the work for which this permit is issued.
m Q' I have and will maintain workers' compensationinsurance,-as required by
Q: U• Section 3700 of the Labor Code, for the performance of the work -for which this
r4 a`a H permit is issued: My workers''compensation'-insurance carrier &policy no are:
- ZrCarriePolicy No.;
:oo 001,DEN KA" 119. ak l"•349t9b�•t� ,
Q (This section need not be completed if .the permit valuation is for. $100.0 or less):
(, ) I certify that in the performance of the work for which this permit is issued,
1 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
E subject to the workers',compensation provisions of Section.3700'of'the Labor
N Code;.l shall forthwith comply with those provisions
Date: //,/k//2/ Applicant- �')'
v 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 inSection.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., .,.` 4
1: Each person upon whose behalf'this application is made & each -person at tf
-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 'res'ult 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 -me ntioned•prope rty for inspection' purposes.
tsignature (Owner/Agent) X I'F4V 'Date
i' BUILDING PERMIT PERMIT
DATE VALUATION :+ ' LOT "��� TRACT
{
JOB SITE
A_PN
ADDRESS '. 76-870 MOMMA' MIA,i . SAY •
;6W -0W026
OWNER _
CONTRACTOR / DESIGNER / ENGINEER
'3 r' iZI<YImar a)I A3 . 1~ .O
i o ilwi:i'tfR�C �;�-'LO T&L .00.�1�:U2tiY.��!' 9 • .
FQ BOX 5140
.200
k1'R'W(J&TP". CA. 92662
S,A2�.1B NAMM10 CA, 92A09
.
(909)381.-4M CDT.* 2129
j
USE OF PERMIT
STO.VLAN 3C: IDT.47- A,RRAUT' Tjdn tfCii' INCLUDE r
id K-Of.41,I.WPC)OUDR:iVB'8 AY'',APi'RO1&Cli•'M 1); PLAN Cl.-I&C"K, k.KK "
IRiEDUCT ION YOB' AIU'i,`MLtE IdSSIJA'WC'E OF R&ME MAN TYTIE
TRACT CONSTRUCTION' 3 nob III?
,
PClR'CI'ilt?a TIO3 98.00 SP
GARAnWCAMtC%RT KSI 333.ftti
FTf'.:Ek1a r i6' : SIU M:PJ.# ..Y.
CON;OTRUCTION:tFER 101.000-418.000'
ALAN CHECK FEE 1011-000439-318 Std9. fin
MECHMICA1,FED; 1€DI�41it�-� 3.d3U1� SI41.
ELECTRICAL tr�f:. 01-t 0t9�42t�-c`?Ufb . RB A G.7I
PL.Gi 9a11<t7 1 1E :' ' ' 101.000.419,.000 5134.75
f
STROND MOTION FE, Z AMID 101-000-24-1-000 $11.87
0Ii.1 D1N0 FEE Moo .
0FV1,, i%,I?q IMPACT FSE
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yy�7- �+{ `yE�y.[k4y �;.p/+�y {cy y /�p•.�y. q}' �q,�p��y/�
sY67{3' 4.��14:".YCIJ�r.0.1aiAi1{NS�.��.S,�6YSV lwd1L'v
gg /� `�,
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IXESS P°RE-FAI! FM
$0,00
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EIPT
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DATE f `. v� f
BY r#-':
tier
DATE FINALED
INSPECTOR
if �3
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Z7
Underground Ducts
Forms & Footings
Ducts
Slab Grade
_tri
Return Air
Steel
3��
Combustion Air
Roof Deck
CQr 34_
Exhaust Fans
O.K. to Wrap
7
7�2f-
F.A.U.
Framing
/
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall -Int. Lath
Final
Final
POOLS - SPAS
BLOCKWA
L APPROVALS
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
.j ((A
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
OX for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection_
�t
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
9�
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)
00000,
AUG -20-2001 1509 WESTERN INSULATION
909 686 8786 P,04i14
i
WE TERN INBULATIU , Lool
4211 Latham Street, Riverside, Califon%ia 92501
Tei. (909) 666-9760 Bax (909) 666-9766
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 3
LOT #: 47 J
SITE ADDRESS: X8670TMORN1NOtSTARWAY--LA- Q_ U�INTA�, GA
------ ----- --
EXTERIOR WALLS:
MANUFACTURER: JOHNS MANVILLZ THICKNESS: 3 5/8 8 -VALUE.- R-13
CEILINGS: BATTS BLOW
MANUFACTURER: GREENSTONE THICKNESS: 10.3 " R -VALUE: R-38
ICE LINGS: �BAS BLOW
MANUFACTURER: JOHNS MANVILLE THICKNESS: 13 ` R -VALUE: R-38
GENERAL CONTRACTOR: CENTURY HOMES
BY:
TITLE:
DATE:
INSULATION CONTRACTOR: WESTERN INSULATION, L.P.
LICENSE NUMBER: 794484 _
BY:
TITLE. PR CTION MANAGER
DATE AqGUST 20, 2001