0012-105 (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.
Licens
e
y# q y Lic. Class Exp. Date
p.�
/at e. �f "r' 'l •Signature of Contractor. . •`'�'
' OWNER-BUILDERDECLARATION 1
I hereby affirm under penalty of•perjurythai'l am exempt from the Contractors
License Law for the following reason:
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fas 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).
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:
(.) .1 have and will maintain a certificate of consent to self -insure for workers'
compensation; ,as provided fors by Section 3700 of the.Labor Code,'for the
performance of the work for which this permit is issued
( )a 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. '. ; .
(This section need not be completed if.the-permit valuation is for $100.00: or less).
( 3)• 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.tne
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 'shallorthwithcomply with those provisions.
Date: .f f .! i is 7;,,, "Applicant
I.Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penaltiesand civil fines up to $100,000; in
addition to the cost of compensation, damages as provided for in Section_ 3706
of the Labor Code, interest and attorney's fees. '
IMPORTANT Application is hereby made to the Director of Building and Safety
for apermit •subject to .the. conditions -•and restrictions set forth on .his.
application. ?; '
1. Each person upon whose behalf this application is made & each.person at
whose request and for whose benefit work.is performed under or pursuant to.
any permit issued as a result of this applicator agrees to, & shall, indemnify
& hold harmless the City of La Quints, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null'anclvoid if
m
Work is riot comenced within 180 days from date of issuance of such
permit, or cessation of work for 180 clays will subject permit to cancellation.
I certify that t have read this application and state that the above information is
correct. I agreeto comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon'
the above-mentioned property for inspection purposes. J
signature (Owner/Agent) ' Date
BUILDING., PERMIT PERMIT# j
DATE VALUATION LOT. 00;12405 TRACT
JOB SITE
ADDRESS 115WEAR NVA
APN
—HORNING
OWNER
CONTRACTOR/DESIGNER/ENGINEER.,
ffP.AiIRU£3•,1 I'DiildE S X.l.Ct .
CENJIURIF*GRCaV+T�a7 L a �owidUKT112:8
JPO DOX S 140
1535 so. ".C3"'% i-r.m #200
MWP0R1'RRJC1i CA, 9266.2
SAW BUNA$,.DIN0. (*,A V2408
t;�f9Sy �;�1 aEOO� CPUt'
USE OF PERMIT
SFO>PL,AN'4A LCIT.54-PERMIT DOES NbT INCLU61I '
EBFOCtCWAY..1(MPOC►LIL)ItfVk,VATA.k'k'Rt3,ACt
TRACT C'ONSTRUCa ON OF
PORCH:PA'1`.IO d .ti0 S$'
CA,RAWCAP.POR''i QST
%' 't�!;<!UTED .d 090 C��'. C S'i'7�'C`:�ON .
17Syk6� '10
PLAN C;3^xi.. X Felt. t 0*1-000-4?9-a R pt
a 101.000.421.000..
P-1.=TRIC:.ALrkkP,. ; 40Syt7t�t?�.��Cd»£ftif9 $i l., tr
FLUMBIHO F&A. 101-000419-000 SWIM"
S'f'40NO MOTION FM, — RESID 101-000-241-060 1.17 5
ORADINO'FER. I Q1 -000-423-000 $20.00
6W?4- C014M.IRUCI'Ir3i AM 1 T—W Cl3ff=
$4,004.58
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_ JAN ,y�•82001 � ' :
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RECEIPTDATEf
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BY ,. r
DATE FINALED
INSPECTOR
U raj.
i
INSPECTION RECORD
e --
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
'
Underground Ducts
Forms & Footings
Ducts
Slab Grade
(
Return Air
Steel
�-2 (moi O�
Combustion Air
Roof Deck
'�—�
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
_ 6
Compressor
Insulation
—Y
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
BLOCKWALL APPROV LS
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
7i (
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
CAv:t�
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)
(Certificate, of Occupancy
City .'of La Quinta
Building -and Safety Department 6' F.
This Certificate issued pursuant to .the requirements of Section 109 of the Uniform Building Code,
certifying that, at the time of issuance, this structure was in compliance with the various ordinances
of the City, regulating building construction or use. For the following:
BUILDING ADDRESS: 78-875 MORNING STAR WAY
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0012-105
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL '
Owner of Building: STARLIGHT DUNES LLC
Building Official
Address: PO BOX 5140
City: NEWPORT BEACH, CA., 92662
By: DANIEL P. CRAWFORD JR.
Date: 9/19/01
POST IN A CONSPICUOUS PLACE
,,
AUG -20-2001 15:12 WESTERN INSULATION 909 686 8756 P,11/14
VMTERN INSULATION 9 L.P.
4221 Latham Strut. Rhrmlde, California 92601
TeL (909) 6M-8760 Fax (909) 086-8786
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 #23773-5/PHASE 5
LOT # : 54
SITE ADDRESS: 78-875 MORNING STAR WAY. LA QUINTA, CA
EXTERIOR
MANUFACTURER: JOHNS MANVILLE THICKNESS: 3 5/8 " R -VALUE: R-13
CSILINGS: BATTS BLOW A
MANUFACTURER: GREENSTONE THICKNESS: 10.3 " R•VALUE: 8-38
�ATTSSLOW
MANUFACTURER: JOHNS MANVILLE THICKNESS: 130 R•VALUE: R-38
GENERAL CONTRACTOR: CENTURY HOMES
BY:
TITLE:
DATE:
INSdJLAT10N CONTRACT.Og� WESTERN INSULATION, L.P.
LICENSE NUMBER: 784484
BY:
TITLE: P D ION MANAGER
DATE AU ST 20, 2001
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('_nrfifir�fu of nrrunanr�i ,�-..,
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City of La Quinta
�oFtiBuildin and -Safety Department
This Certificate issued, pursuant to the requirements of Section 109 of the Uniform Building Code,
certifying that, at the time of issuance, this structure was. in compliance with the various ordinances
of the City regulating building construction or use. For. the following:
BUILDING ADDRESS: 78-875 MORNING STAR WAY
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0012-105
Occupancy Group: R-3 Type of Construction: VN ' Land Use Zone: RL
Owner of Building: STARLIGHT DUNES LLC Address: PO BOX 5140
` City: NEWPORT BEACH, CA., 92662
By: - DANIEL P. CRAW FORD JR.
Date: 9/19/01
Building Official
POST IN A CONSPICUOUS PLACE