0012-101 (SFD)• Y
LICENSED CONTRACTOR DECLARATION
lihereby affirm under penalty of perjury that I am licensed under provisions of
Cha$ter 9 (commencing with Section 7000) of Division Sof. the Business and
itrofessionals Code, and my License is in full force and effect:
License # Lic. Class Exp. Date
ate �•¢ �/ l
Signature of Contractor
V
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
(:) I, as owner of the property, or my employees. with wages, as. their.sole
compensation,: will do the work, and the structure isnot intended or offered for
sale (Sec, 7044, Business &'Professionals Code).
( ) I, as owner of the property, am exclusively contracting With licensed
contractors to construct the project (Sec. 7044" .'Business & Professiohi is
Code).
O I am exempt under Section'.,',B&P.C.�forihis reason
Date '' Signature of Owner •
'WORKER'S 'COMPENSATION DECLARATION
I hereby,.affirm under penalty of perjury one of./tHe following declarations:
(,) I have and will maintain a certificate of consenf•to self -insure for.workers'
compensation, as• provided foi by; Section 3700 of the Labor Code fortle
performance of the work;for which this permit, is issued
O1 I have and will maintain workers' compensation Insurance, as required by
Section 3700 of the Labor Code,. for the performance of the Work for which this
permit is issued: My'workers' compensationinsurance carrier &"policy'no. are:
Carver Policy No:
L,I?fft;T dSAOS�$ INS.. , . • AY'�iC4940.60.07
(This section need not be completed if the permit valuation is for $100.00 or less).
O 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 forthwith comply with those provisions. ! ,
Date: 111416 APPlicant -; 1 !?1 10 14
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. Section',
IMPORTANT Application is' hereby made to the Director of Building and.Safety
for a permit subject: t6 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 'r
& 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 ofsuch
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. 1 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 purposes ,` yy
Signature (Owner/Agent )/3 t��'t~ Date f
"'BUILDING PERMIT PERMIT# ;
DATEPAL VALUATION LOT�•TRACT
SAA. 9I753d;373�5
JOB SITE
ADDRESS 7,Q4 .kY9.07E?NWG SUR WAY*
APN
OWNER - - -
CONTRACTOR/DESIGNER/ENGINEER
VTAR,.L.. GI ONES LT
C"�]'f'fi.�RY �O UAL C0104314UM
PO B>;iXS M0 .....
1535.30. 'Do S"J.'C 9200
Nt?'WPi OR BRACT CA 92662
ffA11PM- VT.A.R1. Y1N0 '; CA 92408
21,20
-
USE OF PERMIT - - --
MOTE- FAY Dw Lngo ,
'SND,tPI.P. V X %iJT 5.1'- PERmi? &QOM'0010 IN LURE:
;
BL0CXW AL1,5 F'C 0L9fKbR1V, '1AY APPROACH. 75% PLAN I; HT OK FEY
REDUCTION FOR MUi. 1PI. f, ISSUANCE OF SAW, PLAN TYPE
'RCT CONSTRIIC`,? ION 7,Q59 tdt1: F
POkC ittPA VO �t4:flU S#
C' LB#f.IUerAii'I ORT (9F) knn,20
&'.8L&6C[ r J7 F, CluAV386'J,BtI i .. :.
CONSTRUCTION ME . 101-0_00-419 00 Y
P,IJJ4 C:;-rECK VFX l Ui. x•000-439�3I8
Ya4.ECE•lMICAI; "a 101-000-421-000 V7,00
M.,iBrrCTRIC!?,: ,.I!' I6.1-000-420.000
PIAT d? BIND V : ' .101.000-419w'0f3Ct
STRONG MOT1.014 IES; n RESIi3 101-000-241-000
1�.aik7il"YC's E& SAGO
!7i?S ELOPP.R IVIRACT FFA $iF,?biY7:0i►
H
SU13 10TAL. C01, MxRLiC;`d1,0X AND P 3• CHECK
74
$3,228.60
IX.93 PPM -PAID MW
$0,00
• JAN ,1 8 "2001
RECEIPTj,
DATE
5 1
BY. _
DATE FINALE[
INSPECTOR
,
t
INSPECTION RECORD
V OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
$
Underground Ducts
Forms & Footings
_���
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
O.K. to Wrap
S _ �j�
Exhaust Fans
F.A.U.
Framing
Insulation
Fireplace P.L.
_ _
`� _
_ /_
Compressor
Vents
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL AP ROVA S
POOLS - SPAS
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 rest
Electric Final
Waste Lines
Zl��
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
2`2Z
Pool Cover
Sewer Connection
_2Z
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 Qunta
80ilding and Safety �roF
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: 78-885 MORNING STAR WAY
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0012-101
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL
Owner of Building: CENTURY CROWELL COMM.
Building Official
Address: 1535 S. D STREET, STE 200
City: SAN BERNARDINO, CA., 92408
By: DANIEL P. CRAWFORD JR.
Date: 9/21 /01
POST IN A CONSPICUOUS PLACE
=0=
AUG -20-2001 15:12 WESTERN INSULATION 909 GGG 9796 P.10i14
WESTERN INSULATION t Lo Pe
4211 Latimm 8troet, Riverside, CallfcmLs 92501
Tti. (909) 686-8760 Fax (909) 68&878e
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 5
LOT #: 63
SITE ADDRESS: 78-885 MORNING STAR WAY. LA QUINTA, CA
EXTERIOR WALLS:
MANUFACTURER: JOHNS MANVILLE THICKNESS: 3 5/8 " R -VALUE: R-13
CEILINGS: BATTS
MANUFACTURER: GREENSTONE THICKNESS: 10.3 " R -VALUE: R-38
CEILINGS:BATTS BLOW
MANUFACTURER: JOHNS MANVILLE THICKNESS: 131, R -VALUE: R•38
GENERAL CONTRACTOR: CENTURY HOMES
BY:
TITLE:
DATE:
INSULATION CONTRACTOR: WESTERN INSULATION, L.P.
LICENSE NUMBER:: 94484
BY:
TITLE: PR92'070N ON MANAGER
DATE AUGAT 20, 2001
.w„
Certificate of Occupancy
City of LaQuinta. �l
Building and Safety DepartmentoFti
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 variousordinances
of the City regulating building construction. or use. For the fol%wing:
BUILDING ADDRESS: 78-885 MORNING STAR WAY
Use Classification:
SINGLE FAMILY DWELLING
Bldg. Permit No.:
0012=101
Occupancy Group:
R-3 Type of Construction:-
VN Land Use Zone:
RL
Owner of Building: CENTURY CROWELL COMM. Address: 1535 S. D STREET, STE 200
r
Building Official
City: SAN BERNARDINO, CA.', 92408
By: DANIEL P. CRAWFORD JR.
Date: 9/21 /01
POST IN 'A CONSPICUOUS PLACE
e