0012-104 (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 P 1 r • 10 •tl2C
,/Date `/O� %�� Signature of Contractor �", - "T,7/ ✓,�� �`
- a ✓" e ..
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjurythat 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 ofthe following declarations:
() I have and will maintain a certificate of consent to self -insure for workers'
compensation, as provided, for by. Section *37001 of the Labor Code, for
performance of the work'for which this permit.is.issued.
(J 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. x
001,09141.A01,9INS, h�idC S�i13�3-0;a
(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 Secti6n`3700 of the Labor
Code, I shall forthwith comply with those provisions.
Date: J`tc✓ ,� Applicant
40l,f - 4'',
Y
/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 onhis
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 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 propertyfor inspection purposes.
Signature (Owner/AgentDate'/)'r}"�
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 00121104 TRACT.
Y. fl, 3tiJTd 48 2r�7-l3iS
JOB SITE
APN t
ADDRESS 78-M MORM4 ` .,"BAR WAY '
'_WM6 .
OWNER --
CONTRACTOR / DESIGNER / ENGINEER.
.TrAR ..FGIV DUM- 3 LIC. '
CMTIoply CSO S. CrobagUFdIMUS
PQ DOX 5140
153:3 SC. `DY M R '1', UTE5 0200
(909)381�, 007 ` C 4 2120
USE OF PERMIT
MOIX FAMILY &)W.'Lx.UM,
SSyyIFI/°1-AP�LyA�1try14y 3',e£�R�,�pplyp.//�i//`X.�,,'}�1�3 -PERMITirpg&,Yf,.7+t:At3y+r'���ytS95C1'p1'yD�iy�yZ:I.UDE .
lllJhiY.rR9.�TJIv.1Jip?A O,0CYd.�R1 L"i7AY APPROACH,
`9'RAC!' CONS T RUCT1044 3;450.G0 VF
fORCWP.ATIO 29.00 SY
0AR.I1MUCARPORT C. -F) - %173,20
PIMMI 'F LT 9014tI Any
C'OM',TrRUCT34N AKE 101-000.418-W-0 �'73fr,50
Rt 014 CFitt;M PIKE 101-000 -439-318 OVA
M C1-FNHICALYZE 101-000-421v000 877,30
ELECTRICAL P911 1(i 1-fl�1 �l?d1-fiilt7 d! 77 S9
;PLliMBW0 FUZ 101.000.419.000 1134,'75
A
STROND MOTION F E - RESLID 101 -OW -241-000 $14,16
CKA.WN0 IfLE..$29.00
DEI2.11OiPF0, IMPACT FEE $1,91)I,OA
'
n q
RC1!" AL Ci;fll�'"i`.CS1I+3Ly
ESO FrCE-PAID AMU`
UM
2401 MESDUENO
,AN 18
��fr %1eEMMET
RECEIPT
DATE/
BY
DATE FINALED
INSPECTOR
:U .
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
2AOr7' _
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Steel
Roof Decker
O.K. to Wrap
Framing
%2to
/� ado'
6
Return Air
Combustion Air
Exhaust Fans
F.A.U.
Compressor
Insulation
Fireplace P.L.
_� _
Vents
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall _
Exterior LathB_
Drywall -Int. Lath � /%��—
Final
Final
POOLS - SPAS
BLOCKWA
PPROVALS
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
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
C_
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas) �
-
ELECTRIC 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)
AUG -20-2001 15:10 WESTERN INSULATION 909 686 8786 P.05i14
WESTERN INSULATION s L. Pe
4211 Latham Street, Rimeide, ew i rriia 9750 i
TeL (909) 686.8760 Fax (909) 686.8786
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 #: - 48
SITE ADDRESS: 78-890_MORNING-STAR-WAY: LA=QUINTA, CA
............. .................... .----------- =- -------•-
EXTERIOR WALLS-
MANUFACTURER: JOHNS MANVILLE THICKNESS: 3 5JO " R -VALUE': R-13
CEIIIIdGS: BATTS =BLOW
MANUFACTURER: GREENSTONE THICKNESS: 10.3 " R -VALUE: R-38
CEILINGS; BATTS SLOW
MANUFACTURER: JOHNS MANVILLE THICKNESS: 13 " 9 -VALUE: R-38
GENERAL CONTRACTOR: CENTURY HOMES
BY:
TITLE: e
DATE:
INSULATION CONTRACTOR: WESTERN INSULATION, L.P.
LICENSE NUMBER: 794484
BY: C
TITLE: PR4ia ON MANAGER ,
DATE AU ST 20, 2001