0012-096 (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
IW31/2f
Date ` ? f% � Signature of.Contractor 01.
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that l•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:
(,) 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.
GOLDEN RAOLE 13,48, rsW+'444063:02
(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,
Ishall 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 Laboi
Code, I shall forthwith comply with those provisions.
Date: i. i i U! ,', Applicant—
Warning:
pplicant 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. = "?
1. Each person upon whose behalf.this application is made &'each person at s
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 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'property for inspection purposes.. { R
/�
Signature (Owner/Agentri S J f P,�'A1 Date r `
- -
PERMIT#
BUILDING PERMIT '
DATE VALUATION LOT 00% TRACT
$1.18,71.9.'9) 49 24773.5.
JOB SITE
ADDRESS
f- 8 'A0 0:RJ k)rNG 4T ". WAY
APN ,
I t •. -0 6
OWNER
CONTRACTOR/DESIGNER/ENGINEER
PO WX 3140'
1535 .50, dna D'Tx .T, S.M #200
NEWP Xf DIACS CSA, 924662
SPSIMMARMTO CA 924.09
�nfl;�3$��i50iY? t'3 2120 y.
USE OF PERMIT
ri Mme IF'Al'I:III..Y?!WTU wC3
Sy -p -PLAN 2t. R 'LOT 49 P'FIIRPt) .' r').0,03 NOT INCLUDE
%111,M C°HWK Fft
REDUCTION FOR MUMS 119St3M1C:E OF MUM, .Pl. AN TYPE
TRACT CONS5'RUCT1040 x,033. Do�;p
PORC;I'1tPATIO 49.00 SP
10ARAGEMARPORT (811) MUM
MMMATEd) COST OF CWF9fR'="1!0N
I 719,30
PERM17.11419N 8MMARY
CONOTRUCTION FXF, Lill Of o4l8-000 n,4:OU
Pt." CHECK FFE 102•.4013-439-318 $144,60
MECHANICAL FFZ 101-0m,421-000 MUD
ZI=TR.ICiAL1*,C SOI-faGila-= 20-000 $Ik2"17e
l'i..ElhAPTHO FRE 101.OW-4119.000 S13,435
S'I'ft0180 l40TI0N FEE - =81D 101-000-2,41-ODO $13:117
GRAW40 PER 101,00 -42 3L-000 $20,00
ous-,xvy ' ..1� ;k%�MION ME) k?1AN CHECK
$�9Cl$�6:s..
ASS PRE -PAID IS
V�3o
1 V+.. f Al.t Jl XX1'kY.•�a! .7 F' .:.A:r+f) .il1Y9 HO '1'0
EOali�
JAN 18.2001
• I _ tom, " ��
RECEIPT
DATE 6f BY j
DATE FINALED
INSPECTOR
g
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings 2 2Z
Ducts
Slab Grade
Return Air
Steel 3 C
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrapl� d%
F.A.U.
Framing l
Compressor
_
Insulation �G _� _
[[[[YYYY
Vents
Fireplace P.L.
Grills -
Fireplace T.O.
Fans & Controls
Party Wali Insulation
Condensate Lines
Party Wall Firewall _
Exterior Lath tp _ W5_
Drywall - Int. Lath y
Final/(o
BLOCKWALL APPROVALS
Final
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines ZI- `p_��
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral ��-
Pool Cover
Sewer Connection '2,122._ Ca
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final _/
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles 0-0
G.F.I.
Smoke Detectors
Temp. Use of Power
Final Z��yj
Utility Notice (Perm) —ill
COMMENTS:
FA
AUG -20-2001 15:10 WESTERN INSULATION
909 686 87GG P.06i14
WESTERN INSULATION, I J
4211 LaUwm Street, Rlverside, Cali&orrria92601
Tel'. (909) 686-8760 Fax (909) 686-8786.
INSULATION CERTIFICATE
THIS 18 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 #23773-6/PHASE 5
LOT #: 49._
SITE ADDRESS:__,_78 y90p MgRNING;STAR==WAY- -
LAOUINTA, CA
- t -
EXTERIOR WALLS:
MANUFACTURER: JOHNS MANVILLE THICKNESS: 3 5/8 " R -VALUE; R-13
CEILINGS., 6^: BATTS
MANUFACTURER: GREENSTONE THICKNESS: 10.3 " R -VALUE: R-38
EI I BATTS - BLOW
MANUFACTURER: JOHNS MANVILLE THICKNESS: 13 " R -VALUE: R-38
GENERAL CONTBACTOR; CENTURY HOMES '
BY:
TITLE:
DATE:
INSULATJ®N CONTRACM: WESTERN INSULATION, L.P.
LICENSE NUMBER: 94484
TITLE: PRO TION MANAGER