0002-455 (SFD).= vLICENSED CONTRACTOR DECLARATION
JI`hereby affirm-under_penalty of perjurythat I am licensed under provisions of
Chapter 9 (commencing with Section 7000) of Division 3 of the. Business and
Profes^ionals,Code, and my License is in full force and effect.
License # - Lic. Class -Exp. Date
rn>
714199 i is tut s1/L�t!
I.
DatE� � �� •� Signature of•Contracta;'�J; •� .
OWNER -BUILDER DECLARATION
er
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 is not intended or offered for
sale (Sec. 7044, Business & Professionals Code).
( ) I, as ownerof the property, am exclusively -contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
() I am exempt under Section B&P.C.'for this reason
Date Signature of Owner
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penaltyrof 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..
cGi) L E.�iC7LL INS: NWC.: X440634 1. .
(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 sous to become subject to the
workers' compensation laws of California,,and agree that if L should become
subject to the workers' compensation provisions of. ection 3700 of the Labor
Code I shII rth 'th comply with those previsions
Da Applicant
Applicant �� r
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
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 L•a,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.'
Signature (Owrer/AgenV" Dat��
e
BUILDING PERMIT PERMIT 01.45. .
DATE/ 1 1� i VALUATION 81-37.32'],`Zo LOT '13 TRACT 23773-.4
ISSSI(
JOB SITE
ADDRESS 43••IIPIN�} ��I1�, ES i:OUK
APN
4i9JS-�'sil�-•�gRCB
OWNER
CONTRACTOR/DESIGNER/ENGINEER
:'.t`;.t�.i�.3i•1 K ": R; S !,I C
C.F:�1':'�J;�l' C:'.'�i�tilrlu;:,l; CQAn;tfi�11t11"�i1?S
PO .BO?s: 3140
1533 Ski. "13" ME3,37" s- rc. nod
Nk`tAlP0RTIMEA.CR CA 32662
SJiNBERNAR.I:ITNO . {A 92408
(909)381-60071 :l. - , 09
USE OF PERMIT
siNG E FAW41L Y" DW/1/Pi 1JNU
SFU -LO i 13 PLAN 3F0DR, PERE TT,MES NOT, 'F!�CL I)L POOL G4k
N#.l)f:KWA6-S. 7v"./o i'1,XV' CNk(:.K FRE 17Li7t C1'ttA4 Kilt .ivli;i3.TI1 L.0
f.SSUNC E OF' SANT k'LAfr4 TYPE
/
itiAL f CCENSTfiUCT1014 2.376.00 V
c;1\itb��t%�Vdi `{�I2`l 42-41.00 SF
,
.
&S INIATED COST OF CONSTRUCTION
137.327,2e?
r;JOI3S310JI 1'10N FEE 3.01-000-418-000 -V
III -A)`7 C>IE CK1•
i IE aiAMICl'if. F1i'u'' i01 -COO-42,11 4WO
fi1L C. T i2ICAL Flit 101.-000420-000 V40.14
PL UiM8INGFEE 10t-000-419-000 $134:.75
-
rfro{f1t C)'T'CEN i'f 7;•i F,SIT? t01. ()t1-�d'1 -l1l1Q Rt A,^rn3
f/,�RrYf
f>L"11k:L.tDt; rUR !i*v PACT F'EE
A:k':f [N .P(7E1L'1C," PLACES - M.SX '703.-000-2SS-OW
- _'_` .-`t.J±3 1'C�"�Af., 'C>NSJ'idli� f►C7A[ �ti't4���++yl�`7C€}i•�E�Cp'K,
;/S�ryw'.".
D r -
_11)T AL PERTNUT VOKS DUE N&W
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
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
Exhaust Fans
O.K. to Wrapv7�
,/ v
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
—-p
Drywall - Int. Lath
s
Final
Final
BLOCKWALL APPROVALS
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 Test
Electric Final
Waste Lines
/ pa .
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral_
Pool Cover
Sewer Connection
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
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
NOU-21-2000 13:46 WESTERN INSULATION 909 636 8786 P.17/24
W,ESTERN INSULATION' lNU •
9211 Latham Street, PImmido, Cali mia 92501
Tel (909) 686-8760 Fax (905)•6868786
1NISULATION CWICA�'E
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 - 23773-4
LOTS 13
SITE ADDRESS: 43-680 PISCES COURT, BERMUDA DUNES, CA
EXTERI®R 21;
MANUFACTURER, JOHNS MANVILLE THICKNESS: 3 518 " R -VALUE: R-13
BATTS BLOW
MANUFACTURER: GREENSTONE - THICKNESS: 10.3" R- VALUE: R-38
CEILINGS: BATT$13Lo
MANUFACTURER: JOHNS MANVILLE THI SS: 130 R- VALUE: R-38
GENERAL CONTRATOR. CENTURY HOMES
BY:
TITLE:
DATE:
INS-ULA►i-10N CO 6'TRAGMR: WESTERN INSULATION, INC.
LICENSE NUMBER: 481278
BY:a
TITLE: PRODUCTION M WAG
DATE NOVEMBER 21, 2
I
I N