0002-454 (SFD)LICENSED CONTRACTOR DECLARATION
U) I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapt�
qr_q'"(6ommencing with Section 7000) of Divi iS
ioln 3 of the Business and
Professionals Code, and my License is in full force and effect.
M Exp. Date
O
Li6ense # Lic. Class
04) . 1.1-114188 B - - I
LLJ
r` r
6 r� Date Signature of Contra
0.
r- I.— C) OWNER -BUILDER DECLARATION
0 (0
W W I hereby affirm under penalty of perjury that I am exempt from the Contractor's
U) License Law for the following reason:,
Z_ 1, 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).
( ) 1, as owner -of the property, am exclusively contracting with licensed
contractors to construct the project'(Sec. 7044, Business & Professionals
Code).
C0 I am exempt under Section B&P.C. for this reason
LO
C\J Date Signature of Owner
0 C\J
0)
< WORKER'S COMPENSATION DECLARATION
CL I
C:),� Z one of the following declarations:
LO < Cr I hereby affirm under penalty of perjury
, I.� O. ( ) I have and will maintain a certificate of consent to self -insure for workers'
X UJ, compensation, as'provided for by Section, 3706 of the'Labor Code, for the
m_J < performance of the work for which this permit is issued..
J
<- (')( have and will maintain workers' compensation insurance, as required by
O 0 S461ion 3700 of the Labor Code, for the performance of the work for which this
cl: Lo �ermit is issued. My workers'' compensation insurance carrier & policy no. are:
a)
Carrier Policy No..
co 5 00LIMEN EAGLE INS. NWC 5�14065-01
< (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 tgthe Workers' compensation -provisions of)Sec 'on 3700 of the Labor
th comply W 0, 7
Code I �h g prbv*s(orrs.
epro
Date: Applicant _e'
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal lSenaltiesand 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 performid -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
pi nsj,5jec on 371
v S(
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 forlinSpedon purposes.
. I.. - .1
Signature -(Owneir/AgEin`f;',�Date
PERMIT I
BUILDING PERMIT W, K 12- 46 4
DATE VALUATION S.1.17.726.20 LOT 12 TRACT 2-1771-4.
111NO
J ADDRESS
OB SITE 43-690 FACZSCOURT APN if �_()Jfo
OWNER CONTRACTOR/DESIGNER/ENGINEER
I'lu(C
C.':,:�TTURY,CROWML COMM. 311TIES
X) BOX 1140 1535 2:10. 1)- MUM. SM. 9200
NF,WPQR1'.88AC1H,, CA 92662 SAN 1iVkWA.KDtN0' CA 92408,
(PN)IST-6007' ent'o. 1.10�
USE OF PERMIT
&3vGL6 FANICLY fAVELUNG
SED D_a4
-LOT 12 PLiQi 301CK- P IT' DOES 140T INCLUDE POOL OR
ti U Q C K W AL L S. I K AN C& -'C K FEE RL, 0 U C J.J 0 N FOR ki U LT JA E
ISSUNCE OF &Va PLAN TYPE
TRACTI" co*ti,,r),,TwjcvoN,, 2, 7/ 6. 0, SF
F
POR
4UAKA0FJCiUfY0Wf 424.00 Sr'
N ISTINW. ED CUST Ole COINS RUC ITPINT,
PKIINM FAC SOMMARV
CONS'1'i;` X740N FEE
101-000-418-000
�M.50
(7M1„K- FFTF�
IM -OM -41.9 -Mg
$15861
TYIECHANWAL FIM
10 t-00042:-000
35111110
WiJECTIUCAL VEE,
101-000-420-000
914�0. 14
K WNW ING "FEE
101-000419-M
$134.115
S ck V()f!QNF F!- -!u_s11)
RINVIRNG FEF
000a
101-0042-30
j7
.)EWLIOPFIR ft&ACT FEE
si,907,.00
$94.32
'R-T(ITA'G C.0
I EVS PfLT-" T1
'Pe
-TOTAL PMMIT FEE-44.4VUENOW. 1 53,294.59
RECEIPT DATE B -DATE FINALED INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
, Set Backs
Forms & Footings
Z _
Underground Ducts
Ducts
Slab Grade
(
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
_p�
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
ryy
Drywall - Int. Lath
✓��
Final
Finalest -POOLS-SPAS
BLOCKWALL APPROVALS
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
09
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) 1
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 13:45 WESTERN INSULATION 909 686 8786 P.16i24
WES
T' In
iTI�AI� I1�C
4211 Lenham timet, Rivereidc, Cedilbmin 92501
TeL (909).6$6-8760 Fax (909) 686.8766
'EN9TJL&TiON CEIFICA"TE
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
LOT # : 12
SITE ADDRESS: 43-690 PISCES COURT, BERMUDA DUNES, CA
-------
EXTERIOR WALLS:
MANUFACTURER: JOI'iNS MANVILLE THICKNESS: 3 618 " R -VALUE: R-13
CEILINGS: BAr1rS BLOW
MANUFACTURER: GRE THICKNESS: 10.3" R- VALUE: R-38
CEILINGS; BATTS BLOW
MANUFACTURER: JOHNS MANVILLE TRIC 13" R- VALUE: R-38
QUIERAL CONTIG QUIR: CENTURY HOMES
BY:
TITLE:
DATE:
INSI&ATION CONTRACT WESTERN INSULATION, INC,
LICENSE NUMBER: 481275
BY:
TITLE: PRODUCTION MAMA
DATE NOVEMBER 21, 2000