0002-452 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I amlicensed under provisions of
f%rhapter 9 (commencing with Section 7000) of Division 3 of the Business and
Profession,als Code, and my License is in full force and effect.
,License'#- Lic. Class. Exp., Date
14i
Dat/ �7 Sgnature of Contractor
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 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).
() I am exempt under Section' B&P.C. for this reason
Date Signature of. Owner
ti
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:
,mer Policy No.
fF 01.131 t4 EAGLE, 1ivTS. '+ %IC 54406`4. -i
(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 Section 3,700 of the Labor
Code, I s all forthwith comply with th9.seisions.
Date—ZVWpplicant q
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 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.
f _
Signature (Owner/Agent) Date +
`
/ BUILDING�PERMIT PERMIT
DATE /�?l/VALUATION 1,;f'%,7y(S, Q LOT 10 TRACT 9 -
37/34ADDRE
JOB SITE
S/(((///,-4l4/69:i PISCEES .OUR
APN G�� -tB. f9-iif�0
OWNER
CONTRACTOR/DESIGNER/ENGINEER
"RI'ARI..I.GIT], DUNES LLC
C;I;1tit FURY CROWELL colvit"TilE S
PO BOX 5lX10
15:15 SO. "D" STREET, 42OU Y•.. L � ..
NEWPORT UEACH CA 92662
SAIN i3lskKAIRi INO : CA 924080
(900)38 a —5007 - C 1 #� t� 20 7
«h':
USE OF PERMIT
SN
OLE DWELL WOSM-LOFT
16 t'I...� 30& FORIVOT DOES NOT INCLUDE POOL OR
BLOCKWALI.S. -7MY,& VN AN C"Jr1ECK. FF8 itt3DUC.f'10 N F0.1:L M UL'1`t!'1 E
t SLfNoe- Yk SAt1IF- Pl,AN-fiCPE
TRLAC T s,ONST RUC MR4 2,376.00 SF
PORCI-1i K-114- 30.00 9F
C; �ARAUlYCA1tFC>R 424.00 S -F
• L.t,1'.��IY.Y.{'%A.Ml1 k�l-YiA� ��A• 'i.'i.i'3 `f 1.i i6.6'LC.1i.,115
.1:31f.6�J'.2V
('`(;X3`T'R.t1CTf0NFEE 101-000-4I18-000 SIM. 50
PY--0sCSiI C.-1{ rF I 101_(}M -439-W t5i{.6i
AIEC1-Y'"UCAL FM !.01-400-421-000
aEC`i: RfCAfi, M, 101-000-420-Cl00 $140..14
PL'LWBit4G I r E 101-0OW-419-000 $J :14.75
.
a rRc3;\fr a n rc3z�rt��i r fir. r rD IQ ( 0.2ea i Sl l x e �3,?7
, -•
C=:CAi)N,1 F11TN 101400-123-000
DT.;'VL,L0PMR 1W.AC`f F -E $1,rt)7.cJti
Ait'i' laid t U'81:.iQ PLA0E8 - €tESM 701-000-2"-000 $94,3«
`t3B-'3"twilit, r�NS7'RIa1C? I�Ji"i la:N!7 pt,AN t;11jC..h
;�z�7.gq �9^ ..
LESS PRE E-:1 AID FEES
sp0.00
Ti.OTA]., R.iERA;1117' .Y i 'ES' .13U �':1e OW
'.x'3.1:514.59
RECEIPT
DATE
B.Y (
DATE FINALED
INSPECTOR
INSPECTION RECORD
'OPERA
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
f BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
_
Underground Ducts
Forms & Footings
Ducts
Slab Grade
. pati
Return Air
Steel
Combustion Air
Roof Deck
�,
Exhaust Fans
O.K. to Wrap
�Q ery
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
-
Final
Final 21�
BLOCKWALL APPROVALS
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final I?i t 00
Utility Notice (Gas) .�! �y
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring ;
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior .Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
. II 9ci
Final
Utility Notice (Perm)
COMMENTS:
NOU-21-2000 13:44 WESTERN INSULATION 909 686 8?86 P.14i24
,r
WEST' I UIrATI I
4911 LEulam J$tMet, Rivgreide, California 99501
Tel. ") 6S6-8760 Fit (909) 686.9786
INSO ATION CERT H A`fiE
THIS IS TO CERTIFY THAT INSULATION HAS BEEN INSTALLED IN CONFORMANCE WITH
THE CUMRENT ENERGY REGULATION, CALIFORNIA ADMINISTRATIVE CODE, TITLE 24,
STATE OF CALIFORNIA, IN THE BUILDING LOCATED AT:
TRACT I PHASE: STARLIGHT DUNES - 23773-4
LOT # : 10
SITE ADDRESS: 43-695 PISCES COURT, BERMUDA DUNES, CA
gKIIERIOR WAA
MANUFACTURER: JOHNS INANVILLE THICKNESS: 3 5/8 " R -VALUE; R-13
BATTS SLOW
MANUFACTURER: GREENSTONE THICKNESS: 10.3" R- VALUE: R-38
CEILI GS: BATTS SLO
MANUFACTURER: JOHNS MANVILLE THICK 13" R- VALUE: R-38
GENFIRAL CONTFACTO.& CENTURY HOMES
BY;
TITLE:
DATE:
INS_ ; WESTERN INSULATION, INC.
LICENSE NUMBER: 481278
C
BY:
TITLE: PRODUCTION MA
DATE NOVEMBER 21, 2000
.i