0002-458 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
<s•hapter. 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
7143 88 B 1.0131/20(
i
Date/ I �l Signature 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)..e.
() 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.
�Q I, have and will maintain workers' compensation insurance,, as required, by
pteCtiod 3700 of the Labor Code, for the performance of the work for which this
ermit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier `" . I;; I .. Policy No. ., rr m a a
001; v41
F E1.0ME.rivS'. 7rdGd A?K1l6 r41
(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 the workers' compensation provisions of Section 3700 of the Labor
Cod�'�I s/Ilal�fo -with comply with ttaos �r, visio &-
Da e:.� r( Applicant—
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.
��j`x-
Signature (Owner/Agent) �'Date
BUILDING PERMIT
1,3DATE / to
VALUATION S137,726.20 LOT
JOBSITE
ADDRESS .78-7-50 3.
-50 ORION V A
OWNER
PERMIT #
tPi34i'L-�5�
TRACT 237734-
CONTRACTOR
:;7734
APN
CONTRACTOR / DESIGNER / ENGINEER
grARLIGH'T DUNIES LLC C;E1`: RJ:I'v 1CJR(.a Arr,fi; t 0,NA[ ,;Mfarit; c .
PG GJb 51 �i0 1535 SO. "D' STR FT,11200 • a
-,\rl~4UPOW1' 8i?A:CH C:s'i 9366? SAN BERN.Ai2.l INO CA 91409 s:
(909)381.-607 CSUIX120 - -,
IISF nF P�FtRMIIT��tt FAMILY DWELLING
" t
131,10C{a,W'.A7.:1..S. ?5% PLAN CHECK FEE tt}SC:1tJG"1`IU'N FOV, iti3d7LTIPL)
(SS'IJNCF CW SAAV3'NiLFU f'9"iCF'.E
`d'RACT CONSTRUC111101v. 1.,3161.00 SF
Pdl(IPA10 2h).00 SF
GAR AQEA,'�qd0Wf 424,W SY-'
.50
,6i
S;1
.'75
.77
'0
137.726. Nis
rSLIB-TM': J, ('.(lNti"fl;t lC1`ft"j4 ANV P'.,AN CHECK 4+3,7:94,59
( 11• 't.; t' 7"i "C1175
LESSES T(Y.f Al, .8 CR.tVl:rrf VKES .DTJE ti1OW $3,294<1.54)
RECEIPT I DATE
FINALED i INSPECTOR
t 0N3TJ(UC','r1C)N, FLI
101-000-41€-000
$77'
FT -AN C4?6= `14 _FTF
101-11W-419-318
Will
Z•7 `tlri ; '1"ES
1.01-000-412,11 -000
Sial
T?u:Ea,TC.1t.A( S.TE
01-000420-000
$.140
P t!(IBINCr FEE
101-000-413-000
$ 04
11'4't2_MOTMN f 0i i2 F'11"'41?
101, -111X) -IM f 411)(1
C;SAL`.''NC MEEl0i-Q`JQ
i:2:' v'E3J
s0
AR3 IN Kt?I•..1C PLACE•~,'S - ltfi'S :C 701-000-255-000
$94
.50
,6i
S;1
.'75
.77
'0
137.726. Nis
rSLIB-TM': J, ('.(lNti"fl;t lC1`ft"j4 ANV P'.,AN CHECK 4+3,7:94,59
( 11• 't.; t' 7"i "C1175
LESSES T(Y.f Al, .8 CR.tVl:rrf VKES .DTJE ti1OW $3,294<1.54)
RECEIPT I DATE
FINALED i INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms
Underground Ducts
_ & Footings
Ducts
Slab Grade
— —tv-p
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
�
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
_
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING
APPROVALS
Gas Test
Electric Final
Waste Lines
—
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
74
Encapsulation
Gas Piping
' / 7
Gas Test
Appliances
Final
COMMENTS:
Final
J 2 l 2 05 -
utility Notice (Gas)
(Z, 'A CL....�'`
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Law Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
�a7
NOV-21-2000 13:47 WESTERN INSULATION 909 66E.87206 P,20'24
ww TE SLIN 9 INC e
4211 Lat wim Sweet, Riverside, da1116roia 92501
T (909) 686-8760 Fax (909) 68EP-8735
..; INSIMATION R IFI�1�.��
THIS I$ TO CERTIFY THAT INSULATION HAS BEEN INSTALLED-IN CONFORMANCE WITH
THE CURRENT ENERGY REGULATION, CALIFORNIA ADMINISTRATIVE COLE, TITLE 24;
STATE OF CALIFQRNIA, IN THE BUILDING LOCATED AT:
TRACT / PHASE:, STARLIGHT DUNES - 23773-4
LOT # 1 e
SITE ADDRESS: 78.750 ORION WAY, BERMUDA DUNES, CA .
EXTERIOR WALLS:
MANUFACTURER: JOHNS MANVILLE THICKNESS: 3 518 " R-VALUE: R-13
CEI` S: BATT SLOW
MANUFACTURER: GREENSTONE THICKNESS: 10.3" R- VALUE: R-38-
CM GS• BATTS BLO�1
MANUFACTURER: JOHNS MANVILLE THICKNESS: 1 R- `'ALUE:,R-38
GENERAL CTnR: CENTURY HOMES
BY:
TITLE:
DATE:
CONTRACTOR: WESTERN INSULATION. INC.
LICENSE NUMBER: 481278
BY:
TITLE: PRODUCTION NAGER
DATE NOVEMBER 21, 200
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