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Y 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
G?rofessionajs Code, and my License is in full force and effect.
..aLicense # Lic. Class Exp. Date
Date 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:
( ) 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).
( ) '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
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•wcrk.for which this
permit is issued. My workers" compensation insurance carrier & policy no. are:
Cartier Policy No.,
00LII: EN 11A OLE INS.
(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 shall forthwith comply with those provisions.
Date: Applicant '
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject ad 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 onhis
application. . .
1. Each person upon whose behalf this application is made & each.person of
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to'l 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.
Signature (Owner/Agent) Date
= BUILDING PERMIT PERMIT#
DATE VALUATION LOTQttd¢s6i•��f11 TRACT
JOB SITE
APN
ADDRESS
78-16S 10,TUOR WAY
OWNER
CONTRACTOR/DESIGNER/EN INEER
tGA.��+l�"�a�i'F�
PO BlYX 5140
r� DCS, "Do nrno�er, r��', t�ixw
MWORT SCACrfla . CP, 92"x2
RAN BE dNia,�'�C.'131; O ' CA, 92,,408
(90.9pla1-6007. CBT -41 2120
USE OF PERMIT
i� F"BLY LMMILWO.
f1 -L+)`3' !g PI. A14 �41P kl ?1?�1:'d/t,IT 001 S 140 T 1'NCI.lYL�L� POOL 0
4 L0C"X1•VA,.X.'1S"'r'o PIA14 Cl -WOK, .CiSLe EcRDU T1014 tails M111.TIPI
1.1SLYANCY OP SNUB PLAN TYPE
Tii. kc- is010M-P, Ruff TION 9;60100 S
,
POPIC,tifpWrio 24,00 SF
,
C0:mT11.umIoN 1:•Llr 101 -00-418-000 ffi��8.59
PLAA CRECK FrIS lot -000-439-319 $170.0 .
1U1 ORANICA1.PER 101.000.421.-000 $79,00
EL,'1"(::'f,'t;.lri A.L VIM, 101-(1(10420-000 $152.20
1'1:.114 Ball FEE 10 1 -0100-419-000 $134.71
STRI WI MOTION FF;1; -1a.:WID '101-000-241-000 $15.39
Es31,d41X11' 1�T :1X31 -000.423 -CW'
6J1?'tl'VI,C1PER 1NIPtt„✓ T r/28 $1,007.00
.ART IN l'US iC IPL.AC-91 - RUllw 701-000-255-0013. st3A.36
V3,142.67
LXV5PRE-PAID 1J4
'P91AT, PFXWr 11'2195 DUE NOW
442,67 -
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD �0
`f
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
_ BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs %(a-
Underground Ducts
Forms & Footings
_
/�
Ducts
Slab Grade
_
Return Air
Steel
Roof Deck
_
Combustion Air
Exhaust Fans
O.K. to Wrapr
F.A.U.
Framing
Insulation
Ov _
Compressor
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath ��
n
Drywall - Int. Lath
Final
Final
1?�2?h�
Csr�
POOLS - SPAS
BLOCKWALL APPROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
_
Waste Lines /�/�
6
Electric Final
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans��/3��
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
-
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
,
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)�`—
NOV-21-2000 '13148 WESTERN INSULATION 909 686 8786 P1*23i24
WESTERN I ,ASI 9 INC
4211 Latham Street, RIVOS10e, CaMmia 92601
TeL (909) 666-8760 Fax (904) 686.8786
INJI ATION CERTIFICATE =
t THIS IS TO CERTIFY THAT INSULATION HAS BEEN INSTALLED IN CONFORAIIANCE WITH '
THE CURRENT ENERGY REGULATION, CALIFORNIA ADMINISTRATIVE CODS, TITLE 24,
STATE OF'CALIFORNIA,.IN THE BUILDING LOCATED AT:
TRACT I PHASE: STARLIGHT DUNES - 23773-4
LOT # ; 19,
SITE ADDRESS: b8-765 ORION WAY, BERMUDA DUNES, CA
E3 ERIOR WALL
MANUFACTURER: JOHNS MA AWILLE THICKNESS: 3 618 " R-VALUE: R-13 `
CE9LIN ATT$ BLOW
MANUFACTURER: GREENST THICKNESS: 10.3" R- VALUE: R-38
C iLE INGS� BATT9 BLOW
MANUFACTURER: JOHNS MANVILLE THICKNES& 13 R- VALUE: R-38
GENERAL MIRACTM CENTURY HOMES -
BY:
TITLE:
DATE:
INSULATION-CONT ACTOR-: WESTERN INSULATION, INC.
LICENSE NUMBER: 481279
BY:
TITLE:- PRODUCTION M
DATE NOVEMBER 21, 2000 .- ,