0002-457 (SFD)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
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp.. Date
71418E A s0/31r2of
Date'? (Signature of ContractbF—� -/
S
"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).
O 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
Sidon 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.
00TAY N fcs'A,Ci1 L? 1N,"3. b'C '544061 ,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 to the workers' compensation provisions of Section 3700 of the Labor
Code, hall forthwi 'comply with ttWse, rovisions.
Dat . �'��Applicant
'J
Warning: Failure to secure Workers' Compen ation coverage is unlawful and
shall subject an employerto 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 fo080 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 i spection purposes.
Signature (Owner/Agent) ,W Date
J V
PERMIT#
t BUILDING_ PERMIT 0024'57
DATER/1 J- 0 VALUATION f E 'F'� �� } LOT TRACT 7� 77, gyp,
ADDRESS
'78-77 � ORION WAN' APN 6091ON-026
OWNER CONTRACTOR/DESIGNER/ENGINEER
�+? t v�au•r DUNES 5 r r f"''"t� 1 4' nr+ria: z r,�,r>t�r�t1 rttrr
.l�Y•f-LR11,♦ f,t.11 V. v 14.31 1w,b l 4.of/,. Y L11, C �' tt 4 A.fE Y -
PO BOX 5144 1535&0. ".D" ,S rRF.ET STE.1`r200 t r
NEWPOR'1`BEA.CH CA. 92662 SAN BERNARDINO C:!1. 92�09�
l�0�31'. r-bU:l7 2,0
USE OF PERMIT
,046L,E� F-PUN1,1L]' la1N LL.iAf�i
SF -1'r0 s 15 'PLAh1 sv ie .17INA rT DOES NOT INCLUDE 1001.011
HL0C:KZV.1ALL5. 75PA PLAN CHECK YFE liE'DUC'I+. ON YA NIU1,11PLE f ,
ISS'i,J"itl'CE Of- SA 413 PLAN `1 VN"s
'ki: ne C:1143 12Zi1PCN �-2,37F6,00Y .of
Si'
?Oi'le`r; i/?AT10 30A_ gN
GARA,C41J0ARP0R.T 124.00 SF .
rX.rUNMTEU.) COST OF CONSTRIX-MON
P'ERNiff FET,8UNIMARY
C+;+3idS9.RUC[ ION F88
101-000-418.000
5771.50
PLAN C HECK FFF
101-000-42W-318
$1518.61,,
'1z3C11AN31Ct1J1F
A`coo
$✓3.550
UEC`I'tilt:AL FF1
M-000-4120-000
S.140.14
i'yAilVtBINO FIX,
101-OW419 000
5134.75
41'RONO %1(1'flOW FHE- -RESiD
(01-0115-241-i?ti(1
V177
GlIZA lit* G FITI
101.-000-42131-000
$10.00
.Ax1' 1'N FSU)_4JAC P1,ACE-'.fZES1r�
70.1.-(!()0-255-000
$9432
137,72-6.20
!3VLVV r1_*AL (70MKI RUG" ION AND PLAN C U ..CK 1 s-ai294.5i)
LESS PRE RA.1P FEE'S $0.00
'&'MA1, Yk, 11:1111 NOW s3af)4.19
RECEIPT I DATE I BY B� I I DATE FINALED I INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set BacksUnderground
Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing — / —gyp
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
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
7—If
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final 2 1 CD
Utility Notice (Gas) i+Z
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)%2A,�J C{
COMMENTS:
;7
NOV-21-2000 13:47, WESTERN INSULATION 909 E6 8786 P.19/24.
T ' 1"Cle
4211 LaU== Street, RiV=*i", CaUfNT" 82501
Tel. @909) 686.8760 Pax (909) 666-8786
_
IN%SULATION C TIFICATE
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 / PHASE: STARLIGHT DUNES — 237734
LOT 15
SITE ADDRESS: 78.770 ORION WAY, BERMUDA DUNES, CA
�(TERlOR 1MALLS..
MANUFACTURER: JOHNS'MMNVILLE THICKNESS: 3 618 " R -VALUE: R-13 CEILINGS:, -BATT BLOW
i
MANUFACTURER: GREENSTO .HICKNESS: 1013" R• VALUE: R-38 i
CEILIN BATTS BLOW
MANUFACTURER: .JOHNS MANVILLE TRIC S; �DlR- VALUE: R-38
GENERALCONTH CENTURY HOMES �`,•
BY:
TITLE: ,
BATE:
I�1�lIL . 1QNC K&Sj I K. WESTERN INSULATION, INC.
LICENSE NUMBER: 481278
BY:
TITLE: PRODUCTION MA
DATE NOVEMBER 21, 2000
• i
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