0002-462 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapt$r 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
,� �i•:.1�t1 B l0,3irii�t
Dat a Signature of Contractor�.�� n...
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).
( ) 1, 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
Sefctio 700 of the Labor Code, for the performance of the work for which this
permit is issued. My workers' compensation insurance carrier & policy no. are:
CarrierPolicy No.
{igi..fiil;;i�i i�,1C?Ll 1Tv: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 b the workers' compensation provisions of Section 3700 of the Labor
Cod shall. s1 orthwith comply witb4hor_Msio s,/
D fe �� " Applicant d'" -
Warning: Failure to secure Workers' Compensati9 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 i nspectlon purposes. .rs�
Signature (Owner/Ag e`rit f• F Date �
BUILDING PERMIT PERMIT#
DATE +/ VALUATION S137.7.26.24) LOT 7(i TRACT ?,1714 -4,
JOB SITE 79.785 ORION WzXY
APN 649_03" 24
ADDRESS
OWNER
CONTRACTOR / DESIGNER ENGINEER
STA Rf.&GJAff M +NES I.0
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SAN B11-,WvIAIO N() ("A 92iW3
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USE OF PERMIT
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PLUMPINO VW 1014)00-41.9-13(10 8134 'e ti
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ART IN PkA3L1t' PLACk:st , RE31lr A7)1-000•-2'5-1300
I I -TC yi'AX. t -"f iN SPZ1.)('" !ON ANT) P1 -A%, Vl'►4P,tC'ryW
°WYAL
RECEIPT
DATE
BY `.
DATE FINALED
INSPECTOR
°
V %
u
INSPECTION RECORD
OPERATION
a
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
t MECHANICAL APPROVALS
Set Backs
Forms & Footings
.-
Underground Ducts
Ducts
Slab Grade
— o a
Return Air
Steel
Combustion Air
Exhaust Fans
Roof Deck apz�
O.K to Wrap
_ �Ft2C
F.A.U.
Framing
�� _
Compressor
Insulation
Z
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wali insulation
Condensate Lines
Party Wali Firewall
Exterior Lath
Drywall - Int. Lath
_
Final
Final
2 o
POOLS - SPAS
BLOCKWALL
APPROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. 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
COMMENTS:
Final eQ CO
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 / tea'
Utility Notice (Perm) p
NOU-21-2000 13:49 WESTERN INSULATION 909 686 8786 P. 2424
WESTOERN INSULATI"Kv INC
4211 Latham Street, Riva, de, California 92501
TeL (969) 686-8760 Fax (909) 686-8786 ,
INS ATION CERTIFICATE
r 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 1 PHASE: STARLIGHT DUNES - 23773-4
LOT # 20
SITE ADDRESS: 78785 ORION WAY, BERMUDA DUNES, CA.
-------------------------------------------------
EXTERIOR WALLS:
MANUFACTURER: JOHNS MIANVIUS THICKNESS: 3 5/E " R-VALUE: R-13
CEIIJNGS:ATTS BLOW
MANUFACTURER: GRE ONE THICKNESS: 10.3" R- VALUE: R-38
CE : BATTS BLOW
MANUFACTURER: JOHNS MANVILLE IC SS: 13" R- VALUE: R-38
GENERAL j;gNTRACT®R: CENTURY HO
BY:
TITLE:
DATE:,
INSULATI-ION CON TOR: WESTERN INSULATION, INC.
LICENSE .NUMEER: 481278
BY:
TITLE: I'RODUCTI N RAA
DATE NOVEMBER 2000
TOTAL P.24