0006-059 (SFD)LICENSED CONTRACTOR DECLARATION
hereby affirm under penalty of perjury that I am licensed under provisions of
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
Date '�f Signature of Contractor
r
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
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:
Garner CI41.Tj$N HAC3LE INS, Policy No. - NIVC-344063.02
(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' comp nsation laws of California, and agree that if I should become
subject to the orke/s' compensation provisisp �f Secti • n 370 of the Labor
Code, hal �Applicant—
Warning:
go�mply with,t-20 gyp• -o Islons
Date: Failure to secure Workers' Compensation coverage is.unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize re resent, fives of this City to enter upon
the above-mentioned grope • ` 'e tin rposes! j
Signature (Owner/Agent Date
PERMIT
BUILDING PERMIT .
'`
DATE -�/ ) VALUATION LOT ,TRACT
t�J(. 11 tl►1. 75.6 79.20 Q�b77•S
JOB SITE
APN N
ADDRESS 43c4.J'7"ADUS Cut=
6U9 -CJ -0i
OWNER
CONTRACTOR / DESIGNER / EN (NEER
1535 50, Til 91=7y, =13 200
15351301 "D" -Tr—pk "I°, FIM 0200
SJW . MZNARDW0v CA P2408
aW RFM4ARDINO CA 92408
(909)381.6007 CBL# 2120
USE OF PERMIT
SNOIX FA2,t[ ff DWX Ci
SFv. PLAN 4CLA L.OT42 PERMIT DORS NOT INCLUDE F.tLOCI:W,t LLS OR. '
POCIL7$%PLAN CHECK) EE REDUCTION FOR MULTIPLE ISSUANCE OF
SAME PLAN TVP?_
r
TRACT CONSTRUCTIOrN 3,000, Do SP
POIZCHIPATIO 28.00 ISF
CIARACIFJC'ARPORT (SP) 12,406.80
I Um COST OF CONSMUCilon
175,67920
P1yM1C MJ E SUMMARY
CONSTRUCTION RUCTION FEE 101-000.418.000 $905.50
PLAN CHECK ME 101-000-439-318 Sia,7.21
MECHANICAL M; 101-000.421-000 $92100
ELF•C: i TICAL. I'EE 101-000-420-000
PL13MBTNO M 101.000.419x000 $162,50
'
:;T>1,0Ns. MOTION FEE - MSID 101-000-241-0001. $17.37
GRADING FEE 101-000.,423>000 120.00
DEVELOPER IMPACT PEE �i,9iY1.00
S'LJ33-`D`L`AI. COl`di'[�2 lJCfiiC)A1' A76 PT,i CI C
$3,442.94
LESS 1 RF;-PA'CD M2
$0.00
NOW
&3,442.94
...! :. !
�4
1111 ,f it,•..Tl.�
R'BY�'4
RECEIPT
DATE
)
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs—;7
Forms & Footings
Underground Ducts
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
_
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Insulation
,�
- ��6�
Compressor
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
_
2 a
Drywall - Int. Lath
Final
_
Final 31301
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
= / 2 -Z v F ZtT
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
�V
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
Final
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 \-Z
Final
Utility Notice (Perm) 2\Z 8(
COMMENTS:
WES'T'ERN INSULATION, INC.
4211 Latham Street, Riverside, California 92501'
Tel. (909) 686-8760 Fax (909) 686-8786
INSULATION CERTIFICATE
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 23773-5
LOT # 42
SITE ADDRESS: 43-635 TAURUS COURT LA QUINTA,'CA
——————---———--———--—————————————————————————--————————————————————————
EXTERIOR WALLS:
MANUFACTURER: JOHNS MANVILLE THICKNESS: 3 5/8 " R—VALUE: R=13
CEILINGS: AT BLOW
MANUFACTURER: GREENSTONE THICKNESS: 10.3 R= VALUE: R-38
CEILINGS: BATTS BLOW
MANUFACTURER: JOHNS MANVILLE THIC ESS: .13" R— VALUE: R-38
GENERAL CONTRACTOR: CENTURY HOMES
BY:
TITLE:
DATE:
INSULATION CONTRACTOR: WESTERN INSULATION, INC.
LICENSE NUMBER: 481278 ,
`BY: s
TITLE: PRODUCTION M NAGE"
DATE