0005-334 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions -of
CQ)ter 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
7A
1 13 0/31/2(
Date f l�Signature of Contraeto,t -
P OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that_1 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 isnot intended or offered for
sale (Sec. 7044, Business & Professionals Code).
( ) I, as owner of the property, am exclusively contracting with licensed
contractors tot construct the project (Sec. 7044, Business & Professionals
Code). -
( ) I am exempt under Section' B&P.C. for this reason
Date 'a 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:
Carver OOLDZN RAOLR INS Policy No. "C444068-02
(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' compensation laws of California, and agree that if I should become
subject to the workers' compensation provisions of Sectio!X.the Labor
Code, I hal f h t comply with those ovisi • nS?„
Date: 'GApplicant _^" �� .
Warning: Failure to secure Workers' Compensation co erage 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 applicators 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 purpos s.
Signature- (Owner/Agent) f Date
BUILDING PERMIT PERMIT#
430i)� - 334DATE
�j VALUATION LOT TRACT
jc(.Y,)
41
JOB SITE
�a.wTww- iscouirri�_026
JAPN.ADDRESS
OWNER - -
CONTRACTOR / DESIGNER / EN &NEER
ti'1 TYJ`Yi)RY CROWF,i. L COMMUNr=
CENTURY CR.OWIML CO f.3NN ( W
.1535 30, "].3" UTRMrf, S'.� 1 #200
1535 00, "1D" MRZk?, MR 0200
SAN E ARDWO CA 92400
SAN BERNARDWO 'CA 92408
(909)381.6007 CBJA 2120
USE OF PERMIT t
SMIGLE FAMILY i WE13-D40
SM. PLAN 4 AR LOT 41PERMI T DORS NOT INCLUDE BLOt::ICWALLS OR
PO01, 7 ►'Vu PLAN CHECK PER REID it'+, Ti0'41 rok A+iuvri.PL:F wUANCz of
SAME PLAN TYPE.
Ti1ACT CONSTRUCTION ZOCOA SF
PORCHIPA.TIO 79.00 SF
GARAGWARPORT ISF) 12,328.40
FM=A1+1.m> C®8T Or Ct)Pl'IT'.RigallUw
253j663.60
]PILT-AW, FM SUAOTAVY
CONEVRUCTION FEE 201-000.418.000 $828,50
PLAN CHECK FEE 101.000-439-318 $172.14
MECI.IAVICAL FEE 101.000-421.400 DOM
ELECTRICAL 1+'EE 101 -OW -420.000 $136.94
PLUMBING FEE 101.000.419�OQ0 $149.23
STRONG MOTION FEE - P.irMO 101-000-241-000 $15.37
OR.ADING FE 101-000.4235000 X0,00
DKVPLO P9R IMPACTWX 51,90%Op
t..
0'LM-TOTAL C09 ' (r1'10N` AND PLM C`.kWP.. C
IMS PRI~' -PAID FM
$0.00
RECEIPT
DATE
BY -JZJ
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION j
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings
_c� /_ _
?� /� Y/
Underground Ducts
Ducts
Slab Grade
3
Return Air
Steel
Combustion Air
Roof Deck
_
Exhaust Fans
O.K. to Wrap
02
F.A.U.
Framing
Insulation
_ _��
Compressor
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 312�(0�,G�
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
_
/'
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final 3��3
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) 2�tfp�_ CX
COMMENTS:
• . r•,... tri -.'^'\ k r.r yry •
WESTERN INSULATION INC*
r' „• 4211 Latham Street, Riverside, California 92501
.4 Tela (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 # 41 A
SITE ADDRESS: 43-665 TAURUS COURT LA QUINTA,•CA
_———————————————————————— ——————————.——————————————-.-—-—-—————————
EXTERIOR WALLS: `
MANUFACTURER: JOHNS MANVILLE THICKNESS: 35/8" R—VALUE: • R-13
CEILINGS: BATTS BLOW,
MANUFACTURER: GREEN E _ k THICKNESS: 10.3 R— VALUE: R-38
CEILINGS: BATTS LOW is
MANUFACTURER: JOHNS MANVILLE THICK SS: 13" R- VALUE: R-38
GENERAL CONTRACTOR: CENTURY HOMES
BY: Y a r
TITLE
DATE: f • r
INSULATION CONTRACTOR: -WESTERN INSUI ATION,'INC.
LICENSE NUMBER: 481278
BY:
TITLE: PROD OCTION M NAGER 4
DATE' .. ,
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