0005-328 (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
4
7.41 1 23 ,� 0/3712(
tie Signature of Contract
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:
Carrier GOLDEN FKAOLE 1N3. . Policy No.. MVC444063-02
(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 Section 3700 of the Labor
CDoatdeed, /sh fort th comply with hose revisions/
�
pplicant
Warning: Failure to secure Workers' Compensati6n 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, indemnity
& 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/AgentDate��
BUILDING PERMIT PERMIT"
DATE ! VALUATION LOTS TRACT
JOB SITE
ADDRESS oa_Gb(DTe3iTRXJS CCY[Jkr.+`�,�.•
APN f�c�n ryry�
OWNER
CONTRACTOR / DESIGNER / ENGINEER "
C`'ENi'( Y CROWELL CO1tigAAi7AT1'L"1F.,S
CENT(1":E�Y CRO` ELL CCtiiYiMUN'.I O
1533 so, "D9 S'1TtnT, M # 8o0
1535 so, "v unm. *r. TIE, 4200
RM BERNA:RDWO CA 92409
SAM B ARDINO 'CA 924-08
(909)381-5007 Ck-Vt 2120
USE OF PERMIT
01,E FAI&LY D)9ZL .Z1` G
Slt'L3d P1,AN 3CVR IAT 3-i PERMIT DOPES NOT INCLUDE BLOC:MALLS OR
K)06156/oPIAN CRECi; PE9 i1MUCT10114 POR Ml1i I IPUZ ISSI1'ARCE OF .
SAME PI A14 TYPE,
TRACT C"ONOTRUC`PION 2,402,00 SF
PORCIi![t:F TIO 9.00 SP
0ARAMC.A,RPORT "S %173.20
TMAT11:`i3 COST OT C011MR(YC'RON
135,112140
J'EPIAW VX E SUA04ARY
CONfSTIIUCTION FEE 101-000-418x000 M.00
PI.KW CHECK FEE 141-000-439-318 $161.17
MECHANTCAL F'ER 101-000.421,000 $77.00
ECECTR IA11FEE 101-000--420-000 $125.91
PI.UMPTHO FRE 101-000.419.000 $156,50
ST'I2ONO MOTION FEE - RESID 101-000-211-000 $13.0 '
UA17T OF'ET? 101.000.423.000 S2040
i3LnPM.t')1>XR IMPACT FEE $1,907.00
t3 -TOTAL COMMi3MOR AND PPM CHECK
X3,237.45
1=3 PRE PAID FMS
$0,00
tai 4',
TOTAL, PEPMTMIS DUE NOW
r }} r
RECEIPT
DATE
BY ej(ODATE
FINALED
INSPECTOR
Na./
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
���
Underground Ducts
Forms & Footings
_
Ducts
Slab Grade
Return Air
Steel
1 21121.E
Combustion Air
Roof Deck
Exhaust Fans
OX to Wrap
_ �
+��go�
F.A.U.
Framing
,_
Compressor
Insulation
1—�
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
��2
Drywall - Int. Lath
s ,sem
��--
Final
_
11
_
Final
POOLS - SPAS
BLOCKWAL,L APROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final I
I
Gas Piping
PLUMBINGPP ALS
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
.L
(�j�
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
/ v/
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
( v/
Final
Utility Notice (Perm)
M
� L" N i Li�i\ i i\ A7 V Lri i i V i\' i i\ V•
4211 Latham Street, Riverside, California 92501
Tel. (909) 686-8760 Fax (909) 686-8786
r
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 # 35
SITE ADDRESS: 43-660 TAURUS COURT LA QUINTA, CA
EXTERIOR WALLS:
MANUFACTURER: JOHNS MANVILLE THICKNESS: 3 5/8 R -VALUE: R-13,
CEILINGS:. BATTS BLOW'-
MANUFACTURER: GREE NE THICKNESS: 10.3 R- VALUE: R-38'
CEILINGS: BATTS LOW
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: '
TITLE: PRODUCTION MA AGER
DATE