0005-333 (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
.0
7 Y4 188 ' B 1 O%31/2C
`_- -Date!/Signature of Contractor ��
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OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I 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 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). L
() I am exempt under Section B&P.C. for this reason
Date Signature of Owner
n
Z WORKER'S COMPENSATION DECLARATION
i
= I hereby affirm under penalty of perjury one of the following declarations:
D () I have and will maintain a certificate of consent to self -insure for workers'
compensation;,pas,provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
j( ) 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 EAOLS INS. Policy No. WC -544068-02
(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 th - workers' compensation provisions of Section3700 o
he Labor
Code, shafQforthw� �p mply with t ,o e iisio S.
Date: �A'pplicant _ `�
Warning: Failure to secure Workers' Compensatj n 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 propert „f .r�spectioWpurpo ee-s----- l/G
Date e;
Signature. (Owner/Agent) ' y
BUILDING PERMIT PERMIT# t
DATE VALUATION . - LOT • ^ '• ► TRACT
I
40 23773-5
JOB SITE
APN
ADDRESS . 4 J TAURUS C®T W
6094)80-021115
OWNER - _ - •_ -- - -- - - ` Y - ' -
CONTRACTOR / DESIGNER / EN (NEER'
CU3'IURY CliOt EIZ COMMUNITIES
Can—C Y CItC>WR L COMMM1
1535 so, IVI STRM— M x#200
1535 30. -D" MR%:ls"C, ,. ' 02,00
SA14 BiERNARDINO CA 92408
SAN BF—PWARD1140 CA 924408
(909):581.6007 Cudi ?•,120.
'
USE OF PERMIT
M4•01Z?71alt+s.J..9-Yi WLLffl 1
SFDI PLAN 413L LOT 40 PERMIT DOES NOT INCLUDE HLO.0 rVIAL OR
POOL 75% PLM'CHE.CK 1= 1 RPIDUC T ION FOR MULTI W1.1 ISSU:ANM, OF'
SAMYPLAN TYPE.f ,
TRACT CONSTRUCTION 36000.00 3F
-
`' POACH/PATIO' 22.00 SF
OARf OFICA.R.PORT (St. 12,406.80
F5" wmD Corr of CaNmi1CT.ton
1.75,679..20
CONSTRUCTION FEE 101.00O-4418.000 $905;30
PLAN CHECK FU, 101-000-439-318 $187,21
MECHANICAL MTE 101.000.421-000 $92.09
ELECTRICAL bZS 1 n1-Ono-c42C1-i 00 $151.16
PLUMBING ECE 101-000-4W-000 $162.50.
STRONO MOTION IW - RESID 101-000-241-000 $1757
ORADW FEE 101.000.42:3.000 $x0.011
-
DEVELOPER IMPACT FBI $1,907.00
OUB-TO'CAL Ct'iM8"i UC't ION ANIS PT,." C1 1EC K
$3,44.2.94-
1=3 PREPAID FJ
f1,0n
.
0,442,9 4.
,
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RECEIPT -
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
. BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings
% _ _
/ ' l
Underground Ducts
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
:- �n-p _
Exhaust Fans
O.K. to Wrap
p /9 Q p
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
_
_T575L4
5L1
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
I
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 t
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 $ t o
Utility Notice (Perm) '2 k!?1
COMMENTS:
,y
WESTERN INSULATION, INC.
4211 Latham Street, Riverside, California 92501 F
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 241
STATE OF CALIFORNIA, IN THE BUILDING LOCATED AT:.
.TRACT / PHASE: STARLIGHT DUNES 23773-5 ,
LOT # 40
SITE ADDRESS: 43-695 TAURUS COURT LA QUINTA, CA
---------------
EXTERIOR WALLS:
MANUFACTURER: F JOHNS MANVILLE 'THICKNESS: 3 5/8 " R -VALUE: R-13
CEILINGS: CEO
T 'S BLOW
MANUFACTURER: GRENE THICKNESS: 10.3 R- VALUE: R-38
CEILINGS: BATTS BLOW
MANUFACTURER: JOHNS MANVILLE THI S: 13" R- VALUE: R-38
GENERAL CONTRACTOR: CENTURY HOMES
BY. r
TITLE:
DATE:
INSULATION CONTRACTOR: WESTERN INSULATION, INC.
LICENSE NUMBER: 481278
BY:
TITLE: PRODUCTION MANAGER
DATE
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