0005-330 (SFD)LICENSED CONTRACTOR DECLARATION
U)I hereby affirm under penalty of perjury that I am licensed underaprovisions of
khapter 9 (commencing with Section 7000) of Division 3 of the;Business and
04 Uj Professionals Code, and my License is in full force and effect.
O =) M License # Lic. Class Exp. Date
I\ 7 41 � l UJ;3112(
`o Z r-' -Dat e Si0. gnature of Contragtor� ,
CO
r` U p OWNER -BUILDER DECLARATION
J
LLl W I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ co License Law for the following reason:
Z_ ( ) 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
( ) 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:
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:
CarrierGOLT?.Is'N 11AGL9 MS. Policy No. NWC-344069-02
(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 tot a wor ers' compensa�t,,i:o�n--pro �isions;of Section 3700 of the Labor
Code s II• ort It . omply witrl�tn;0, prov�.isi n
v
Date � r�Applicant" � �•
Warriing: Failure to secure Workers' Compen ation 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 inspection purpo es..
Signature (Owner/Agent) _2 � M� Date
BUILDING PERMIT PERMIT"
CfW&3i30
DATE,
VALUATION � � LOT - TRACT
JOB SITE APN
ADDRESS �33I�720 TA[71e!us cmw 609-08"26
OWNER . - CONTRACTOR / DESIGNER / EN (NEER
C1'EMRY C.ROWELL C:OM.Ivtt. 11:`TE� Cwr(my CROWk.'LL C90WbiT.1AirAF'S
1535 SO. /f200 1535 s0. M" 9'Ai MIrT, 9M #200
SAN B ARDWO CA 924.08 SAAf DEiWARDWO CA 92408
(909)381-60(17 MA 2120
USE OF PERMIT
SYD- PLAN 4.A. LOT 37 PERMIT DOES NOT INCLUDE SLOCKWALL.S OR
.POOL 75%'PLAN CRECIC b'%E REDUCTION POR MULTIPLE, ISSUANCE OF
SAME PIAN TYPE.
TRACT CONSTRUCTION 2,595100 OF
PORCH/PATIO I 28.007S1r
43ARAWCA."ORT (OF) 1%128.40
ESTWA' XT) COST OF C OMS RU=i?0
1531W.60
Pk TFEE 9Erh M%RY
CONSTRUCTION FEE
101-000-418-000
$$20.54
PLAN CHECK FRF
101-000-439-318
S172. 2. I4
MECHANICAL FEE
101.000.421.000
89$,50
ELECTRICAL WE
101-000*420-00'0
$136;94
PLUMDING FEE
101.000.419.000
$149.25
STAONO MOTION FEE r RESID
901-000-241-000
$11},:_7
GRA.DWO PER
161,0011.423.000
$20,00
1"aL ELCaP)?R. IMPACT FEE
51,40? D>y
nM -TOTAL COi SOM ICT'.ION AND PT AR C1TACK
L03 PRE -PAID 1 33
. -fir t'� �•.t<-, r ..
I RECEIPT I DATE
1 DATE FINALED IINSPECTOR
$3,327,70
$0,00
$3,327,70
INSPECTION RECORD
" OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
�j_ c�
— l
Underground Ducts
Forms & Footings
/ /'� /U4E�'
Ducts
Slab Grade
atm
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
0 pp _
F.A.U.
Framing
-
C'
Compressor
Insulation
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
3 _ n� Cgc�-
POOLS - SPAS
BLOCKWALL APPROVALS
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
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
—/Z•-t95
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
�J
��
Pool Cover
Sewer Connection
d
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
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
�i`'IJ,►��
Final
C-0
Utility Notice (Perm)
2�—�ceop*
WESTERN INSULATION;
INC.
4211 Latham Street, Riverside, California 92501
Tel. (909) 686-8760 Fax (909) 686-8786
= i INSULATION CERTIFICATE
THIS IS TO CERTIFY THAT INSULATION HAS BEEN INSTALLED IN CONFORMANCE WITH
THE CURRENT ENERGY REGULATION, CALIFORNIA ADMINISTRATIVE
CODE, TITLE 24;1;
STATE OF CALIFORNIA; IN THE BUILDING LOCATED AT:.
TRACT / PHASE: STARLIGHT DUNES 23773-5
". LOT`# 37
SITE ADDRESS:', 43-720 TAURUS COURT LA QUINTA; CA
r '!
———————-————————————————————————
EXTERIOR WALLS: .
——————————— =——
MANUFACTURER: JOHNS MANVILLE THICKNESS: 3.5/8,"
R—VALUE: R-13 ??
CEILINGS: ', ATT BLOW
SW
'!+
..
a
MANUFACTURER: " �GREENSTO —__ � ., THICKNESS:, 10:3'
R—'VALUE: R-38 .
CEILINGS: BATTS LOW
`
s
MANUFACTURER: JOHNS'MANVILLE THICK. SS: 13",
R— VALUE: R-38
GENERAL CONTRACTOR: CENTURY HOMES
BY:
;
TITLE
DATE:
r
1�
INSULATION CONTRACTOR: WESTERN INSULATION, INC.
LICENSE NUMBER: 481278
BY:
.TITLE: •PRODt CTION tANAGER 1'
DATE
t
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