0005-331 (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
,PrIr fessionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
B _ lOnrt2e
Date ignature of Contract r
s
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/constructsthe 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 jjC>I,DEAI 1,AOi.$ jN.,41 Policy No. NWC444068-02
(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 t e workers' compensation provisions3kSection 3700 of the Labor
Cod��ys II o vv�t omply with-t'Tio��d!0" iQ,Iris.
Date.�r��-1 C Applicant I' �' / °
y
Warning: 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 representatives of this City to enter upon
the above-mentioned property foorr'i�nspeectioonn purposes. /
Signature (Owner/Agent)^r-{' i "� �` Date
BUILDING PERMIT PERMIT#
°
DATE c'.r ? , VALUATION LOT ^S-3.3 TRACT
I �fl11E3,7,i�.➢ 38 ?,37'73.5
JOB SITE AJAPN
ADDRESS 43-7'SS TAumus coo YJw6094=-=
OWNER
CONTRACTOR/DESIGNER/EN (NEER
O.E, rnmy (MOWML COAOAUNT
CMMRY CROWELL CO1AMUN11M
1535 SO. "D" STRKK1, S'T.E. #200
1535 BO. V, 5TWwr, STi`4fi 4200
SARI BERNARDINO C.A. 924.08
SANBERWARDINO CA 92408
(909)381.0007 CaL4 2120
USE OF PERMIT
(3EZ FP2,MY DWEILING
VD - PLAN 313 LOT39 PFRM[T DOM' ROT INCLUDE BLOCKs3i'ALLS OR,
POOL 15% PLAN CF<T1tCK. FEZ REDUCTION FOR MULTIPLE ISSUANCE OF
SAME PLAN TYPE.
TRACT CONSTIkUCTION 2,023.00 SF
PORCHIPATIO/ 48.00 9'
OARAGEICARPORT (SP) X32.00
ES7CiTVlAUD COST OF C°0N9fRLTC`n0N
138,719.30
PF10M90AOURY
CONSTRUCT1011 FLP. 101.000.418.000 $7706.00
PLAN CHECK FEZ 101-000-434-318 $144.60
1, ECH.ANICA11 IEE 101.0110.421-000 $47.00
ELECTRICAL ME 101-00"20-000 $113.71
P1IUMB1NG r, EF, 101-000.4199000 $134.73
STRONG MOTION PEE , RESID 101-000-2411-000 $11.87
GRADTAIO FEE 101.00(1423.000 $20.00
DEVZLOPER IMPACT FEE.
9UB= I'O'IAL, CON 9fRUCT;tO AND PLPN CFM:Y..
$3,083.93
LEOS P.RR-PAM F
`110,00
Et
1•. •t
TOTAL P1 .1Y T FEKS WEB OW
po i
RECEIPT
DATE r
°B `�
DATE FINALED
INSPECTOR
� W
INSPECTION RECORD
F OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms $ Footings
��/�� lam'
Underground Ducts
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
O 404)
F.A.U.
Framing
Compressor
Insulation
y A
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
cn COV20r+—
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
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
Sewer Connection
/
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 ZZ
Final (
Utility Notice (Perm) 2A ?yam �,
COMMENTS:
WESTERN. INSULATION, INC.
4211 Latham Street, Riverside, California 92501
Tel. (909) 686-8760 Fax (909) 686-8786
INSULATION CERTIFICATE •. , t
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:.
t.
--TRACT,./ PHASE: STARLIGHT DUNES 23773-5
LOT4-': 38 T
•� SITE ADDRESS: 43-755 TAURUS COURT LA QUINTA, CA
- --------r- --------- -------- -- --- ------------- --
EXTERIOR WALLS: - - -"- - -
MANUFACTURER: JOHNS MANVILLE •-'THICKNESS: 3,5/8",R -VALUE: R-13
CEILINGS: ; BATTS , BLOW
MANUFACTURER: GREENS NE THICKNESS:, 10:3 'R- VALUE: R-38; .
CEILINGS:" BATI
TS. -BLOW'
MANUFACTURER: �' JOHNS MANVILLE THTC NESS 13" R- VALUE: R-38
4 . •) • r
GENERAL -CONTRACTOR: CENTURY HOMES }, `
TITLE' '
r
.DATE:
r
INSULATION CONTRACTOR: WESTERN INSULATION, INC. 7
LICENSE NUMBER: '481278
t
BY:
TITLE: PRODUCTION MA AGER
DATE
n .
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ti
i/
WESTERN. INSULATION, INC.
4211 Latham Street, Riverside, California 92501
Tel. (909) 686-8760 Fax (909) 686-8786
INSULATION CERTIFICATE •. , t
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:.
t.
--TRACT,./ PHASE: STARLIGHT DUNES 23773-5
LOT4-': 38 T
•� SITE ADDRESS: 43-755 TAURUS COURT LA QUINTA, CA
- --------r- --------- -------- -- --- ------------- --
EXTERIOR WALLS: - - -"- - -
MANUFACTURER: JOHNS MANVILLE •-'THICKNESS: 3,5/8",R -VALUE: R-13
CEILINGS: ; BATTS , BLOW
MANUFACTURER: GREENS NE THICKNESS:, 10:3 'R- VALUE: R-38; .
CEILINGS:" BATI
TS. -BLOW'
MANUFACTURER: �' JOHNS MANVILLE THTC NESS 13" R- VALUE: R-38
4 . •) • r
GENERAL -CONTRACTOR: CENTURY HOMES }, `
TITLE' '
r
.DATE:
r
INSULATION CONTRACTOR: WESTERN INSULATION, INC. 7
LICENSE NUMBER: '481278
t
BY:
TITLE: PRODUCTION MA AGER
DATE
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