0005-332 (SFD)LICENSED CONTRACTOR DECLARATION
1 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
Dater ignature of Contractor CC
_01 ti
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 OO1,DEW BAOLE 018, Policy No. NW.J44069-02
(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 provisionI5Af Section 700 of the Labor
Code�Lsh forth i{h omply with those•G.,.ov`s''I`ons.
Date:?%� Jlr PPlicantr .f
Warning: Failure to secure Workers' Compensation cove age 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 propertyF
spection,purposes.
r
Signature (Owner/Agent) ' -� Date
BUILDING PERMIT PERMIT#
DATE L VALUATION LOT 39 .. TRACT 23773-5
JOB SITE `
APN6094AM-OW
ADDRESS 43-7 TA19RUS CO�.1 f
OWNER -
CONTRACTOR / DESIGNER / EN (NEER
i
CF`Al'Pi7 y C:R�tOWM�L COW►fi.MM
CENTURY CROVaalL C.''OMMfUNi`I111S
1535 SO. 'Do `=FF,1', aU.T.1 4200
15,35 30. "DO n3TRM, S'M #200
SANPAMNA12C)INO AWA 924.08
SAN BMNARDItNO CA 92408
(903)381.6007 C B14 2120
USE OF PERMIT
31WOUFAWLY FJW1g,1.WG
SFD. PLAN 3AR I.,Ot' 39 PERMIT DOES NOT MCLUDE 1JLOCIC'`,VAL1S OR,
POOL 73% PLAN CHECK FRF. UDUCTION FOR MULTIPLE ISSUANCE OF
SAMA; PLAN T'YPK
TRACT CONSTRUCTION 2,450.00 SIT
PORCH/PATIO 29.00 SF
OARA0EICARPORT (sl) 31173.20
Wi'.&"= COST OF 0101 RUCTION
142,593,9D
1'EcSt41T >3 EE KTiL,RVCckif Y
CONSTRUCTION FEE 101.000-418.000 s1rKS0
PLAN CHECK FEE 101-000-439-398 $161,$0
M1;CNAMICAL FEE 101.000-421.000 '3'71.00
ELECTRICAL, YZE 101.000-420-000 $127.59
PLUMBING In ' 101-000=419.000 $134,'
STRONG MOT101-1 "X - RPSID 101-000-241-000 $14.1.6
GRADING FEE 101-000.421.000 $20.00
DEVFI.OPZR. IMPACT Fft $1,967.00
WB-TOTAIL, COIVM1.TCT109 AND PLAN OMCK
$3,228.90
IMS PRE -PAID F+Y-9S
$0.00
'T QfAL aAE 1+11'1' MS ]YIJE N0W
$3,22863
�BY//
RECEIPT
DATE
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
I INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings
7��9a
Underground Ducts
Ducts
Slab Grade
3 Gb
Return Air
Steel
Combustion Air
Roof Deck
_
Exhaust Fans
O.K to Wrap
49/6-t3
ArO
F.A.U.
Framing
j ,� _�jy
>
Compressor
Insulation
oo
Vents
Fireplace P.L.
Grills
Fireplace T.Q.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath�
2J LLA
5
Drywall - Int. Lath
_g,71 -C>(
F
Final _ (l 0(—
BLOCKWALL APPROVALS
Final
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
Sewer Connection
//
/�
��
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas) 3 -4
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)��
COMMENTS:
WESTERN• INSULATION, INC.
4211 Latham Street, Riverside, California 92501
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 24,.
STATE OF CALIFORNIA, IN THE BUILDING'LOCATED AT:.
` TRACT / PHASE: STARLIGHT DUNES 23773-5
LOT # 39
SITE ADDRESS: 43-725 TAURUS COURT LA QUINTA, CA
EXTERIOR WALLS:
MANUFACTURER: JOHNS MANVILLE THICKNESS: 3 5/8 " R -VALUE: R-13
CEILINGS:. BATT BLOW
MANUFACTURER:. GREENS E_„ THICKNESS: 10.3 R- VALUE: R-38
CEILINGS: BATTS O
MANUFACTURER: JOHNS MANVILLE THIC S: 13" R- VALUE: R-38
GENERAL 'CONTRACTOR: CENTURY HOMES
BY:
TITLE:
DATE:
INSULATION CONTRACTOR: WESTERN INSULATION, INC.
LICENSE NUMBER: 481278
BY:
TITLE: PRODUCTION MAN GER
DATE
u