05-321 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Imo- Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
N W Profess!;zials Code, and my License is in full force and effect.
O =) co Lic. Class Exp. Date
NLo
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o ZO lr� Dotr' -qgnature of Con -
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J U CD OWNER -BUILDER DECLARATION
W W ~ I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ a 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. 7444, business & Professionals
Code),
M () I am exempt under Section , B&P.C- for this reason
u7
N Date Signature of Owner
ON
0)a- Q WORKER'S COMPENSATION DECLARATION
oQ � I hereby affirm under penalty of perjury one of the following declarations:
_ O () 1 have and will maintain a certificate of consent to self -insure for workers'
X w �= compensation, as provided for by Section 3700 of the Labor Code, for the
O J Q performance of the work for which this permit is issued.
m Q C) ( ) I have and will maintain workers' compensation insurance, as required by
O U Q Section 3700 of the Labor Code, for the performance of the work for which this
Zpermit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier (11O ,1�9N K�i(.ILE INS, Policy No.
00 �
C)
J(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 YoirisioAns of Section 3700 of the Labor
Code, sh 11 fart I h comply Ah a . 'visio
Date:1)"CIA pPIIcm-a t_ r
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 applicator 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 purposes.
Signature (Ownerlflgent) t-' - • rr •?. batd.
BUILDING PERMIT PERMIT#
DATE C't VALUATION LOT TRACT
JOB SITE APN
�•I7 p
ADDRESS =jg-ki.,l Liil.�f.,i.LrLi
OWNER
CONTRACTOR/DESIGNER/EN INEER
C RI -1 ITTR Y CR(DWE11, CO3vIR'Tim4r : L
ch2TRIEZY:`1?.i ��iiFL i. C0Mrh i1_'WA11V
15:5 ;;+-t, T " .`3l"RIFtRr. WTI', OL200
15-35301 "I?" Jl.:R . .111 12Tl.h #200
SAW BiiNNA'RX11140 i'",A 92.4.08
OM BL':td-1A'i M1' 0 CA 24W
(9w)n.14xxn CT'L H 111-120
USE OF PERMIT
Sir .3Gil.•E.4MB..~��.IrTWELLIf.;G
SAPID, ;a1.,' N 3Ei LOT 29 PERMIT 0GIMS NOT PWLLtI)E;ftl.Os;KWAIA-1 OR
KX L, 15%PLAN 0MICK FEE 11f i5CICT OIN FOR fAYI1,TIPfI f:!;.3,1K.9CF; OF
UAI<: F PL,IiIA TYP&
T1"tt3,OT CONSTRUCTION M511,4R 2F
POKCI IPATIC) 29.00 SIF
(JARAC1EWATiRPORT (OF)
i F.YrTA1A3X0 V0,1T 011'
341 4503SJO
CONSTRUCTION HEY 101,>000-419-000 s,isft„311
8k
PLE' H CHECK "LE 101-000-439-318k
I'MCIMICA1, FEE 101.000-X121-000
XLECTR IC:lAL, F ZZ 101-000,420-000 $127.59
PLUNIRIIHO FEE, 101000.411'-000 $1103111
STRONG MOTIUM FEE - RESID 1011-000-2A f -000 �IS.1G
0W_)ft411f IFF_Z 101 «000
DEV-1W)PER IMPACT FRE �:,�►lt7.bil
SUB -TOTAL. CCONSTI1'_L.TCIMON 1W)PLAN C",fCF,c',K.
s:1,2'?8,8o
T Y'00 YM' -PAM TT,.F, I
$0100
TMALAMMMYY n'J!!S DIT -NOW
$3,22-0.80
RECEIPT DATE
I
DATE FINALED
INSPECTOR
NSPECTI N RECORD
OPERATION DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs /[/
Forms & Footings �j
Underground Ducts
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck j
Exhaust Fans
o. 11 to Wrap—
F.A.U.
Framing
Compressor
insulation S
Vents
Firepiaae P.L. j
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
party Wall Firewall
_
Exterior Lath
Dn/wal! - Int. Lath
Final
Final ? ��
ELOCALL APPROVALS
POOLS s SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover f
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
PLUMBING APPROV.,'�LS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
iTh owu Pans
O.K. for Finish plaster
Sewer Lateral p
Sewer Connection —/
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wlring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power �1
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 # 28
SITE ADDRESS: 78-905 ZENITH WAY LA QUINTA, CA
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EXTERIOR WALLS:
MANUFACTURER: JOHNS MANVILLE THICKNESS: 3 5/8 " R -VALUE: R-13
CEILINGS: BATTS' BLOW
MANUFACTURER: GREENSTONE THICKNESS: 10.3 R- VALUE: R-38
CEILINGS: BATTS BLOW
MANUFACTURER: JOHNS MANVILLE THICKNESS: 13" R- VALUE: R-38
GENERAL CONTRACTOR: CENTURY HOMES
BY:
TITLE:
DATE:
INSULATION CONTRACTOR: WESTERN INSULATION, INC.
LICENSE NUMBER: 481278
BY: ya)-,
TITLE: PRODUCTION MANAGER
DATE