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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 w�]fTlFsr"Ii. r-- tY I f Y r �J o ZO lr� Dotr' -qgnature of Con - T.11 3' 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 ------------------------------------------------------------------ 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