05-317 (SFD)LICENSED CONTRACTOR DECLARATION
C/) I hereby affirm under penalty of perjury that I am licensed under provisions of
C�pter 9 (commencing with Section 7000) of Division 3 of the Business and
CV LU Professionals Code, and my License is in full force and effect.
C) 5 M License # Lic. Class Exp. Date
~ Z r,- Uat$�; {� Signature of Contractor`s
CZODO f !
J I.—
OWNER-BUILDER DECLARATION
LLI W I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ U) License Law for the following reason:
Z ( ) 1, 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).
C'') () I am exempt under Section B&P.C. for this reason
LO
N Date Signature of Owner
ON
0)
Z WORKER'S COMPENSATION DECLARATION
o rr I hereby affirm under penalty of perjury one of the following declarations:
LO O ( ) I 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
(i U Q Section 3700 of the Labor Code, for the performance of the work for which this
M permit is issued. My workers' compensation insurance carrier & policy no. are:
It zCarrier y o.
Policy N
ob 0OLDF44 L A0 1,R INS, N KC:-5440u?42
r- 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' compensati�prrovisions opSection 3700 of the Labor
Code, sh II rt ith comply w' hose pfav cions.
Dater '"4A�pPlicant r . ..
Warning: Failure to secure Workers' Compe,satlon 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' action purposes.
Signature (Owner/Agent) ent,
9 ( 9 )--" r J N Dat
ii BUILDING PERMIT PERMIT#
DATE{/ j{} VALUATION LOT g 0005-11 �� TRACT
,nn
JOB SITE
APN
ADDRESS1W-aW_y
101-��-�2
�
OWNER
CONTRACTOR/DESIGNER/ENGINEER
CIAOkyCROWELL'CrCMbAU24ITs
CEliRCRffArhL.11 )P✓jFlv2l0L!0
1535 0, -D7PEF-Iymo
1531C 30: ID31iTiLITrY
S1 J CA 924 08
SAW BIN1;1< ARD100 CA F�2 40 is
USE OF PERMIT
1J) -r_• FANi.L•Y '! "WELS •ING
S1 i7� PLar 13 d:11 I2 I C)'1' Q4 P1aI Y�91'I 13[)1s tdty7' II4CLIJT)E 1i1 f?C'K W I:L I :; 0"
K30 , i % PLAN CI4F(..!r FK�i: I:MICTION FOR r1I111 TIPLP'..
SAME PI.,r4V TYPE.
TRC:T (:Orris URkJOTIO1'a ,0)t).00 ')F
PORC',H/P.O.T10 ; R.Ofr 3F
C3A]tAO};',lfw.&RPOR T ;SIF) 12,,4dlfr. 0
EMMM) COST OF C='•(.la<`i.�iMIUC 10%.11
1.7-55,679-110
T�L.yy--yy ��,/fryy Tx ..�w�,
C(M0').'R00`fl0N FEE 101.000-418.000 $901110 0
PL-ANCHF-CKE�:E 101-0004.1319-518 ;0� I
1v EC",HA)AC AL. FF;E 1014MA I -000 %92.0D
ELECTRICA-L NEE 10)_000•-4120-000 $151.16
PL 1MBINGFVIE 101 -000.419 -OW $162.50
S9'R0140 MOTI0I4 P'EE - RE ;ID 101-0'00-241•-000 $17.57
' EVE`.IX)PER IMPACTFEE sI SIto-mt0
,T]IB- I UI AL CC.yi11&MUMON AND PL..A(!14110K
;13,442,94
lM.3 P.T11'r•k'AlIE)I�T rl�
$0100
TOTAL PKIR34!E1:1' :i)IE+.N IRIS 1VOW
RECEIPT
DATE
BY I j
DATE FINALED INSPECTOR
9
INSPECTION RECORD
OPERATION
DATE INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms 8& Footings —0 -)-
-Grade
Slab Grade p-0
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framin
Compressor
Insulation I��of--�—
Fireplace P.L.
Vents
Grills
.
Fans & Controls
sulation
Condensate Lines
irewall
E
. LE
Final
SLOCKWALL APPROVALS
Final
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footin s
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 '
Neater Final �
Water Piping
Plumbing Final
i umbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral �? 9
5ev+er Connection
Pool Cover
Encapsulation
Gas Plping
Gas Test
_
Appliances
Final
4
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
Z
Final
Utility Notice (Perm)
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 # 24
SITE ADDRESS: 78-910 ZENITH WAY LA QUINTA, CA
EXTERIOR WALLS:
MANUFACTURER: JOHNS MANVILLE THICKNESS:
CEILINGS: BATTS BLOW
MANUFACTURER: GREENSTONE THIrBLOW)
CEILINGS: BATTS
MANUFACTURER: JOHNS MANVILLE THICKNESS:
GENERAL CONTRACTOR: ;-CENTURY HOMES
BY:
TITLE:
DATE:
3 5/8 " R -VALUE: R-13
10.3 R- VALUE: R-38
13" R- VALUE: R-38
INSULATION CONTRACTOR: WESTERN INSULATION, INC.
LICENSE NUMBER: 481278
BY:
TITLE: PRODUCTION ANAGER
DATE