0005-315 (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
-Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
Date/ Signature of Contractor lam.
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).
O I am exempt under Section B&P.C: for this reasun
Date Signature of Owner
WORKER'S COMPENSATION DECLARATION'
I hereby, affirm under penalty, of, perjury one of the following declarations:
O 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 .aOLDI(&J MOLE MS. Policy No. NWC:-544068-02
(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 w rkers' compensation provisions off Section 3700 of the Labor
Cod�I s Ihfor� with complyith-ttro� provisions.
Date#< r/%, Applican��
Warning: Failure to secure Workers' Compensation coverage is unlawfuland
shall subject an employer to criminal penaltie's,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 insppe•-ct=io�n7purposes. %
Signature (Owner/Agent Dat
r
BUILDING PERMIT PERMIT#
1
DATE/�
q/00VALUATION LOT TRACT
it /I �i75,679.2 22
JOB SITE
ADDRESS 70-W" ZENITH WAY
APN
OWNER
CONTRACTOR / DESIGNER / EN (NEER
CKMIRY CROT WNX COMMC7MrIES .
C>)`N'1 P 5�'.' 1�'
CROWMIL dols UN11'1IRS
1535 00: "Do MMM, V3 ,4200.
B01 01)" ITTR rr, a IF,
ate• BERNARDI TC CA. 92 408
SM BEla.NAfi.DWO 'CA 92409
•(909)381.6007
Mit 212.0
USE OF PERMIT
SWOLB:f~AMLY 19WEGI 7 0
SFD- PLAN 4OLP,1,.OT a8 FW -9.#T DOES NOT 1NCLUD2.BLOCY.'f1f.AL.W` OR.,
POOL
TRACT COrtdT11.UCTION SP
PO.PWI'] RATIO 29.01 SF
GARAOFKAR.PORT (J 1;406.80
ESIMATED cog r or CO:NS°IMLrCTIt)N
PERMi` T+'' : 9MVAARY
z�:
CO NSTRIXTION FEE 101.000-418-000
PLAN CHECK F719 101-tiS3Q-�t3#►-�18 �a%19.r35
y�"'
`.�`'
MP.CirlALNUCAAI. %'IrE 101.000.421-000 $92.00
ELECTRICAL, FF9 101-C40- 4M000 $151.16
PLUMBING ME 101.000.419.000 $162.50
STRONG MOTION FEE • RESJD 1101-1300°•241-000 $17.5?
GR.ADI1' O FFE 101.-000.423.006
DEVE..MPER IMPACT FEE $1,90B.UR
a.3
'V' PLAN C�CC8Z-TCALCOWMI-Irl �
TA,00 .58
I.E. PRII-FA1D FM- S
$0,00
.r(YYAz. MTMff 5 MJW
*4M4.,
RECEIPT'-.
DATE t
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
g� [,�IOO
��
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
_ ���
F.A.U.
Framing
a
—(PI
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
_
Drywall -Int. lath
t
Final
Final
31�� ��
Q�'r'�L
POOLS - SPAS
BLOCKWALL APPROVALS
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
Q.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
1M
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Finalr
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
?�
•�l�
Final
Utility Notice (Perm)
sJ ��
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 # 22
SITE ADDRESS: 78-890 ZENITH WAY LA QUINTA, CA
EXTERIOR WALLS:
MANUFACTURER: JOHNS MANVILLE THICKNESS: 3 5/8 " R -VALUE: R-13
CEILINGS:BATfiS BLOW
MANUFACTURER: GREENSTO E 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: 5
DATE: r
INSULATION CONTRACTOR: WESTERN INSULATION, INC.
LICENSE NUMBER: 481278
BY:,
TITLE: PRODUCTION MANAGER ;
DATE '