0009-173 (SFD)LICENSED'CONTRACTOR DECLARATION
14eby 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
714188 9Al•31/2C
Date USig nature of Con[—F. , n r
✓' X/
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that'I.am exempt from the Contractor's
License Law for the following reason:
( ) 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).
O I am exempt under Section . B&P.C. for this reason
DRto Signaturg • gf Qwnor
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following, declarations:
(;r) 1,have and will maintain a certificate of consent to self -insure for workers'
compensation, as provided fdr.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 'C3C?:L, R14 RAOLF, INS. Policy No. 14WC-54406$•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 notemploy 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 workgrs' compensation provi s of Section 3700 fAhe Labor
�
Code, I sh f forthyJith comply with't ose "., v slo ls' .
Dater /r �f��licant '
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 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 irraaspectio n purposes,
,vsr,.•
Signature (Owner/A6 ar�t) - �"' Date
BUILDING PERMIT PERMIT#
DATE VALUATIONLOT ;' - OP f.73 TRACT
$1715,6719.20 °":'.10 23773-5
JOB SITE. t =
APN
ADDRESS 78-875 2MMU WAY
60949M_026
OWNER
CONTRACTOR DESIGNER /tExNy (NEER
pp� pp q7�«�TTyyy� 7�yyyy,7�r LLC
.T.CAISLA►iTI 1,:%v.[`:Ii'1r'� LL.0
^ ry��p.rx��y
t...�Ev d t.,'L�.0 !SRO W�L.Lk+ C�..�v J, �VS�.L.R.A -8
PO BOX 5140
1535 SU.1Y S• IREE,T, Ste. 0200
MWPORT BEACH H CA 42662
SAN BMWAR€3Il�TO CA 924.08
(909)3.81.6007 CUO X170
USE OF PERMIT
S11;!'aLE ?RAWLY DVIMII.�MG
SPO-PLA94AIX LOT-10._PFRMIT 0OXS NOT INCLUI.)E
5W(,'KWAdAA1'E)Q1432R1VE i`AYAPPTROAf:WM OA PLAIN t' FtROC 1 -NE
Rt DUCTIOV FOR MUI IPI.>E ISSU.ANC E OF SAM.E SAM.PLAN TY1PF,.
TRACT COMSTRUCTION 31000.00 OF
PURCHMATIO - 29,00 .SF
0A13AOFIG'A.1IPORT (Si"} I?406,v0
.S l;;I7 �IJ'con or +C(�k�iS`:PT�1J>1;�;om
r• R 17: ,679.20
"
�'I IRWX11 v SD MARY
4 .a • �. .
CON STl U0IfION r.a., 101.000«418.000 $905,50
¢�4
PLAN, CHECK FER 10.1-000-439418 �t€Y12I
E'"'
^.^moi - i
MECHANICAL ME
FIXXT 2IC:AL FE 109 -�Ca !�2I1�Ut#Cf �13I,.16
� �t'a"°
PLUMBING FEE 101.000.419.000 iliQio
STIi.(i O E OTION FEE, - RFMID 101-000=2.1,000
GRA1CyINO FRE 101.000.421.000
DEMDPER.IMPACT FEE
Mk- CI NSTRU ION ANT) 1?I,.,r M C1-1ECK.
$13,442.94
IMS PRE -PMD MIZ
$0.00
VOTAL P1P. RMT'_PM,$ DVS NOW
$3,442M
RECEIPT
DATE /
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
I ��y
Cel"
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
3 I
fty��
F.A.U.
Framing
Compressor
Insulation
%1�
6
Vents
Fireplace P.L.
(
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
[� �•�
^�
Drywall - Int. Lath
Final
Final
��E16
POOLS -SPAS
BLOCKWALI A ROVALS
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
I �1 op
('�
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer LateralOo
IZ Z,_
Pool Cover
Sewer Connection
i21� /
-
_
Encapsulation
Gas Piping
t
Gas Test
Appliances
Final
COMMENTS:
Final
1
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
Final
Utility Notice
—mss
(Perm;
JUN -13-2001 15:21 WESTERN INSULATION 909 686 8796 P.11i21
4:'�
W ES
N I TLATIONt LoPme
4211 Latham Street, Riverside, CMifomia 92501
Tcl, (909) 685.8760 Fax (909) 68"786
INIFICATE
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
T:'TRACT / PHASE: STARLIGHT DUNES #23773-5/PHASE 4
LOT # : 10
s SITE ADDRESS: 78.875 ZENITH WAY. LA QUINTA,-CA
EOR WALLS: � +
MANUFACTURER: JOHNS MANVILLE THICKNESS: 3 518 " R -VALUE. 8-13
C ILINGS BATTS L0
MANUFACTURER: GREENSTONE THICKNESS: 10.3 R -VALUE: R738
CEILi�I S: BATTS 1 BLOW
MANUFACTURER: JOHNS MANVILLE THICKNESS: 13- R=VALUE: R-38
C;O�IL C®nIT��4C'i0�: CENTURY HOMES
BY: <
C
TITLE;
• , DATE:
INSL, TOOK CONTMCT R: WESTERN INSULATION, L P. ' 4
LICENSE NUMBER: 784484
TITLE: - PR DI' CTION 11�% AGER
DATE JUNE 13, 2001