0005-314 (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
Profes-sionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
71 $ 13 10/3112C
Date �r G USignature of Contractor +
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I ani 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).
() I am. -.exempt under Section B&P.C. for this reason
Date '. Signature of Owner
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
( ) 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 C.tOj Dp.14 ZA%E1A1S. Policy No. NWC-34.1063-02 .
(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 workers' compensation provisions of Section 3700 of the Labor
CodeVIsh tP ort ithcomplywdla�-t 1. $e rovlsl9nsApplicant
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 181D 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 inspec on p rposes.
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Signature (Owner/Agent)_ 71Daae
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BUILDING_ PERMIT PERM'T#
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DATE/_r TRACT
v VALUATION LOT
JOB SITE ADDRESS 78• -WO �:IV11"%d•`d AY
-08()-W(5
OWNER
CONTRACTOR/DESIGNER�APINEER
aDMJRY CAOWEU C.' 01,04mT nEs
CE%rf" R Y' CROV&LL d0WMU 7T`r10-
1535 80, T" 97'ftlr °1`, 1" 0200
1535 :1G. V BrIM . M 4,200
3AN BEMARDWO CA. 92408
SAX BERNARDWO : CA 92408-
(909)381-6007 CB10 2120
USE OF PERMIT
MOLL,FA1v11I Y i WFL- ..LWG
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SFD- PLAN 4 .AR. LOT 21 PRR2491T DO MS 1NC1,UD.0_I3L0CI'FA ALtZ OR
Pool, r
TRACT CONSTRUCTION ;VXQD SF
PORCHlPATIO ttG SE
0A1ZA,.WC.AR1POWI (OI)
R,%Tjmtl;a'il D GoS!° of C('?PiS"miJC" ois
1513"160
FERIWTM SU11G/it RY
CONSTRUCTION FEE 101.000-418-000 S328'so
PLAW CHECK RE 101-400-439-31 ES
MECHANICAL FEE E. 101.000-4216000 $93159
ELFIC`I WCAL Ilr1IE 101-000-420-000
PLUMBING FEE 10:1.0 -419.000 $143.15
ST.R.oma MOTION ME R.1 OAD 01-000-241-040 $13.7
C1RAD1'40 FRE, 101.000.425.000
D1t`V.EL-OPU IMPACT Mi $1,907.110
'fw5
3i.+Y
SUB -'TOS AT, CONMTRLi'C°f ON AND PLAW CEMCK
LESP PRE -PAID M. Rs
$6.00
'C01'AL FMT4V.i PXWVr
RECEIPT
DATE
By j
DAJ;;L
INSPECTOR
O
INSPECTION (RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
CU
Underground Ducts
Forms & Footings
43 4120
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
al
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
o
Drywall - Int. Lath
_
I E2
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
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
/
Waste Lines ®
Gas Test
Electric Final
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voftage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final ll O
Utility Notice (Perm) 2 p
COMMENTS:
- r
.f
WESTERN INSULATION, INC.
4211 Latham Street, Riverside, California 92501
Tel. (909) 686-8760 Fax (909) 686-8786
r
INSULATION CERTIFICATE
THIS IS TO CERTIFY THAT,INSULATION HAS BEEN INSTALLED IN CONFORMANCE WITH
`- —,THE CURRENT ENERGY REGULATION, CALIFORNIA ADMINISTIRATIVE CODE, TITLE 24,
STATE OF CALIFORNIA, IN THE BUILDING LOCATED AT%
TRACT / PHASE: STARLIGHT DUNES 23773-5 • ,
"' LOT # : 21 r#
SITE ADDRESS: 78-880 ZENITH WAY LA QUINTA, CA
EXTERIOR WALLS: 7
MANUFACTURER: JOHNS MANVILLE- THICKNESS: 3 5/8 " R-VALUE: R-13
CEILINGS: BATTS� BLOW
MANUFACTURER: GREENS E- THICKNESS: 10.3 R- VALUE: R-38
CEILINGS: BATTS LOW
MANUFACTURER: JOHNS MANVILLE THICKN S: 13" R- VALUE: R-38
GENERAL CONTRACTOR: CENTURY HOMES
BY:
TITLE: s Y
DATE:
INSULATION CONTRACTOR: WESTERN INSULATION, INC.
LICENSE NUMBER: 481278
4 BY:
TITLE: PRODUCTION ANAGER
DATE
1 I -