0009-190 (SFD)LICENSED CONTRACTOR_ DECLARATION
-1 hereby affirm under penalty of perjury that I am licensed under provisions of
Z Chapkr'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
714.188 B`. 0131 E
Date -Signature of Contralto
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 reason
Date 'Signature of Owner
WORKER'S COMPENSATION DECLARATION '
I hereby affirm under penalty of perjury one of the following declarations:
() 1 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• haveand 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' comperisation insurance carrier & policy no. are:
Carrier c6mN 1<Aou Ci&S, Poli
Cycy No. NWC-344068-02
(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
Code, I hal orth ith comply with those r'�rov si nsr'' ^""- ""•'
Dater �; .applicant - >
Warning: Failure to secure Workers' Compensatio coverage is unlawful and
shall subjectan employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damage's 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 wtiose 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.resdit 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 represeptatives of this'City to enter upon
the above-mentioned property ford•spection purposes
Signature (Owner/Agent),c��
Date
BUILDING PERMIT'PERMIT#
OW9-190
DATE VALUATION LOT TRACT
3.5
20 • ZSV73-5
JOB SITE
APN
ADDRESS 7"7o 1� ryC]•asY.i�.awAyi
•��
609. °Q -026
OWNER
CONTRACTOR/DESIGNER/EN (NEER
STARUGITf MMES ILC
CM2 URY• C1a:owa L COiv1m'f tirr.1;ES
PO BOX 5140
1535 SO. wD93TfMET, STLE 0200
NEWPORT BEACH CA 926,62
SAX, "ARXi13+I.0 CA . 92408
(909)381-6007. Cl3Lrk; ? 1 of . _.
USE OF PERMIT -
"Maill TAMMY 7 WT-L7r. NQ
SPD.P"N: 4A LOT: d0`-PERMITi90P.03 NOT INCLUDr
F11SOC ' 11 [ o +r iSLai f lEWA1TA,PPROACH
t
TRACT CONSTRUCTION 2.596,00 SF
' PORC H/PATIO . 20,00 Sir
Cp►P,•AGEICARPORT (SP) , 12,32140
rs1'A,19 TED GOr.0 or CC)nml7Cnon
CONSTRUCTIO14 FEE 101.000.418.000
PLAN CA= ME 101-000-439-418 sm,3S:•
MECHANICAL .FEE 101.00Q-4.21 X000 X93, 50
k
ELEC2'.W CAL 1?EZ 101-000-4120-000 $136.94
FI,UM8INC}FEE 101-000-119.000 $149,25.
1 •� ff �,'.' ✓D
T'RONO MOTION IEE • PAID 101-000-241.-000 $15.37
*"; • , ' ;
43RAfaIliCi nt.101-000-4U-0013 $1®�00
DEVELOPER IMPACT FrE
�� w A.
SUB-.IOrAL COI7frrRXTG°11OX AND PL.sW CHIC'S:
• S PRE: -PAM FM
,
$0.00
•r 4�p.Y 1� �py��„q�•r t!�•���,+ NOW
FIX
TMA
��q.� 9
RECEIPT
DATE'-.
/C%.-
BY n� r
DATE FINALED
INSPECTOR `
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
:r BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
(2 11
Underground Ducts
Forms & Footings
LZ
u
Ducts
Slab Grade
2
t$ ��..
Return Air
Steel
(-Z't45 �r81
Combustion Air
Roof DeckZA�
Exhaust Fans
OX to Wrap
q(3 IE:pjL
F.A.U.
Framing
�� �f.J�
Compressor
Insulation
Vents
Fireplace P.L.
//
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
!•� f 23
Drywall - Int. Lath
SI2 CQ�
o a (NSvu+Wte�
e.(� a on
Final
Final
POOLS -SPAS
BLOCKWAI
L 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
O.K. for Finish Plaster
Sewer Lateral
C.0�
Pool Cover
Sewer Connection
(�(L�ij CY '""
Encapsulation
Gas Piping
Gas Test
Appliances
Final
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 ZF/
Temp. Use Power
C7
of
Final
Utility Notice (Perm)
JUN -13-2001 1526 WESTERN INSULATION 909 686 8786 - P.21i21 -
WESTERN INSULATION, L.'row.-
4211 Latham St•Bet, RLverdde, CaMrnta 921501
Tel. (9M) 69&8760 Fox (909) 686-8786 ,
INSULATI®N CERIhFICATE
' THIS IS TO CERTIFY THAT INSULATION HAS BEEN INSTALLED the 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/PHASE 4
LOT # s 20
SITE ADDRESS: f` . 78.870 ZENITH WAY, LA QUINTA, CA
... .._ ---=- -———————-------— —————
E) TERIOR WALLS:
MANUFACTURER: JOHNS MANVILLE THICKNESS: 3.5/E " R—VALUE: A-9 3
CEILINGS: ISS: BATTS(=LOW
MANUFACTURER: GREENSTONE THICKNESS:. 10.3," R -VALUE: R-38
CEIOrS: BATTSBLOW
MANUFACTURER: JOHNS MANVILLE THICKNESS: • - 13 R—VALUE: R•38
GENERAL CONTRACTOR: CENTURY HOMES
BY:
TITLE: ,
DATE: 1 r
INSULATION CONTRACTOR: WESTERN INSULATION, L.P.. '
LICENSE NUMBER: 794484
BY S
j TITLE: RKODVCTION TAGER1.
r -
DATE JUNE 13, 20.0
TOTAL P.21