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0009-189 (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 PrQfessionals Code, and my License is in full force and effect. r_'L'cense # Lic. Class Exp. Date 77`i 41 �3 B' , ."""... Date A Signature of Contract" OWNER -BUILDER DECLARATIONi'� 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). 1 . (, ) I, as*owner of the property; am exclusively Contracting with licensed- contractors icensed-contractors to construct the project (Sec. 7044, Business &' Professionals Code). t O I am exempt under Section=' B&P.C. for this reason Date Signature of Owner WORKER'S COMPENSATION DECLARATION F 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. ( )' 1 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 Policy No. (30W. 14 RhOI R NS. 2Jt�i% 44A068-fl2 (This section need not be completed if the l ermit 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 prov stop of Sec ion 37,00 of the Labor Code, I hall f�orthwj}'tf ply with those.•' ovi"sins Date:y7// �AA•pplicant !f Warning: Failure to secure Workers' Compensati(:4o4erage 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. IMPORTANTApplication 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 be 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 forpi' 5s')ection%purpos s. �rf _ <.._.Q Signature (Owner/Agent)'.Date i BUILDING'PERMIT PERMIT" DATE VALUATION LOT, (�© 1 TRACT - 1 e 37-7'-S JOB SITE. APN ADDRESS 784ZO WM WAIT t Z+ 609-08"M OWNER CONTRACTOR /DESIGNER /EN61NEEER 01."Lr3HT MWS ILC .. 0-11, IyR CAOWAL 4+iVVVd s PO BOX S 140 • 1535 so, V STRMf S'M 3200 NE+" JT►OW-17 BEACH CA +2662 SAW BMWA'1RDuWO CA 92408 (909)' 91.60107 MA ? 120 USE OF PERMIT �+3C3�E FA3�iI.Y :4��17�1'C� • ' . SrD-PL -N: 3C LOT:39 -PERMIT OO&SINOT INCLUDE BLOCfCWALMPOWDRIVEWAY APPROACH -75% PLAN CHECK. F99 REDUCT1013 FOR, MULTIPLY ISSUANCE OF SAME Pi A14 TYPE TRACT CONSTRUCTION 7,450.00 SF. PORCHIPATIO - 29.00 SF GA AIMCA.RPORT (SF) ;ffx5'Ilm"TED COST Or CONSMUC17Ofi .141"��; . i? :P1± Offf FEE SUMMARY CONSTRUCTION FRE 103-000-418-0010 PL.A-N CEikcr Pa 101.000-439-31b $161.50 MECHANICAL 101.000.421.000 $77,00 LLECTRIC:.tAL T fg, 101.000-4.20-000 '11%l.Sfj PLUMBF140 FEE 101-000-419-000 STROND MOTION FEE - RESID 101-000-241-000 GRADING FRE 101-000-42--000 Saw DEVELOPER IMPACT FEE =TlC rAL f. OiVSTRUC �1Ci1,i LAIC? 1'�;��1i� C'i3C C�`�," � $3,228.00 LESS! PRE -PAID FEES' $0.40 TOTAL I< -E- W ITES DIDE 14OW X5,222;.10 RECEIPT DATjE,,j BY'�+,(ri' DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs t (e- Underground Ducts Forms & Footings t Ducts Slab Grade 12 I $ C Return Air Steel Roof Deck _ Q> _ Combustion Air Exhaust Fans O.K. to Wrap _��3� �(�C F.A.U. Framing /L C7� Compressor Insulation z' (�� J'L Vents Fireplace P.L. Grills Fireplace T.O. Fans 8 Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath ,5t� _Final Final�� BLOCK W LL 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 Gas Test Electric Final Waste Lines Heater Final Plumbing Final Water Piping Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Z$ Pool Cover Sewer Connection (off Encapsulation Gas Piping Gas Test Appliances1l Final COMMENTS: Final _ Utility Notice (Gas) l 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 (Perm) JUN -13-2001 15:25 WESTERN INSULATION 909 586 8706 P.20i21 WEE"11FEMN INSULATION, L® 4211 Latham Street, Riverside, California 9=1 Tel. (909) 686.8760 Fax (909) 686.8786 INSULATION CERTIFICATE THIS IS TO CERTIFY THAT INSULATION HAS BEEN INSTALLED IN CONFOOMANOE WITH THE CURRENT ENERGY REGULATION, CALIFORNIA ADMINISTRATIVE CODE, TITLE 24, STATE OF CALIFORNIA, IN THE BUILDING LOCATED AT: t TRACT J PHASE: STARLIGHT DUNES #23773-5/PRASE 4 LOT #: 19 SITE ADDRESS: 78-860 ZENITH WAY. LA QUINTA, CA •-------- ---------------------------- --.-- .. .- . EXTEFII(ZR Vl9ALLS: MANUFACTURER, JOHNS MANVILLE THICKNESS: 35/8- R`VALUE: R-13 ' Ell. N S: BATTS BLOW MANUFACTURER: GREENSTONE THICKNESS: 10.3 " R= VALUE: R-38, CEILINGS: BATT SLOW MANUFACTURER: JOHNS MANVILLE THICKNESS: 1.3':"' R -VALUE: R-38 GENERAL CONTRACTOR: CENTURY HOtiAES', BY: a TITLE: 4 DATE: INSULATION -CONTRACTOR: WESTERN INSULATION, L.P. . LICENSE NUMBER: 794484 ' r TITLE: P D ION MA CHER j. DATE JUN 13, 2001