0009-188 (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
D ti
Y741
� Signature of Contractor"'"
4 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 wages1as 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 maintaina certificate of consent to self -insure for workers'
compensation, as provided for;by Section.3766-'bf-the Labor Code, for:the
performance of the work for which this permit is issue'd.':
( ) 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 GOLDEN PA:OIZ IRIS, Policy No. WC -544068-02
(This section need not be completed if the permit valuation is for $100.00 or less).
O 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 Seetion 37.00 of the Labor
Code, I ha fort&th comply with thos rorI
Date:.?Applicant—
Warning:
Applicant 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 fo 'r%pec t. iog purp ses.
Signature.(Owner/Agent) Date�6�� /nth
BUILDING PERMIT PERMIT#
DATE. VALUATION LOT TRACT
$175A79.20 1s-
23773.5
JOB SITE
ADDRESS � WWA y
APN
OWNER
CONTRACTOR / DESIGNER / EN (NEER
SU RI,1GRr DUNM 11P_
(7ENTURY CROWELL
COMMU14=8
PFJ 13OX 5140 •
1535 SSS, WIX STMW, STE #`200
MEWPORr SEWi CO. 92662
SAkT BERNARDWO
CA
9e.408
(9,09)381.60W
C1314
2120.
USE OF PERMIT
GLE 02AILYDVOR1.UNO
SD-PL.AN:dLU LDT.18 -PERMIT D0E3 NW IWC:LUD
Oi.00KWALUSIP001JI)TUVEWAY -APPROACH.71% PIXK CHECK FEE
REDUCTION F'OLy MULTIPLE ISSUANCE OF SAME PLAN TYPE
TRACT CONS" R.PCTlel+f ,9ap,aQ sp
PORC )PATIO 29 00 SF
37,40 3A
0ARAWCARi'ORT Cl�K.WD"'rED
COST OF C0NFfRTJC`D0N
PFAMT FSE 5`UMMA11Y-
CONw`d'RUCTION FEE 101.000-418.000 54a.5,34
PL,W CHWIK: FEE 1011 000.439-319 $197.21
MECHANICAL M9 101.000.421 wOOO "2,00
ELI?CTRICAL FRE 101-000-420-000 $151.16
PLCIMB11'1C! FEB 101-000-419.000 3161501
{tr- f1
STRQ1JC3 MOTION FEE - RLSID .151-000-241-000 $17.57
� a
� {
�
G ADINO F?A 141.000-i23yo00 $20.60
DEV ELOPER IMPAC, T FEE $1,907.1511
�,•�,
ymb>.
-t
}'r'1.►
SUB (Y A1., ClONSI U(TriON AM PLAN CARC1.
$3,442.91
'LAS PRE -PAM M.%8
$0.00
�'C1'�'A 1y 14 f 1�'1�5 �1T.E_ _Pfo W
�'"3�Ii� ��
RECEIPT
.
DATE .1
� � . � r•,1,rd,
BY T ' / ;f
Aye
DATE FINALED .
INSPECTOR
I INSPECTION RECORD
,1PERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs dj
Underground Ducts
Forms & Footings ,an ro
Ducts
Slab Grade
Return Air
Steel t _
Combustion Air
Roof Deck Z 2� Q
Exhaust Fans
O.K to Wrap B_ Z9
F.A.U.
Framing I-
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 2�0
_
Final 7—l��ff
Final
��
POOLS SPAS
BLOC. WALL AIyPROVALS
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 It
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral ��,
Pool Cover
Sewer Connection -fes
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final 7 ! cry
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels 000,
Exterior Receptacles (% G
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
0
JUN-13=2001 15:25 WESTERN INSULATION 909,68G 8756 P,19/21
- `L1
E i OWL _ 4 L.'re
4211 Latham Street, Riverside, CaaMmia 02W I
TeL (909) 686-8760 .Fax W9I 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 OP CALIFORNIA, IN THE BUILDING LOCATED AT:
TRACT / PHASE: STARLIGHT DUNES #23773.6/PHASE 4
LOT#. 18
-SITE ADDRESS: 78850 ZENITH WAY. LA'QUINTA, CA`
--------------------------------------- --------,-------.- - -
EXTERIQR WALLS:
MANUFACTURER: JOHNS MANVILLE THICKNESS: 3 5/8 '.` R-VALUE: R-13
CEILINGS: SAM
r , ,
MANUFACTURER: ^GREENSTONE THICKNESS: 10.3 ° R-VALUE: R-38
i CEILIf+a1GS: TT _ x BLOW
MANUFACTURER: JOHNS MANVILLE THICKNESS: 13 " R-VALUE: R-38
. G NA L_C®NTBACT®B::. 'CENTURY HOMES r
BY:
TITLE:
[ DATE:
INSULATION C!QNTMCTOR: WESTERN INSULATION, L.P.
LICENSE NUMBER: 794484
BY:
TITLE: PKOpkfCTION NAGER
DATE JUNE 13, 2009 ti