0009-186 (SFD)LICENSED CONTRACTOR DECLARATION
1 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
7 41?,;�,Q
1311C
Dat� �� 7 �C$�ignature of Contractof \
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, 8S OWi & of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code). r
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:
( ) I have and will .maintain a certificate of consent to self -insure for workers'
compensation, .as provided for by Section 3700 of the Lab6r 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:
CarrierCOLDnW R-ACIL9,;1 TII, Policy No. NSC- 0�8-Oa
(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 wggrkers' compensation provi aonlof Section 00 of the Labor
C I all forEFy@vt�k�, comply withos6 ro IslonX_
Date: �� ,� vv 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;ari�spti��urp • est
�-a
`Signature (Owner/Agent _-'� � Date �
BUILDING PERMIT PERMIT#
DATE VALUATION LOT TRACT
!�: • r r, �"'t�. ��.��,��.a� 1'7 237'73-5
JOB SITE APN
ADDRESS 7+84o z
a"ja wA.y _0fm_K6
OWNER CONTRACTOR/DESIGNER/EN INEER
A1tlti:,'Lf Yff DUNES LLC C d"i'CJ1tY' cROWELL CoA+II+AuNr
PO BOX 5140 1535 830, SO MRM T, 1.4I :;, Atoo
10WORT BEACH CA 92662 SAN ?X,"A DWO CA 92408
(909)381.6007 _ mo ?,120
USE OF PFRMIT
swoiz, PAMi Y Z`tw..:�L].W)
l
SFU•PLAK: 2C I:.OT.11 &M11T DOES NOT INCLUDE
BIiOCKWAI,.LWPOc .1, DRIVEWAY APPROACK75% PLAA CH6?XK .W
ktS1: D TION FOR MULTIPLE ISSU,"CE OIC SAME PLAN TYPE
TRACT CONSTKUCTION w029.00 OF
P6RCWPATIO10 4100 SF
GARAC RMARPORT (13F)
Uffl,- 9.OTAL CONTI—A13G TION AN:i7PLAIT CIMCY
I.:P.,SS PRE -PAM o'p
TOTAL FERMIr MS DM NOW
RECEIPT I DATE' (, BY 11,I DATE FINALED ]INSPECTOR
rte'.
$3,08:3.93
$0,00
ES"alSit(A'M COS' OF CONURii=ON
1�:�tBdCi'T �T�S; >�i7I1!1.I�Ai2it
-
CONSTRUCTION FEE
101.000,418.000
E90c QO.:
PLAWCHECK FEE
1 Cil-C)0ti-�139�! l8
$3�id 60 +
iviF0MICALFEZ
101-000.421-000
$47.00
ELFbTRIC.AL FEE
101-00042" 00
$112.71
PLUMBING FEE
101 v000.419�WO
$134;�S
STRONG MOTION FEZ AESID
101.000-241-000
$11.87.
ORADINO Ftp:
101-000.425-000
U0.00
DEVELOPER IMPACT FM
$1,907.00
Uffl,- 9.OTAL CONTI—A13G TION AN:i7PLAIT CIMCY
I.:P.,SS PRE -PAM o'p
TOTAL FERMIr MS DM NOW
RECEIPT I DATE' (, BY 11,I DATE FINALED ]INSPECTOR
rte'.
$3,08:3.93
$0,00
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
LZJ�
Return Air
Steel
MAIIA
Combustion Air
Roof Deck
3 ��
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
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
Final I_ _��"
BLOC KWA L PPROVALS
Final
Steel
POOLS SPAS
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
CV
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Q
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final a
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 (Perm)
COMMENTS:
z
JUN -13-2001 1525 WESTERN INSULATION 909 686 8786 P.18/21
WESTZRa
4211 Latham Street, Rftra:de, Callfoml[i 92301 7
TeL (909) 686.8764 Fax (909) 686.8786
-
INS.ULATION CERTIFICATE
THISISTO CERTIF'Y THAT INSULATION HAS BEEN INSTALLED IN'CONFORMANCE WITH-
THE
ITH
THE CURRENT ENERGY REGULATION, CALIFORNIA ADMINISTRATIVE CODE, TITLE 24,
' STATE OF CALIFORNIA, IN THE BUILDING LOCATED AT: .
TRACT / PHASE: STARLIGHT DUNES ii23773-5/PHASE 4' - r
LOT # : 17
SITE ADDRESS: 78-840 ZENITH WAY. LA QUINTA, CA
,F
r ... ..........
EX1ER10; WALLS. .
MANUFACTURER: JOHNS MANVILLE THICKNESS; 3 518 " R -VALUE: R-13
CEILING - BATTS BLOW -
MANUFACTURER: GREENSTONE 'THICKNESS: 10:3 ° R -VALUE: R-38
.. CEILINGS: BATTS - BLOW .
Y
MANUFACTURER: JOHNS MANVILLE THICKNESS: 13 " R -VALUE: R-38
~ GENERAL CONTRA i)R: CENTURY HOMES
BY: r _ -
(. TITLE: „
DATE: -
ONS9�LATi®N e;ObITRACTOR: WESTERWINSULATION, L.P.
LICENSE NUMBER, 794484
' BY:
TITLE: P ION AGER
- DATE JUIG 13, 2qV
:�of