0009-177 (SFD)LICENSED CONTRACTOR DECLARATION
d 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..
d `License # - Lic. Class Exp: Date .
4 7 418 11 1t?/1/ZC
Date/t ��-Signature of Contract4 "y
J 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).
( ) 1, 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:
( ) .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 C30Li?EAd B�iCil,i; INS,Policy No. N�7C-BOG$-01
(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 e wo�ers' compensation prove nns Seco 700 of the Labor
Cody0l s aU;orty�w' hi mply with those rovis' ns.
Dare: //�//applicant %y
Warning: Failure to secure Workers' Compensation co erage 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 ofAhis City to enter upon
the above-mentioned property fo fspectio,n"purpdses.. ;gyp
Signature (Owner/Ageni)--g �' J sy%~`YI Date"
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 4�`�
TRACT
$118.71:9.30 T4
23773-5
JOB SITE
APN
'
ADDRESS 78-M5:7ENMI WAY
OWNER
CONTRACTOR / DESIGNER / ENGINEER
8`I"Ai2T. oyriDuims uc
c%mtvY C owf_L.L COTvimi. Krim
PO 1:: X 51X30
1535 3O, °D" MTOT, SIT 0200
A1EW!ORT BEACH Chi 92662
SAN BM.ARDWO
C.A.
92408
(909)381.6007
CDIX
2120
USE OF PERMIT
SMOLE FAIMBLY DWar7.MG
3FD.P1,sA'N:2A LOT:14 P1 RMIT DOIKS NOT INCLUDE
EIU)CK.*WAI.1,,:3(.POO,UDRrVF-WAY.A,PPROACH,'7,$%P X13' CE'iIsX..K { KE
TWOUCTiON FOR MULTIPLE ISSL1ANPE OP SAME PLAN TYPE
TRACT C°ON.07 UC:'T1ON 4023.00 31<
PORCH/PATIO 49.00 SP
OAI3A.OEICARPORT (33F) x,232,00
E,S't7tf�lil.''1 JD C09r OF fef .K9173CTC711'O 9
118,71.9.30
Fkrf WITT Fn WhOAARY
CUNSTRUCT101A FEF 101.000.415.000 MOD
PLAN CHECK WE 101-000-439-318 $144,60
MECHANICAL FEZ 101--000-421-000 $47.00
ELEC TRICA.L PEE 101-000-420-000 S 112.71
;
.
PLUMAINO FEE 101.000.419-000 SA3403
Fina+?
` I
STRONG MOTION FFE • RES1D 101-040-2.41-000 $.11.97
t I
GRADM i FEE 101-000421-000 $20100
r
DEVELDPIM IMPACT FRE
Y-
"RhY
SU 8 i'OTAL. CIONd•"di'Et[7C° ION AND PLAN Ci•1T:CK
$3,083.93
I S PRE -FAM M0
$0.00
.i IAL 1!'& - MIN DU7.E. NOW
RECEIPT-
DATE/,,, g.
BY .:i
DATE FINALED
INSPECTOR
INSPECTION RECORD -
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
a
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Co
Return Air
Steel
'L) I t �� -
Combustion Air
Roof Deck
�,
Exhaust Fans
O.K. to WrapMot,
F.A.U.
Framing
o of
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
l �p-EJB
Final
BLOCKWALL APPROVALS
Final
Steel
PO S - 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
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
(Z_�
Pool Cover
Sewer Connection
LZ\2® (r
Encapsulation
Gas Piping
Gas Test
Appliances
Final
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
Temp. Use of Power
Final _
Utility Notice (Perm)
COMMENTS:
JUN-13-2001 15,23 WESTERN INSULATION 90q 586 S7G6 P: 15%21
WE
Fft 5 lWoo"ULATION9 '® ,
F ,
4211 Latham Street, Riverside, California 92501 s
' Tel. (909) 686-8760 Fax (90 684-8786
INSULATION CERTIFICATE
THIS IS TO CERTIFY THAT INSULATION HAS BEEN INSTALLED IN CONFORMANCE WITH
THE CURRENT ENERGY REGULATION, CALIFORNIA ADMINISTRATIVE CODE, TITLE 24,
STATE OF CALIFORNIA, IN THE BUILDING LOCATED AT:
TRACT / PHASE: STARLIGHT DUNES #23773.5/PHASE 4 L
LOT # :: 14
• SITE ADDRESS: 787835 ZENITH WAY. LA QUINTA, CA
EXTERIOR WALLS:
MANUFACTURER: JOHNS MANVILLE THICKNESS: 3 618 " R-VALUE: R-13 w
CEILINGS: BATTS BLOW
MANUFACTURER: GREENSTONE w THICKNESS: 10.3.' R-VALUE: R-38
t UN 9• A7TS ` . BLOW
MANUFACTURER: JOHNS MANVILLE THICKNESS: 13. R•dALUE:, 8-38
GENE AL CONTRACTOR: CENTURY HOMES
1 BY:
TITLE: }
DATE: ,
INSULATION CONTRA=: WESTERN INSULATION, L.P.
« LICENSE NUMBER: 794484 r
BY:
TITLE: PAO.EruCTIO ANAGER -
f DATE JUNE 13, 2001
T