0009-185 (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
714188 13 , �i .0131/2(
Dat/6 /I# Sigriature of ContY`acto !
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, At 6Wi)6V 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 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:
Carrier0.01.Z'i} 14 F,401,9 0 Policy No. 14WC-544068.02
(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, ecti • n,3700 of the Labor
Code,Ish f•rt ithcomplyw-fhos rovsiois
C
Date) Applicants_, .-�
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 for 'i3 pectionp'urposes.
Signature (Owner/Agent) 4 Date
a
BUILDING PERMIT PERMIT#
OR-
DATE r VALUATION LOT TRACT
041,593M 16 23' -5
773
JOB SITE
ADDRESS 7E5 �� r A ...:� WA'a'' ”
APN
609-08"26
OWNER
CONTRACTOR / DESIGNER / EN (NEER
S AR1101 r Dulas LLC ,
M iTURY CROW. eu, Ido%Wi3Hmi s
110 ]UM 5140
1335 :IO, *V S'I`FT, 9M W4DO
NLWPOWr MhC,14 CA 92662
SAW BF"ARDWO CA 92406
(90#081.6007 Mut,2120
USE PERMIT --
yyO;;y�F�q {� (p�
N9 10� py�y� yy�yq�y
s1X...TeA !,'lI.! J«�Y4�Sslrl.+3d�!G
k, • ,
SPD -PLAN: 'tri ?.,OTA6 PEWIT DOES NCf INCLUDE
BF.dt"KWAi:.T, IP0014bile+•EWA1t' AP PROACH.75 O PLAN CHF.C4 :, PKE
REDUCTION FOR MULTIPLE ISSA1: ICE OF SAME PLA14 TYPE
T .A.CI' CONSTRUCT1014 2,4*00 Sly
299.I?0 SY
PORCHlFATiO -t7
(/�•(34' / {�y
0AP"FJOARPORT %173.20
X9MAAW1r1 COff OF CONS 11MC 1700
CONSTRUCTION FEE 1 U1 *000'.418.000 $796,$0
Plr 4 CHECK FEE 101-00.0-422.9-318 $161,SQ
MECHANICAL FEFi 101m=-421-000 sr, 00
I?.t ECTR1CA1;'F&F, 101-000-4120-000
PLUMBING FEE-'. 101 -OW -4'19-000 $1.34.75
'
STRONO MOTION PEE • R.ESW -.101-000-M-000 $14,16
t,'k3.AWP O PRE 101.000-423-000 $20000
OL�JLLC}P IMPACTM $1=90'7;00
f-
ti
3 -TOTAL CONS RUC'CION AND PLAR C1XXK i
' � $3.,228.80
N
L=3 3P.Ft& PAV1,2
�
# $0.00
►f, 1)
"(J
'ITY!Ale FMCIT FEES 1AJE NUW %n ���
3 t13_111120..00t�,F
RECEIPT
DATE
BY P
DATEFINALED
INSPECTOR
INSPECTION RECORD
,OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings �Yf
Ducts
Slab Grade I�
Return Air
Steel ��TJ�-
Combustion Air
11Z�0�
Roof Deck
Exhaust Exhaust Fans
O.K to Wrap 3 �23 Cfl°'c,
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
Final
POOL6 SPAS
BLOCKWA L APPROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final I
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 LateralMe x.eD .
Pool Cover
Sewer Connection t 2�2�sJC
Encapsulation
Gas Piping
Gas Test -9
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
Temp. Use of Power
Final
Utility Notice (Perm) .
!UN-13-2001 15:24 WESTERN INSULATION 909 686 8786 P,17i21
W"Q I'MmN IND V LATIUa
4211 Latham serest, Riveraide, Callfornla 92501
Tel. (909) 686-6760 Fax (909):686-8786
INJELATION UR'T'ICAT
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
LOT #: 16
SITE ADDRESS: 78.830 ZENITH WAY. LA QUINTA, CA '
9XIER10B WALLS: 6,
` MANUFACTURER: JOHNS MANVILLE THICKNESS: 3 5/8 RNALUE: R-13
CtiL11dQ6: BAITS BLOW
• MANUFACTURER: GREENSTONE, THICKNESS: 10.3" R-7ALUE: R-38
. CEILINGS: BATTS BLOW
MANUFACTURER: JOHNS MANVILLE THICKNESS:- 13 " R-VALUE: R-38
rZENERAL CONTRACTOR: cENTURY HOMES
BY: `
TITLE: t
DATE: c
INSULATION CONTRACTOR: WESTERN INSULATION, L.P.
LICENSE NUMBER: 784484
BY:
TITLE: AOUCTIO,ANAGER
DATE fUNE 13, 01