0009-184 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am:licensed under provisions of
Chapter 9 (commencing with Section -7,000) of Division 3 of the Business and
1 rofessionals Code, and my License -is, In full force and effect.
License # I Lic. Class Exp. Date
4/14 €I B _ r�' _ (V31/7(
Datefr Signature.of Contractor'" �' ✓r
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, 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 clolx%l A1rrAC9I.$ Policy No. . -NW
(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 should become
subject to the workers' compensation routs' of sectio 3700 of the Labor
-Code sh I fofISwith comply wit , ose- ovu osis ' -------
Dat . fir Applicant-
Warning:
pplicant 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
ees.,%IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditjons and restricfions 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. Anypermit. issued as a result of this application becomes null and void if
work is not c. Kmmenced within, 180 days from date of issuance of such
permit, or cessation of work for: 180 days will subject peryit 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 represerrltatives of this.City to enter upon
the above-mentioned property -f is ecti R'pur 'ses >
Signature (Owner/Agent�� y Date e
L� ✓
BUILDING PERMIT.. PERMIT#
DATE VALUATION qLOT ow.. -184
' It 'G{) $118,719.30 15
TRACT
23773-5
JOB SITE
APN
ADDRESS rim WA
-08".146
OWNER
CONTRACTOR / DESIGNER / EN (NEER
S AAR UGRT DUNFS.LW
CENTURY CROWELL COWUNITIES
IES
PO BOX 5140
1535 00, -D' TfR MOT, UI`.C, r,00
149W.PO r BFAal CA 92662
SAN BIMNAitDD10
CA
92408
(909)381.6007
C
1.4 2120
USE OF PERMIT
`3ING`LE F41LY I7VJ X199 -Y
SFD-P1ARF:2B LOT:13 dPERMIT :1010ES NOT INCLUDE
SiOCi'CWALL'.SIE'c7OUDIN'IFEtI A Y APP)'hOACH,75% PLAN G`I-IWK me
UDUCTIOAI MR MULTIPLE ISSUANCE OF SAME PLAN TYPE
TRACT CONSTRUCTION %023.09 ar
PORCH/PATIO 48.00 SF
-GARAQRICARPORT (30 0,23100
ES'1"91VJCA17D COST OF C0Yq9JrR.UCM0X
1A�,7I,9�35i
1;''E' .R.Md.1T FEE NUMAURY
WKSTRUCTIOAI FEE 101.000-416.000 X106.00
PE< tH CHECK; NEE 101-000-439-318 $144.60
MECHANICAL FEE 101-000.4421'-000 34700
EI..ECTRIC,Ab FEE 101-000-120-000. 1
PLUAr1BW FEF: 101.000.419.000 SIAM
STR.ONOMOTION-F'E'E RESID 101-000-241.000 $11.3?
ORAD1NCr FE, .101-000.423-000 120.00
1DEVEIAPER IMPACT FEE SI,907.00
M
°A f )
.
'('� p �,�' �,� ��,/�
�r�. � y /�1r,y, ��1 ��yt �/�ri�y. p^q AND
J7L 017,,01 i1S DPL7[';I,r W.i[:N+,LL
,►1CYda�"'�3.1/,�I'!ir'Lrl,/3Y.\7.l
L°. LESS PRE -PAM FEES
` {
$a00
:TOTAL P1 R1V1f YQUS UVE NOW
RECEIPT
DATE, .
BY , O
DATE FINALED
INSPECTOR
OPERATION
DATE
INSPECTOR
OPERATION
DATE
I INSPECTO
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
12,1 cn
Ducts
Slab Grade
CReturn
Air
Steel
) IM —
Combustion Air
Roof Deck
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
BLOCKWA
Z
PROVALS
Final
POOrS/. SPAS
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 Lateral
12123 CQ
Pool Cover
Sewer Connection
Encapsulation
Gas Piping r
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICA A PROVALS
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: 24 WESTERN INSULATION 909 686 8786. P. 16/21
�JIAK I
;
4211 Latham Sheet, Riverelde, California 97501
` - Tel, (909) 6868760 Fax (909) 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 OF CALIFORNIA, IN THE BUILDING LOCATED AT:
TRACT / PHASE: STARLIGHT DUNES #23773.5/PHASE 4 !_
LOT
.
SITE ADDRESS: , 78-825 ZENITH WAY, LA QUINTA, CA -
-.lIVALLS,Y..r...''- -..--.'._°____ ________________________.___
_
••`EXi'EROQ3R
MANUFACTURER: .'JOHNS MANVILLE THICKNESS: 3 5/8 " Ft -VALUE: R-13
`
ScE� BATTS W
- MANUFACTURER: GREENSTONE THICKNESS: 10.3 " R- VALUE: R-38
CEILINGS: `�' ' BATT6 BLOW
MANUFACTURER: JOHNS MANVILLETHICKNESS:. 13 " R -VALUE: P-38
.
9ENERAL OONTRAOTQR: CENTURY HOMES
BY:
,
TITLE:
DATE:
INAL&ABON C-0-NTRAOTO8: WESTERN INSULATION, L.P.
- UCENSE NUMBER: 784484
m BY.
'
- TITLE -CION NAG ER
DATE 'J E 13, 1 : + `