0009-162 (SFD)F1
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
Profession6kCode, and my License is in full force and effect.
License # Lic. Class Exp. Date
i
DateA6� � ignature of Contractor d
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).
() I am exeinpt under Section B&P.•C-fer^t*i5Yeason%r .
Date ignature of Owner-- -- '
WORKER'S COMPENSATION DECLARATI N
I hereby affirm under penalty of perjury one of the following declarations:
( )z 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 0OLDMI4 SAMA-:IN,S Policy No. NViiC»5.44063-01
(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 the workers' compensation provisions of Section 3700 of the Labor
Code; I shall f hwit -comply With tho a ro .isions.
Date: ✓e %.Prplicant 2�!r
Warning: Failure to secure Workers' Compensation goverage 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 inspection gIrposes.
,r�-' �' , - / l
Signature (Owner/Agent) : f Date a V
BUILDING PERMIT PERMITq x.
DATE VALUATION LOT 0009-162 TRACT
Sx75,S79� ` 1 Z37`�3••S
JOB SITE
APN
ADDRESS 4 _tftm G 1YRM
609-080.026
OWNER
CONTRACTOR / DESIGNER / EN (NEER
STARUIS- .`z Di3ITE9 LLC
CrM'MY CROWE`1:.L COMAIJOrfIRS
PO BOX 5140
1535 30. PDO ==', S'M 0200
NEWPORT BEACH CA 92662
SAN BEMAR7DWO CA 92408
(9139} 381 x6007 CBLO 2120
USE OF PERMIT
a Ntil, E F.AMfi>Y DVW_L11e G
SIS -PI ANALAR- LOT:1 PERMIT DOES NOT INCLUDE BLOCK
%VALLSIPOOUDR1VEWAYAi'P11c,AC.H,
TRACT CONSTRUCTION V00.00 BF
POR.CI'UPATIO 18.00 SN
GARAGUCA R.T (SP) 17,40030
1''�d7. MAT]l9U COh-I' OF C01V9MT1rylt 01'T
175,6-79:20
CONSTRUCTION EEE 101-000.418.000 $905.40,
KA14 CHECK FEE 101-000-439-318-
MUCEtM41CAL PEP. 101.000.421.000 591.00
.�
EL1✓C:`17RICAL FEIY 101.-000-420-000 $1St. I6
PIIUM81110 FEE 101.000.419.000 $16.1.50
;� • ° �
STRONG MOTION ME - RES1D 101-000-24.1-000 $17.57
�
ORADINO FRE 101.000-423.000
1
DVLs'LOPER IMPACT FEE '$1,907.00
S'i:M-TOTAL. CONSTI1UCiaON A14D PLAN CHEM
$4,104.58
LEVS PRE -PLM FM
$0,00
T+Ci'r AL 1"IMMIT:£r "0-.,8 DOR -N Ow
$4,004-58
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Setgacks
�Z�of E
Underground Ducts
Forms & Footings
iZ�o�
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Z p
Exhaust Fans
O.K to Wrap
��$ (�+L
F.A.U.
Framing
Compressor
Insulation
��jL
Vents
Fireplace P.L.
_
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines-----'
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
�eC
Final
Final
/-��
P OL - S AS
BLOCKWALL AP ROVALS
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
Heater Final
Water Piping
Plumbing Final'
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
I2_12�
Pool Cover
Sewer Connection`.�
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Vottage Wiring
Fixtures
Main Service
_
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
JUN -13-2001 15:1? WESTERN INSULATION
S
i
S
7'
909 686 8786
uwwr FA TE R N IN S L ,STI , L.P.
42 l 1 Latham Sheet, PjvcrWdo, CaUfonlin 92501
Tal, (909) 686.8760 Fax (909) 686.9788
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 I PHASE:
STARLIGHT DUNES #23773-5/PHASE 4
LOT #:
1
SITE ADDRESS:
43-605 GALAXY DR, LA QUINTA, CA
EXTE:EilORMLLS'.
..... . . . . . . . ....... . .
MANUFACTURER:
JOHNS MANVILLE THICKNESS: 3 5/8 " R -VALUE: R-13
CE:I�C�S:
BATTS B LO W
MANUFACTURER:
GREENSTONE THICKNESS: 10.3 " R•VALUE: R-38
FILINGS:
BAITS SLOW
MANUFACTURER:
JOHNS MANVILLE THICKNESS: 13, R•VALUE: R-38
GENERAL CONTRACTOR:
CENTURY HOMES
BY:
TITLE:
DATE:
IN-SJULATION CONTRACTOR: WESTERN INSULATION, L.P.
LICENSE NUMBER: 794484
BY:
TITLE: UCTION YKNAGER
DATE JUNE 13,2001