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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
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
., 11— LS f(1i31i:c"i1
Signature of Contractor -
Vat.
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 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
perfo ance of the work for which this permit is issued.
( P,have and will maintain workers' compensation insurance, as required by
Se tion 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:
Carner 4r1 ✓vRtd+lr ier AV t :r . a rn+Policy No. N +r. 5,141 nvcu°ial
.
(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 provisins of Section 3700 of the Labor
C20 e-vhall forthwith complytwitFr s ioGisi
�" te: % /1 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 for -inspection, p rposes.
�Sig"nature (Owner/Agerrt)' Date
PERMIT #
BUILDING. PERMIT 410112-1I.S7
DATE .y f� VALUATION S137J27 *�, LOT 3 TRACT 2-1773-2.
JOB SITE // .+. ..v APN w
ADDRESS ��^viw.l.l1l ,.W114t�' A.b7-QF�-fjS /
OWNER
4'?73t rCONTRACTOR
. DESIGNER ENGINEER
A�i.f�J.rj, 111 %m :o 11 r C1) f"11,err'. CONp11.t.kNIMc
PO BOX 51-10 1335 SO. "rY #1200
N1.wpulcl` CA 4202 SAKI8ERNjU..tD1-N0 CA 42d08
(�ti91:t��a5fJA7 ('"13i,# 2 f 24
USE OF PERMIT
MNIOLE .FAMfl,V 43iNI:.t..l.a{Nti
ai D4.QT31*1,AN &rL; i+l:12.t RT DOES NOT INC.i.UD9 BLOCK WALLS OR
Nt. /CJL
iaAACT CONSTRli�." 100 1r,376.00 W
6i <!•9'YRp A lrl' A CONT ,O I"4'Vi*i1•%"a9 Y'�/`��A �i jr
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t°N;I.iNO' FEE' SUMMARY
CUNS'1RUCTIONFE F
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$134.75
OtTRON('f'MtTION 1147 . R VSR 1
'101-i}i1i1-1414,W
t1 171
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1/!1.040- 423.000
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Dh_ J,CJPER INIPAC7 Flilb-
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ART 1N PUBLIC PLACES - M511,
701- i00-14�-000
593.32
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SI TR'11(WA1, C'ONSTRIf(-TW)N ANTI-) FLAW r.I4' ('V
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RECEIPT I DATE I BY J.I DATE FINALED I INSPECTOR
0,3 760 18
$3,3.S9. ill
INSPECTION RECORD
OPERATION
DATE
INSPECTOR OPERATION
DATE
INSPECTOR
BUILDING APPROVALS MECHANICAL APPROVALS
Set Backs Underground Ducts
Forms & Footings Ducts
Slab Grade Return Air
Steel Combustion Air
Roof Deck — UU Exhaust Fans
CK to Wrap�!/�� F.A.U.
Framing Compressor
_
Insulation 8 Z 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 �� POO S : PAS
BLOCKWA L PROVALS 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 —4s0 Heater Final
Water Piping Plumbing Final
Plumbing Top Out Equipment Enclosure
Shower Pans O.K. for Finish Plaster
Sewer Lateral �J / Pool Cover
Sewer Connection /-7 Encapsulation
Gas Piping 1,7
Gas Test
Appliances
Final
COMMENTS:
Final /
Utility Notice (Gas)
ELECTRICAP 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 (Penn)
ESI/FME, Inc,
Structural Enainet�rs Date : 9-28-00 By: R.M.B.
1921 East Camegie Ave., St 3 J
Santa Ana, Cciifornie 92705 Sheet _1 Of 1
Cornpnny : CEIJTURY HOVES Client Job No.
Address : 1535 Soutl`i "D" Street, Suite 200 Project Name : Starlight Dunes"
Sen Bernardino, CA 92408 ESI / F M E Job No.: 9173
Contact : George Project Eng.: RRW
Phone : { PH.: (7 14) 261A811 1 Fax 261-M
Phone Cawbr+ =Ftp Wecl'g �M�arp ®CltenCa =In -Hasse Meetng
TOTCL P.02
WESTERN INSULATION, INC.
4211 Latham Street, Riverside, California 92501
Tel. (909) 686-8760 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 PHASE 1 B
LOT # 3
SITE ADDRESS: 43635 GALLAXY LA QUINTA, CA
------------------------------------------------------------------
EXTERIOR WALLS:
MANUFACTURER: JOHNS MANVILLE THICKNESS: 3 5/8 " R -VALUE: R-13
CEILINGS: BATTS BLOW
MANUFACTURER: JO H MANVILLE THICKNESS: 13" R- VALUE: R-38
GENERAL CONTRACTOR: CENTURY HOMES
BY:
TITLE:
DATE:
INSULATION CONTRACTOR: WESTERN INSULATION, INC.
LICENSE NUMBER: 481278 r\
BY:
TITLE: PRO
DATE