0012-103 (SFD)N U)
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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
,P&te ,f !,;?g✓�✓ Signature of Contractor f
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. 7.044, 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
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' compensatiori insurance carrier & policy no. are:
CarverC5u3.L`+5'N FAOLE 114S,.. Policy No. 1YG�C`-94dt16S-fid
(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 forthwith comply with those�provisions.
,/bate: ,/ 1 ��fr? ` Applicant t
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 ,,y
& 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
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 relaying to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for,
r spection purposes.
Signature (Owner/Agent)
UILDING PERMIT PERMIT#
DATE VALUATION LOTS TRACT
JOB SITE ',
ADDRESS 43, Y0 CaAL Y X��Y�I�.
OWNER
CONTRACTOR / DESIGNER / ENGINEER
START Ct"BHT LasiNVZ LLC
CIEN'X`i;(RY MLOWLIL C:t7Miv1'!i 11'rm
PO BOX 5140
1533 80,'D" MU -2% MR 0200
N`FWORf BEACH CA 92662
SAYB A RD1N'C3 CA 92408
(909)391,60(Yi CMIX 2120
USE OF PERMIT
914)-PI.AI'4 3A .LOT .aJ • ViCIiMIT rKAS HOT I11CLI D11
BLOC1CWAL1SWCilaDP.IV'LIWAY,AIIPR.CLAC.I-1, 75% PIAN CHECK. f,7%
MUCT1013 POP, MULTIPLE IS: UJWC:s> OF SAIIE PIAIN TYPE
TRACT CONSTRUCTION "MSD.00 a
Ps�l Cl0A710 W100 SP
0A4C?iCf.GP'CARN)RT (,SPF) I%173„ 0
diJ •i/�iidiill �' �.94�'1:i 1�. 1%, V� i�"4 AF'W S.I b.�,�at��
141"3,M
PE,L Ao.r,,R iAUM)8R68R7. '
CONVAUC'T1014 FEE 101.000,416.000 $W16.50
PLAN CHECK FILE 101-000-4:39-318 $161.88
MECHANICAL 1� 101-(1 ,421.000 rn,00
1. rL,LC`k'MCAL.,FE 1411-�t2-"42fl-dr`OLI 17.59
PLq!'M8940 WE 101-000-419-000 RUM
ST'ROND NOTION ME - RESID 1031-00.0441-000 $14,16
ORADINO F'U 101-00OA23.000 X0,00
DEV.E1.0F'E�. IMPACT FEE $D;9Iil.0(!
�-
�A 4
SUB- i'XYML CC71d'MZI1 t` IION AND 1'JL ON WE CK
83,223.80
LESS I)RE: )AM FMI
$01M
9ID .�1't1EL�`� li'$i i�1SI� �D �AiP�
JAN 18 2001 = _ ,
RECEIPT
ATE/, 1i ( )
BY,:i
v:
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel (� _ �!b'–
Roof Deck 3 _ _ ��—fi
0. K. to Wrap
Combustion Air
Exhaust Fans
F.A.U.
Framing
Compressor
Insulation ��y _
Fireplace P.L.
Vents
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath_
Drywall - Int. Lath "Z_0;
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Hacks
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric.
Underground Plbg. Test
Final I 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 2�Z3 �G
Sewer Connection 23 _
Pool Cover
Encapsulation
Gas Piping
Gas Test
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)
AUG -20-2091 15:14 WESTERN INSULATION 909 686 8756 P.14/14
ra
EST RN IN . wzITI0 � LoP.
4211 Latham ft=t, Rivmide, 0611 wfA& 92301
Tel. (904) 6WS76C Fex (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 5
LOT # :
57
SITE ADDRESS:
43.680 GALAXY DR. LA QUINTA, CA
EX3T,AIOR WALL
MANUFACTURER;
JOHNS MANVILLE THICKNESS: 3 5/8 " R -VALUE; R-13
EI INGS;
BATTS BL011Y
MANUFACTURER:
GREENSTONE THICKNESS: 10.3 " Pi -VALUE: R-38
CEILINGS:
BAITS BLOW,
MANUFACTURER:
JOHNS MANVILLE THICKNESS: 13 " R -VALUE: R-38
GENERAL CONTRACTOR: CENTURY HOMES
BY:
TITLE:
DATE:
INSULAIlO N CONTRACTOR: WESTERN INSULATION, L.P.
LICENSE NUMBER: 7944944_��,.�
BY: . J✓
TITLE: PR U !ON MANAGER
DATE AU ST 24, 2001
TOTAL' P. 14 —
Certificate of Occupancy
City of La. Quinta'
Building. and Safety Department
This Certificate issued pursuant to the requirements of Section 109 of the Uniform Building Code,
certifying that, at the time of issuance, this structure was in compliance with the various ordinances
of the City regulating building construction or use. For the following.-
BUILDING
ollowing.
BUILDING ADDRESS:
Use Classification:
Occupancy Group:
SINGLE FAMILY DWELLING
R-3
43-680 GALAXY DRIVE
Type of Construction
Owner of Building: CENTURY CROWELL COMM
Building Official
VN
Bldg. Permit No.: 0012-103
Land Use Zone: RL
Address:
1535 S. D STREET, STE 200
City:
SAN BERNARDINO, CA., 92408
By:
DANIEL P. CRAWFORD JR.
Date: 9/21 /01
POST IN A CONSPICUOUS PLACE