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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. e
License # Lic. Class Exp. Date
71418,9 1fl 31/201
Xpat G�0 Signature of Contractors = y
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
pe ormance of the work for which this, permit is issued.
(••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 ff,, [[^^ ��` Policy No.
C3 J1.+. UN EAGUE S2413'. fiV VVfiyV, VU J.
(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 pr0visioni of Section 3700 of the Labor
Co e-4 s to hwith comply wi h th t,� se prove ions
D e�� Applicant_ •f—
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 Grinspect'ion pu oses.
Si -nature (Owner/Ageni� �- Dated
le
PERMIT #
BUILDING PERMIT
0002-1&5
t,, y
DATE 0-1 OD VALUATION .V 37,7 6.20 LOT 1 TRACT ?,t771,J
JOB SITE
ADDRESS 43-695 CseR"KII DKi.+EVE
APN 60-480-016.5
OWNER
CONTRACTOR/DESIGNER/ENGINEER
NS;" LIKIL :'J1U.NTES,11,11";
ti � si.ni'i.nr�`,rr,';� � ��e31:;`.1'�:�;`s
P U BOX 5140
1535 SO. "I7" Si1ZM, S -M. H2O
NUMIIat;.iltT C.A. 92662
SAN Ii NAR INO CA 92408
09()9) R1 07 C131.# 21,20
USE OF PERMIT
S1NA1-: F<UWIL NVELL1NG,
ST t5 -LOT .f PLAN 3A-Pl aiivSi.i' DOE -5 NOT ilIC UDE WJ_0 `i+. WALLS OR
.Y3tdt. .
n -m .m• .- 3 ♦ern. t n rvn
4.Vtvtva.ai ia�.!a.+7%v a,:IV. 3!, 2)
1Yi. RCILT.A.1'10 X00 uF
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a,s t aw :+�. H r;,.r� �...•,,�s.� win•
i 1"fIda
a. + r, $ 41re.AAO
„� £ FL
c:ONSTRIJ(;:TION FFJL 101-000-418-1" $!72.50►
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tin)••
h..a. ANIItCAL PJF, 1 11"1:(u',,0�'•t4y+1 -000 353,"
�r�it
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r1J,-" il.. CAL FEE t101 -f. 00-420-000 $,146.14
•` .
PLUMfil.NG 101 -M -419-0W S I -M.7.5
XMONQ Mf1TFON R—E - RE',9 )
CRADIING r! D3 .101-0004223-000
D VEA..Uf0.01.I&WA.C. i:0- $1,407.00
ART fN IxVBLIC YLAC hS -_RE&i 701-000-255-000 $44.-42
t.�, I��iyOS1'r I q) -Op{► -Q30 -?I I is _�ett0 0(;
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UYFA1, 1'KRAIVC FEES 01)E NOW
x;.3,270..42
RECEIPT
DATE
BY /
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
/"
Underground Ducts
Forms & Footings
— t'/
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
—{,'D
Exhaust Fans
CK to Wrap
F.A.U.
Framing
Compressor
Insulation
' _A o�
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lanes
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
—pad
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
— --�� ��
Neater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral/
Sewer Connection
/
// 6
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final Q 3%
Utility Notice (Perm)
COMMENTS:
NOU-21-2000 10:36 WESTERN INSULATION 909 696 9798 P.02/03
lwmw"FATE"INSULATIt3'ihm', INC*
4211 Latham Street, Mversift. C Mmia92501
TeL (909) 686.8760 Fm (409) 680-8786
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 I PHASE: STARLIGHT DUNES - 23772-2
LOT # : 1
SITE ADDRESS: 43-1395 GALAXY DRIVE, BERMUDA DUNES, CA
XT IQRWALW;
MANUFACTURER: JOHNS MANVILLE THICKNESS: 3 5/8 " R -VALUE: R-13
ATTS BLOW
MANUFACTURER: GREEN TCKNESS' 10.3" R- VALUE: R-38
(�GSj BATTSBLOW.
MANUFACTURER: JOHNS MANVILLE THI SS: '13" R- VALUE: R-38
GENERAL ONTR TOR: CENTURY HOMES
BY;
TITLE:
DATE:
INSULA110 CO TRA WESTERN INSULATION, INC.
LICENSE NUMBER: 481278
BY;
TITLE: PRODUCTION ANAGER.
DATE NOVEMBER 21,-2000