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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
714188 11
Date Signature of Contractor
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
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 insu,ance carrier & policy no. are:
Carrier Policy No.
�lf.�I.�I3'�'�d ��,�tw91.;� T�i�. AI'!v'4t'C-38A�iS8••S3�
(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.
Date: 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 purposes.
Signature (Owner/Agent)
Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 001q,..(W4 TRACT
$118.719,30 .46 23T13_5
JOB E � Q/�
APN
ADDRESS
Baa ec., r.11U4AX ' 1,MVE.
d fi�A �J2
OWNER
CONTRACTOR/DESIGNER/EN INEER
PO BOX 5140
i.335 so, `",.r "mrara, w i7- 000
'14it"rAi'.P?O:i 'f DEALS CVA 92662
SAN BIMMARLAX0 CA 32408
(F)09)381-6007 C rand 23,20
USE OF PERMIT
SPrj-.'PLAN`2HR, LX)T 46 PERMIT DOES NOT MCLt DF,
fat. CXVAUAW001A)1UV&W Y APPROACH,75 % P►Ag O.H&^ R.31
104MISCTIO14 M. at MU131P,Yle, V$SUAINI CE OF'.,AM. " PI.A14 TY1P
I�O�C���'d� i��� j�.�� a✓r
�,4r4�lC'Ri.IRI�CsJ3Y (�� ��p.(rfl
Cry 43TRL.3MIJON YEE 101a000-4,18.00 i SMID.D.
PL,FfN CHUX M, 101-000-439-118 9144.60
KWIIHAIWAL RIB 14M "V10,421 -000 WOO
101-000.420-000 $11171
PLUME11140 Fer, 101-000-419p000 $134."
JMONG MOTIGH FYI); - MID 101 -000-W -001) $1 I."
ORADING RY. 101-000-4-23-000 $20,00
DEVELOPM IMPACT PEP,
SUB-MULCt?MP�'i`t�+..:I.TIG`". ION,f M PLM MIRCK
I ii PRE PAID X FEV
$47.00
TMA . 31-711 'U F "1 ,°N .R?UE NOW
elM�lp .u�e�
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Z
Underground Ducts
Forms & Footings
2�
Ducts
Slab Grade
3 l
f
Return Air
Steel
3
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
Final
POOLS - SPAS
BLOCKWALL
APPROVALS
Steel
Set Backs
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
Water Piping
��
Heater Final
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
��222
Pool Cover
Sewer Connection
C�
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)
l�
F LICENSED CONTRACTOR DECLARATION
I herby 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
Date /%�/�'� Signature of Contractor
arnr m _-_
OWNER -BUILDER DECLAR
I hereby affirm under penalty of perjury that I am exempt from a Contractor's
License Law for the following reason:
( ) I, as owner of the"property, or my employees with wages.as eir sole
compensation, will do the work, and the structure is not intended or offe d for
sale (Sec. 7044, Business & Professionals Code).
( ) I, as owner of the property, am exclusively contracting with license
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' compensation insurance carrier & 'policy no. are:
Carrier Policy No.
10014DEll RAGLE, INS",
(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 th
workers' compensation laws of California, and agree that if I should beco e
subject to the workers' compensation provisions of Section 3700 of the L or
Code, I shall forthwith comply with those provision1
Date:/ irwOr Applicant
Warning: Failure to secure Workers' Compensation coverage is un wful and
shall subject an employer to criminal penalties and civil fines up to 00;000, in
addition to the cost of compensation, damages as provided for in ection 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of B Ilding 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 ade &each person at,
whose request and for whose benefit work is perfor d under or pursuant to,
any permit issued as a result of this applicaton agr es to, & shall, indemnify
& hold harmless the City of La Quinta, its office , agents and employees. '
2. Any permit issued as a result of this applicat' n becomes null and void if
work is not commenced within 180 days fr date of issuance of such
permit, or cessation of work for 180.days wil subject permit to cancellation. i
I certify that I have read this application and s to that the above information is
correct. I agree to comply with all City, and tate laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.-
Signature (Owner/Agent)Date
BUILDING PERMIT PERMIT /I
DATE VALUATION LOT CYHDTRACT.
46 17 i M173 -S
JOB SITE
ADDRESS
OWNER
CONTRACTOR / DESIGNER / ER
"IAR:f.1CRIT DL IRS LCC° .
(1WdRY CFtC1WML C°O.MMUNa7.T.'IU
ISO B Ok S140
X35 30. "LY, VIRFE , S.ip. 4200
2v(1:1h1Powr BEAM CA 926,62
SAN BEMIARDINO Cly, 92408
USE OF PERMIT
SWOU- FALMA 1rD)1VWMMM1_W ZS
S1P0--PLA'X AR 1,OT DZi 3A JT 0 -CI SAdOT INC:LUCIP,IXiCKWA.i�i
Of
NEW� Y �,,�'1'Y't.O.e�,C'Hr75 %PLAN CHECK FELEUCT1.OAf
X46
POltIPLE 19S$iANC;P. OF SAME Pb AIA TYPE
ACT COINMUCTI034 2,023.0: ski
PMPATIO 400 SF
0A , OEIC:ARPOR:T (SS') 21,232,00
C00f OF CONSTRUCMON
CONS1'.la.UCTIONFES
PLAN CHWX Y99 10 ? -000.439-3'1$ $144.00
MECHANICAL FEE01•hET -421.000 141.00
LLWTRIfi141 FE9.. 01-000420 000 Irn
PLUMBING M t S2X:A
STE mo MoroN n • Raa,S1E) 101 00 r,41-ODO $11,97
OSAADDI IR 1.01 0-423.000 $201A
DEVELOPER d21lMCT FEE
,
T
�"1'�...,••TC�'TAL t,'',t�:�,T�T,�.L'�4"'.�IC)�3' A1�iO g'' ,R1n� C.CiC
�3,(}t�3,S"S
MIS MPAU) Maw
$0, CEJ
D,
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�. iry'
l g 2001 T -
�IrSTUMM-
,JAN
LA,
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d!
RECEIPT
DATE B/Y. „
C'• z
A
DATE FINALED
INSPECTOR
1 (. -C•V
INSPECTION RECORD "
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
2\277 CIA�
Underground Ducts
Forms & Footings
Ducts
Slab Grade
3l Y0/,
Return Air
Steel
3 f (p co
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
Exte '
D II - Int. Lath
Final
Final
BLOCKWALL APPROVALS
POOLS - OAS
steel
Set Backs
ric Bond
Footings
Main in
Bond Beam
Approval over
Equipment L tion
Underground EI c
Underground Plbg. t
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Zi—�r'-��
Heater Final
Water Piping
Plumbing Fi
Plumbing Top Out
EquipmgAf Enclosure
Shower Pans
O.K r Finish Plaster
Sewer Lateral
Z ZZ �(3a.f _
_
I Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Ga
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)
COMMENTS:
1
i
P.O. Box 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
December 10, 2001
Christy Williams
Century -Crowell Communities
1535 South "D" Street
San Bernardino, CA 92408
Dear Ms. Williams:
(760) 777-7000
FAX (760) 777-7101
Please be advised of an address change for the following structure. The structure formerly
addressed as 78-860 Mo nr irWay, (Lot 46, Tract 23773-5) APN # 609=080-026, the
construction for which building permit 0012-094 was issued, will now be addressed as
786-5 Galaxy Mrive_.
For your information, this home was rotated on the lot from the original location on
Morning Star Way which created two addresses for 78-860 Galaxy Drive. Therefore,
pleasv_make-the address chan --n� 11'etLon the comer, map attached.
Ele�sesio�ot_chanae t e recorcisfol Z8Sz0_Czalaxy_Drive�Lot_7_,She_Bau.m_F_am.i.l_y.
You may contact me directly at (760) 777-7019, if I may be of further assistance.
Thank you very much.
Sincerely,
. LI
Diane Aaker
Building & Safety Department
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P.O. Box 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
August 16, 2001
Christy Williams
Century -Crowell Communities
1535 South "D" Street
San Bernardino, CA 92408
Dear Ms. Williams:
(7 60) 777-70.00
FAX (760) 777-7101
Please be advised of an address change.for the following structure. The structure
formerly addressed as 78-860 �ai<}a, (Lot 46 -Tr. 23773-5) APN# 609-080-026,
the construction for which building ermit 0012-094 was issued, will now be addressed
as 78-865 _Galaxy Drive. orn 411%
Please note this change and contact me directly at (760) 777-7019 if I may be of further
assistance.
Thank you.
Sincerely,
Diane Aaker
Building & Safety Department