0009-172 (SFD)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 001,MN FAM, INB, Policy No. NWC-344063-02
(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 a ee that if I should become
subject to the worjers' compensation w i's�ons f Sec iun 3700 of the Labor
Code�Y�ha��ort W�tivcomply W�*tfti,�sie.prq on
Date: G*�p�pplicant" /�
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 fons,ectionRpurpo S. /6
r l,�/1 C
Signature (Owner/Agent) �- Date
BUILDING PERMIT PERMIT#
LICENSED' CONTRACTOR DECLARATION
U)
I hereby affirm under penalty of perjury that I am licensed under provisions of
l'-
Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
Cv w
Pi ifessionals Code, and my License is in full force and effect.
�r?
d License # Lic. Class Exp. Date
rZ_ C7 L6.!
►LJ
7 41,08 13/ 1013 1 Mo
Z
//
Da"tem C� Signature of Co�ntraeloc%'" �=
CD 0 ~
SAN 81?MARD1140 CA 92dOS
wU C:)
OWNER -BUILDER DECLARATION
WW rl-
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
W in -
U)
License Law for the following reason:
Z
( ) I, as owner of the property, or my employees with wages as their sole
TRACT CONSTEt;t3CTION 2,450.00 81?
compensation, will do the work, and the structure is not intended or offered for
POI.CHIPATIO 29.00 SF
sale (Sec. 7044, Business & Professionals Code).
0A,RAQWCARPORT (8F) %173.20
( ) I, as owner of the property, am exclusively contracting with licensed
1�yw'gSy7C.t11,�.ATM') COW OF COfiIRRID(,MOR
contractors to construct the project (Sec. 7044, Business & Professionals
9 3�'p����+ L y+� �V �L�q�,g
Fdt+iZ.641L1 A!�F9 �7ULM1Ci�J Z
Code).
L'`)
Ln
() I am exempt under Section , B&P.C. for this reason
N
OC\1
Date Signature of Owner
MYWHANIC.AI, PEE 101 �000.421.000 rno
d Q
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 001,MN FAM, INB, Policy No. NWC-344063-02
(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 a ee that if I should become
subject to the worjers' compensation w i's�ons f Sec iun 3700 of the Labor
Code�Y�ha��ort W�tivcomply W�*tfti,�sie.prq on
Date: G*�p�pplicant" /�
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 fons,ectionRpurpo S. /6
r l,�/1 C
Signature (Owner/Agent) �- Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 001139 -I'll TRACT
/r �`
•! (.t,. $141,593.90 23773•5
JOB SITE
APN
ADDRESS 78-8W GALAXY DRIVE
609^080-0.?..G
OWNER
CONTRACTOR / DESIGNER / EN (NEER
STAM ICCHr 3JU: &q LLC
C1 NrMY CROW �' L C0hWfZ3
PO BOSS 51411
1535 S0, OD" MEM, :319, 4200
NE'taDPORT MCR CA 92662
SAN 81?MARD1140 CA 92dOS
(909)3€31=6007 =16 2120
USE OF PERMIT
r ATfyLL r -Am ly DWE=40
3FD-PL AN:3AI1 LOT -19 PERMIT DOES NOT INCLUDLP
BTOCKWAx,i..WOOUDR1`i`E AY. A.P13StCiAI` H,1i5%O PLAN CHECK 1' E
UDUCTI014 :/'OR. MULTIPLE ISSUANCE: OF SAME PLAN TYPE
TRACT CONSTEt;t3CTION 2,450.00 81?
POI.CHIPATIO 29.00 SF
0A,RAQWCARPORT (8F) %173.20
1�yw'gSy7C.t11,�.ATM') COW OF COfiIRRID(,MOR
141,WJ90
9 3�'p����+ L y+� �V �L�q�,g
Fdt+iZ.641L1 A!�F9 �7ULM1Ci�J Z
CONSTRUCTION FEE 101-000-418-000 $78611W
PLAN CHECK P&B 101.000-R131'�'-31$ $161. 0
MYWHANIC.AI, PEE 101 �000.421.000 rno
ELECTRICAI.YXIE 101-000.420-000 #1127.59
PLUMEINO IEE 101.000.419-000 $134.15
S:RONO A OTION FZE- RE -SID 101«'000-241-000 $1416
OkADINO FRE 101-,000-423-000 $20.00
DEVELOPER IMPACT FEE $1,907.N
0. wtk�
13118 -TOTAL C,'0MTRX)C .t 09 AND PIAN CHFCK
$3,228.80
L10S PRE -PAW PUS
$0.00
'6TOTAL .PKRA'1T1 'MES DUE NOW
X1220.60
RECEIPT
DATE
BY. 4!,`
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
121 "'� (,�'^
Underground Ducts
Forms & Footings
Ducts
Slab Grade
.L 2 _
Return Air
Steel
Combustion Air
Roof Deck
Z\_ �F
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
��
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
_
Party Wall Insulation
Condensate lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
_�
POO -S - WAS
BLOCKW
iL '/APPROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Undergfound Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
rbc
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
1zf��
Pool Cover
Sewer Connection
t Z Gp—
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
_
ELECTRIC
L 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 (Perm)
JUN -13-2001 15:21 WESTERN INSULATION 909 686 8786 P.10!21
Vlwy E 8 TE N IN S LTLA'TI N, L9P�
4211 1&thA1t1 Sweet, Riverside, California 92501
Tcl. (909) 686-8740 Flax (W9) 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 #23773.3/PHASE 4
LOT #., 9
SITE ADDRESS: 78-880 GALAXY DR, LA QUINTA, CA
......................................................... --------
EXTERIOR WALLS:
MANUFACTURER: JOHNS MAIMLLE THICKNESS: 3 5/8 " R -VALUE: R-13
CEIUN®S: BATTS BL l
MANUFACTURER: GREENSTONE THICKNESS: 10.3 " R•VALUE: R-38
CEILINGS-: BATTS BLOW.
MANUFACTURER: JOHNS MANVILLE ' THICKNESS: 13 " R -VALUE: R-38
GENERAL CC NT13ACTOR: CENTURY HOMES
BY:
TITLE:
DATE:
INSULATION CONTRACTOR; WESTERN INSULATION, L.P.
LICENSE NUMBER: 794484
BY: '-�— "4&�
TITLE: PRObp&16N M GER
DATE JUNE 13, 2001-