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. LICENSED CONTRACTOR DECLARATION
1 I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapl;r 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 ignature of Contractor r '
r 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 insurance carrier & policy no. are:
Carrier 0OL}DRII�i RAOLE IN& Policy No. N -WC- 063-03
(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 sha(lfort with comply wit Laos rov Sion
Date:C �- Applicant �;V4- +✓
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 far-inspectio�tarposes.
Signature (Owner/Agent) '�� Date
BUILDING PERMIT PERMIT//
tlt3i a2
DATE�WVALUATION LOT jQ TRACT
t 4..� .! �2 i . ti a 23773-5
JOB SITE
APN
ADDRESS •78-00 0JAL Y D -RIVE
6M-080-026
OWNER
CONTRACTOR /DESIGNER / EN INEER
CENTURY URY CROS C(3ivIMU237.; NS
CF4'-F RYr' CRO :,L COIvtI4ii711} Tffla
1535 SU. °TD" Mr—Mr. STIF, #200
1535 SGS, "!D" 91'RM- Te s�[ - 4240
SAN BMWARDWO CA 92408
`►>M ksERl` ARDTi30 CA MOB
(909)381«6007 CRT,# 2120
USE OFFPERMIT
SMILE IFAM{LR DN� !,TJN G
SFU- 'PLAN 30 LOT 3AF PEWIT DOES NOT 114CLUDE B1,0C:IC MALLS OR.
POOL PLKN CHUCK FEE 119DUCTIQ; FOR T.MULTIPL>, ISSUANCE OF
SAME PLAN TYPK
TRACT CONSTRUCTION 2,903.00 SF
POIti°1IlPATIO 9146 SF
GARAGMARI>t7Fi1 (SF) 8,173,20
EMMATPED COST Olr CC3.I'i TRIUCY1014
138,721.50
PYRWr ME .fCiWMARY
CC)NSTRUCT10114 FEE 101-000-418-000 S'y`76,00
PLAN CHECIC FIZZ 141-000-439-x318 $161.17
MECHANICAL FEE 101.000>421-000 MOP
EIAMFUC.AL M, 101-000-4,20-000 $125.91
P1d1N'd11ING FER 101 «("00.419-000 $156.50
5TRC91?i1 MOTI014 FSE - R 1SID 101-000-241 -000 $13.9'
s ll.ADilt 3 i 101.000-441-000 $20,00 .
tAV:EWPPR IMPACT FEE $1,907.00
STS-Ta'r,A,L CC>M1R'CTC:'.10M ) PLAN CHECK
$3,231AS
LLS PRE -PAID IMS
MOO
NOW
tl"MS
RECEIPT
DATE
BY .;
DATE FINALED
INSPECTOR
}
INSPECTION RECORD
,,ft,
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
` BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
�'_!j"� _
Underground Ducts
Forms & Footings
Ducts
Slab Grade
_
Return Air zz
Steel
Roof Deck
_ _
�� 1�� ��_��
Combustion Air
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
c( C0
Compressor
Insulation
Vents
Fireplace P.L.
_
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Fikewall
Exterior Lath
�y
Drywall - Int. Lath
Final_li_�
_
Final
POOLS ., PAS`
BLOCKWA`�L
A�'PROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBINGPp— VALS
�' 2
Gas Test
Electric Final
Waste Lines
(p—
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
i2NZR
Encapsulation
Gas Piping
Gas Test
_
Appliances
Final
COMMENTS:
Final
-
Utility Notice (Gas)
ELECTRICAL 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)
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 23773-5
LOT # 30
SITE ADDRESS: 78-890 GALAXY DRIVE LA QUINTA, CA
------------------------------------------------------------------
EXTERIOR WALLS:
MANUFACTURER: JOHNS MANVILLE THICKNESS: 3 5/8 " R -VALUE: R-13
CEILINGS: BATT BLOW
MANUFACTURER: GREE ONE THICKNESS: 10.3 R- VALUE: R-38
CEILINGS: BATTS BLOW
MANUFACTURER: JOHNS MANVILLE THICKNESS: 13" R- VALUE: R-38
GENERAL CONTRACTOR: CENTURY HOMES
BY:
TITLE:
DATE:
INSULATION CONTRACTOR: WESTERN INSULATION,. INC.
LICENSE NUMBER: 481278
BY: l
TITLE: PRODUCTION M NAGER
DATE
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