0006-060 (SFD)1. LICENSED CONTRACTOR DECLARATION
i. IA I hereby affirm under penalty of perjury that I am licensed under provisions of
H Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
04 w Professionals Code, and my License is in full force and effect.
M License # Lic. Class Exp. Date
r w // s_ l -f—^�, l l0l3lf2t
I Z Dat Signature of Co t ac F'
O ,- 9S.
cfl _ '
J U C) OWNER -BUILDER DECLARATION
WW I hereby affirm under penalty of perjury that I am exempt from the Contractor's
U) License Law for the following reason:
Z ( ) 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).
C'') () I am exempt under Section B&P.C. for this reason
O N Date Signature of Owner
rn
Z WORKER'S COMPENSATION DECLARATION
C:, 2 Z I hereby affirm under penalty of perjury one of the, following declarations:
Lo O () 1 have and will maintain a certificate of consent to self -insure for workers'
X W compensation, as provided for by Section 3700 of the Labor Code, for the
O J. Q performance of the work for which this permit is issued.
co Q C) ( ) I have and will maintain workers' compensation insurance, as required by
p UQ Section 3700 of the Labor Code, for the performance of the work for which this
d rn H permit is issued. My workers' compensation insurance carrier & policy no. are:
z Carver C;c7LflE1 L;AC31,E . Policy No. WC -S44048-02
obZ)r a
Q (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 inany manner so as to become subject to the
workers' compensation laws of California, and agree that if I should become
3 subject to therworker ' compensation provisions�Section 3700 of the Labor
Code, I••sh G hwi cp ply wittrthos provisions.
Date:--��Applicant
Warning Failure to secure Workers' Compen tion 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.
12. 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 purpo es.
Signature (Owner/Agent.) ��' "�� �' Date
BUILDING PERMIT PERMIT#
OW6��
DATE f VALUATION LOT TRACT
:i ,J (1 SlW"6( 43 Z4773-5
JOB SITE
APN
ADDRESS 7/84GIALAXY. DT' i
6W-080-026
OWNER
CONTRACTOR / DESIGNER /ENGINEER
LWWR CRWWr .OryAVM�)
014
4y1JY CAOWBLL yVLa1Vl7IF
1535 SO, '",U' 9=7r, , 9I'E. 0200
153.5 s0. OD" Mmairg, am 4200
S.A>`l' BERNAR INO CA 92408
SAN BERNAT D190 CA 9M.06
(gw)381.6007 MIX 2120
USE OF PERMIT
SFD. PLAN 3C IDT X43 PERMIT DOMS 11}'. r INCLUDE HL OCKWALLS O.R
POOL 75% PLAN CHECK FEE REDUCTION FOR fv IJUNI?U ISSUAN0% ON
SAME PLAN TYPE.
I
TRACT COMTRUtTION 2596,00 51?
PORCH/PATIO 29.00 Sr
GA.1d.AGMARPORT (U6) I? 328.40
Et'S',C!!01#' .13 C.'09T. (V CONS 1i111.7.1'1:011
153,663.60
VERMT 1 11% giT11 moi. Ry
00111STRUCTION MY, 101.000,418.000 086.60
PL.A14 CHECK ES 101-1700-439-318 $161.80
MECHANICAL 1,7E 101 -06042I -ow -, $` 7.00
LL,T!t,TP.1CAL LST? $127.59
PLUMBINO FEE 101-000.4194000 $134.75
` -
^^STRONO MOTION FEE - RESID 101-000-24-1-000 $181.)6
ORAD1146SEE $20,00
L7WEL,OPEk IMPACT $1,90�.QQ
S(tW OT.AT CON911RUCM014AND PLAIT CREC."K
$3,228,80
LJM PRE-PAIDI-TM
1$0.00
_J MAL Pig" YMSDIVE NOW
&4.2-28M
RECEIPT
DATE
B�� xr,~"'r�~`-`
DATEFINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings
`% /
/ 'G
Underground Ducts
Ducts
Slab Grade
_�+0 _�.
Return Air
Steel
Combustion Air
Roof Deck
–OZo
Exhaust Fans
OX to Wrap
F.A.U.
Framing
—% _
Compressor
Insulation
Fireplace P.L.
�� �� -- GU '
Vents
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
_
Final '� (� ��
BLOCKWALL APPROVALS
Final
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
2—/z --on
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral�
Sewer Connection
/ �
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
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power Z CA
Final �O
Utility Notice (Perm)
COMMENTS:
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 # 43
SITE ADDRESS: 78-895 GALAXY DRIVE LA QUINTA, CA
------------------------------------------------------------------
EXTERIOR WALLS:
MANUFACTURER: JOHNS MANVILLE THICKNESS: '3 5/8 " R -VALUE: R-13
CEILINGS:AT BLOW
MANUFACTURER: GRE NE THICKNESS: 10.3 R- VALUE: R-38
CEILINGS: BATTS ffESS-
MANUFACTURER: JOHNS MANVILLE THI13" R- VALUE: R-38
GENERAL CONTRACTOR: CENTURY HOMES
BY:
TITLE:
DATE:
INSULATION CONTRACTOR: WESTERN INSULATION, INC.
LICENSE NUM R: 481278
BY:
V&U &"JO -
TITLE: PRODUCTION ANAGER
DATE