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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
/ 7141 (f B I 0 3112(
Date t./�Sig nature 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 insurance carrier & policy no. are:
Carrier CIOL.Di" O F.AOLE INS. Policy No. WC -544063-02
(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 agree that if I should become
subject to the workers' compensation provisions of Section 3700 of the Labor
Code ,41sh
41 'fort ith comply wit tbose. Fbvisions, l A
Date: applicant
Warning: Failure to secure Workers' Compensatidn 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 inspectionpurposes.of
Signature (Owner/Agentr` '� . Date l
BUILDING PERMIT PERMIT#
DATE_ f VALUATION LOT ®ON -324 TRACT
fLLi�/ C' 31 23773-5
JOB SITE
APN
ADDRESS 7a_9w GA74AXY DWVdF.
C*W-0W )249
OWNER
CONTRACTOR / DESIGNER / EN (NEER
CENTLMY (TRO ,L COiV�"iKUNIfIF,S
C'i RY CROWF.M COlvlR!fU341111,9
1533 SO. 17 STIRLW. `SM% #E200
1535 $O. `V "TIRma, `um X200
SAN 13}?iWARD'1190 C.P. 92408
SANIiMARJDWO CA 92408
(909)381-6007 C B116 2110
'
USE OF PERMIT
OWGI L RAWLY D W2U_WG
SM- PLN 4 AL I.(9T 31 Fl3MIT DOES NOT INCLUDE BL OCKWAV.M 011
POOL 75% PLAN SPECK FEE REDUCTION FOR MULTIPLE ISSUANCE OF
SAME PLAN T'i'PM
TRACT CONSTR.UCT104 ;�000.00 SF
PORCH/PA'I It) 28.00 sr
0ARAGEICARPORT 0011) IZ406,80
FST)wA l) COST OF C"ON37:7it'[TafloN
175,679.20
Y
FERM111i' N SUMMARY
CONSTRUC T101iJ FEE 101.000.418-000 $905.51
PJAN CHECK FEE 101-000-439-318 $197.21
WXHAt7ICAL FEE 101-000-421n-000 $92.00
1?,V=RX,'AL I! i, 10.1-000-420•-000 $13.1.16
PLUMBING ISE 101.1000-419.000 $162.50
STI(01HO MOTION FFA - RESID 101-1,100-241-000 $17-67
OrtAD03 FEE 101-000.423.000 12(3.00
DEV ELCIPLR IMPACT FEE $1,907.00
r
ogD-TC11lA1 C011JM�.'iJ'(TI'10M AND PLAN CHE(IK
$3,442.94
I..k.»9S PRE PAID n ES
$0,00
: ; 1' 'A t�I .1 8 DUE. NOW
&33441954
RECEIPT
DATE
ByFI
ALED
INSPECTOR
v
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
17 jyJ
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
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
1 'Z;7 oO 7(,
Drywall - Int. Lath
Final
Final
3-411
BLOCKWALL APPROVALS
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
p
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 .3)(2—
)(2Utility Notice (Gas) 1,0—
Utility
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 2 l�
Final (Z Co
Utility Notice (Perm) _ lip
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
LOT4,, : 31
SITE ADDRESS: 78-900 GALAXY DRIVE LA OUINTA, CA
---------------------------------- -------------------------------
EXTERIOR WALLS:
MANUFACTURER:
CEILINGS:
MANUFACTURER:
CEILINGS:
JOHNS MANVILLE
BATT
GREENSTONE
BATTS
MANUFACTURER: JOHNS MANVILLE
THICKNESS: 3 5/8 " R -VALUE: R-13
BLOW
THICKNESS: 10.3 R- VALUE: R-38
BLOW
THICKNESS: 13" R- VALUE: R-38
GENERAL CONTRACTOR: CENTURY HOMES
BY:
TITLE:
DATE:
INSULATION CONTRACTOR: WESTERN INSULATION, INC.
LICENSE NUMBER: 481278
BY: &MO
TITLE: PRODUCTION ANAGER
DATE