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LICENSED CONTRACTOR DECLARATION
Cli ereby affirm under penalty of perjury that I am licensed under provisions of
Cry pter 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
71 8 B 's 10131:2C
Dat -� , Signature of Contract 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 Sectio 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:
CarrierGOLDLR EA.OLEFPNS Policy No. 34WC:-544068-02
(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 Sectio 3700 of the Labor
Code, I shall orthwi 1i� mply with t ose pr sloci 'v
Date: °. I �GAplicant �'
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 propert for ' sp ctio: pu poses.
Signature (Owner/Agent)-^- Date %
O y'
BUILDING PERMIT PERMIT#
l j -321
DAtE y 1 VALUATION guy s� +fes LOT r�
TRACT ry
$175,67 .20 32 23773
JOB SITE
APN
ADDRESS gQ%,m w v��"v D VJa
609-M-0266
OWNER
CONTRACTOR / DESIGNER / ENGINEER
C''EA17URY CRt`3WEU. COit4xv1UM17 .8
C1` fURY CitOW-1 1'., rr"015+%I4l1Ai1A
15.35 30. MD, 911mr, S`.iB. 4200
1535 30. •17° 4T' ' 1', .TT& #200
STAN BERHAitMNO CA. 92408
SAN BERA%filaDI1 O LRA 92409
(901)381 "60(Y? MR, 2129
USE OF PERMIT
a WGLE rA1v :Y DWM_J IHG
SFD" PLAN 4BPJ, LOT 32 PER.1'd1T DO ES NOT 1NrvLUMBLOCICWALIZ OR'
POOL?$% PL" CHECK! FFE REDUCTION POR MULTIPLE ISPA A'AC:E OF
SAME PLAN TYPY
TRACT CONSTRUCTION AM.00 ZF
PORGHAI?AT10, 29.00 Sly .
0Ai3,AMC RPORT (3I) I2,406,$0
9SM"TED C09T OF C0JN- '. RLTCa1 0H
27A67,,"O
PIETM7 FEE S17:fVWARY
CONSTRUCTION FEE 101-000.418.0100 $905.50
PLAN C149C.9 FRE 101-000.439-318 $18721
MECHANICP.AL FEU 101-0030.421-000 %92.00
9LECTMIC,ttL MF, 101 -ti O.420-000 $151.16
PLUMBING FXE 1.01.000.419-000 $107,50
STRONG MOTION IEP, " RESID 101-000-241-000 $17.57
GRADIRG FER 101.000423«000 $20,00
DEV) LOPER IMPACT In $1,907.00
SUB-WrAL CO2J8'MUC°%ION AND PL.AM C ,WCr.
$3,442.94
LaFM PSR'` ,-PAll.i IT,
4. Sy��iiG^. rs ••:r. Y.��.L'..�
DO -NOW
�r� An$09.00
191',-S42n4
RECEIPT
DATE
BY
_a
DATE FINALED
INSPECTOR
INSPECTION RECORD
4 OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
s
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Fireplace P.L.
�1
Vents
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
.�
Drywall - Int. Lath
Final
Final 3�� o�
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
ire 77Z40,
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
41
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final 3 l2
Utility Notice (Gas) Icy
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 �Z C
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 # 32
SITE ADDRESS: 78-910 GALAXY DRIVE LA QUINTA, CA
-------------------------------------------------------------------
EXTERIOR WALLS:
MANUFACTURER: JOHNS MANVILLE THICKNESS: 3 5/8 " R -VALUE: R-13
CEILINGS: BATTS BLOW
MANUFACTURER: GREENSTONE 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: P-�w
TITLE: PRODUC ION MA AGER
DATE
AUG -20-2001 15!10 WESTERN INSULATION 909 686 8786 P.07114
7
WESTERM INSULATION, LoPe
4211 Latham SUWA, Riversidc, CaMomia 92501
Tel. (900) 686-8760 Fau (909) 686-8786
INSULATION CERTIFICATE
THIS IS T'0 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/PHASE 5
LOT #: 50
SITE ADDRESS: 78-910 MORNING STAR WAY. LA CUINTA, CA
EXTERIOR WALLS:
MANUFACTURER: JOHNS MANVILLE THICKNESS: 3 5/8 " R -VALUE: R-13
CEILINGS: BATTS BLOW
MANUFACTURER: GREENSTONE THICKNESS: 10.3 " R -VALUE: R-38
CEILINGS: BATTS BLOW
MANUFACTURER: JOHNS MANVILLE THICKNESS: 13- R -VALUE: R-38
9ENgRAL CONTRACTOR CENTURY HOMES
BY:
TITLE:
DATE:
INSULATION COnITRAC'TOR; WESTERN INSULATION, L.P.
LICENSE NUMBER: 794484
BY:
TITLE:P D ION MANAGER
DATE Ali UST 20, 2001
r