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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 7�Q00) of Division 3 of the Business and
Professionals Code, and my License is in full forceiand effect.
License # Lia Class Exp. Date
�L i14I B iGi5ii2O1
Date �'✓ Signature of Contractor% /:-it,.. /__
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 ff 11� Aq ff'yy, Policy No. yy� 11'' FFsp� +
a.�UDE,6y�ACL.1i.+SVi• i'v^YI�4�✓ 'fHVVV'V.1.
(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 'hall forthwith comply with provi ions.
Date; 1'?'- Applicant -
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 orooertv for insDection ourooses.
Signature (Owner/Agent)
Date ' /.5 -ew
PERMIT #
-BUILDING PERMIT 0001"4;i
DATE /%j //d �f� VALUATION S -137.3Z7.20 LOT 6 TRACT 237'R-4
JOB SITE
ADDRESS 79-930 C..P LiM% ��R1VE
APN 609-09".26
OWNER
CONTRACTOR/DESIGNER/ENGINEER
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NEWPORT
Ni::W1'tjRT BEACH Clk 92662
SAN 131r.KNARDINO CA 924018
19N-Y1k1-6007 03- f 1 212V
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USE OF PERMIT
SNA.h,h FAIWL 1' 61NhLL NO
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fS:illNCE OF SA.NI!s.l'i FAN "! Z K
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('UN.S'i`W C."I ION 1;:E 1,01.000-41.9-000 V 112, Stf
PIT, AN t",FTc'rt FF13, 1fbl.-fiftQ-:E�!1-3}R !f:15R 61
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1-1ri RI Ai: r0l t.t1[-0.}V 'sElvi10 V46.14
iaLUMBINO F1Ifil 101,-000-419-000 x;134.73
'iRt�Nc Akr'7;tiNFt?1�-i2FSt0 -OW t17
GRA1.X1NG FIX 101.000.41-3-100
Ui'-VC10PhR i&WACY HX3 51,907.6)
AWV IN PUBLIC .PLACF,S-1?.13.SW 701-000-2.55-M)
St_1
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TCY1't1,ls PERMIT F'li+:� S DUE NOW
83,293.5-S
RECEIPT
DATE BY / ��
DATE FINALED
INSPECTOR
�;9
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
4f, `
Underground Ducts
Forms & Footings
Jam'
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
V —1: ip
Exhaust Fans
O.K. to Wrap
3/-6-tl
F.A.U.
Framing
�_
Compressor
Insulation
V
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
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
—>
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas) p�
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 61 2 p\
Utility Notice (Perm) )
COMMENTS:
-2000 13:43 WESTERN INSULATION 909 686 8786 P,10%24:.-
INSULATIOiNg En"Co
4211 Ladum Strect7 Riverside, California 92501
Tel. PW) 6868760 %. x (909) 686-8786
I,i §.ULATIQi®I VERTIMPA E
THIS IS TO CERTIFY THAT INSULATION HAS SEEN INSTALLED IN CONFORMANCE WITH
THE CURRENT ENERGY REGULATION, CALIFORNIA ADMINISTRATIVE CODE, TITLE 24,
STATE OF CALIFORNIA, IN THE BUILDING LOCATED AT:
TRACT ! PHASE: STARUGHT DUNES -• 23773.4
LOT # 6
SITE ADDRESS: 78-930 GALAXY DRIVE, BERMUDA DUNES, CA
EKTRRIOR, V�A_LLS:
MANUFACTURER: JOHNS MANVILLE THICKNESS: 3 6/8 " R -VALUE: R-13
EILI 9ATTS SLOW
MANUFACTURER: GREENSTONE THICKNESS: 10.3" R• VALUE: R-38
CtS: BATTS BLOW
MANUFACTURER: JOHNS MANVILLE THICKNESS; 13" R- VALUE: R-38
GENERAL CiNTRACTOR: CCNTURY HOMES
BY:
TITLE:
DATE:
lbiSULATI®N .GQIMTRA TIDR: WESTERN INSULATION, INC.
LICENSE NUMBER: 481278
BY:
TITLE: PRODUCTION MA
DATE NOVEMBER 21, 2000