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0002-449 (SFD)LICENSED CONTRACTOR DECLARATION U) I hereby affirm under penalty of perjury that I am licensed under provisions of F– Chapter 9 (commencing with Section 7000) of Division 3 of the Business and cv W Professionals Code, and my License is in full force and effect. C) License # Lic. Class Exp. Date oZ r- Date` �JyTSignature of Contractor r-�_O (p OWNER -BUILDER DECLARATION J W W I hereby affirm under penalty of perjury that I am exempt from the Contractor's ~ U)License Law for the following reason: Z_ y ( ) 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 LID N Date Signature of Owner ON O) d Z WORKER'S COMPENSATION DECLARATION o 2 Z I hereby affirm. under penalty of perjury one of the following declarations: LO FZ 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 r performance of the work for which this permit is issued. C3 QU (�)' I have and will maintain workers' compensation insurance, as required by OU Q Section 3700 of the Labor Code, for.the performance of the work for which this Il rn H permit is issued. My workers' compensation insurance carrier & policy no. are: ,It Z Carrier / /fie ms r swrc• POIICy NO. ..TS r ca aP t '�.1�1A� t-wr liPL(o1.. 1 �6i t....�4.1�JVy`°'V3 r g (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 3 subject? o the workers' compensation provisions of Section 3700 of the Labor CodIF e shal ort wit complycwlth-t Se visions �--�-- Date: > r Applicant's / 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. (F 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 r 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 propertynspection p rposes. Signature (Owner/Agenf� �( / ��'> Date IPERMIT BUILDING PERMIT 04-44`y / DATE6�/1 It J' / VALUATION $175,67),241LOT 7 TRACT 2377 -4 JOB SITE �a�'-93:E'e. GALAXY D.W.W1 APN ADDRESS OWNER CONTRACTOR / DESIGNER / ENGINEER r� :71k IJAI HT ul"V1?S 1.1.0 CET`l'I,URYCKAYELI. CONIMUNrl'ifiS _ •'. PO'BO15140 1533 SO. "Pi" STUfflF 9FE. #200 11 l4H POWI' BUACH CA 322662 SAN t31;k AIRLIANO CA 924()8 1 I (9(39�V 1.6067 C111A X120 - -' USE OF PERMIT S1NG.1.,1i FjVtt11LY ,U%VFLLWNG i L,YD-LOT 7I�Liousi 4111JR, PERMIT DOES NC1`.0 INCLUDE POOL OR 13L(_A;KWM.LS. ?3`"o PLAN CI FEEL kk:0trt6 YI('yN FOR MULTIPLE ISSUNCE OF SAIWE PLAN T%W4 lWtCT C014�1'1',RUC-7110i1 3,000,00 Sr P IRC4IPA"•i:Fig .2$.W SF c3A£t,ltif%C ��liF'(}it't' 633.0 8F rciTra� rr • c �ranr n�a°� a•vwa L„� �,'%��••ara�.�a.,a �a+S s r� jj ��Y1��gg;;��gqppg y �c r;��©� �,e:.t.��a��a.�.t ,li.R{86AY5.A d. i�.ti•�!. �Oa.lYi1.S'.E1'.a[R. 1� C ONI.Irt`w.j r1ON.E<EB 101-000^418-(00 �J(t5.5U Kn14r4Pr,T'F;Ff(11- Xi( 411-3iR 5tfLR 1i iviu�s�it"iiJ1C{if. .r, t��-�.n�e n�re an.•°C�" PLUMBING NkTs :f01-000-419-000 SF!,Z.SO WTR 0N01 M0TYON Ia717 F - R, )01-0(10441,000 C"R.JkDI G FEE 1,01•000-•423-000 320.01) DEVELOPFR. ltE'!i'At, f R-1 St.907,!9u ART 1•N PL&L1(11 ='GAiAo'. i - REStC 701-()00-255-0OU S189,2 i S(M.T('}'TA 1. C'0W,'%"!'Rl.-_rT()N AND P1- t'14 (''K %1,64R (I1: l ES'S PRE, -PAID FT 2S no C(: '11*01" A1, PC+ HIMIX 101i,%S D141 NOW $1,448.4A RECEIPT DATE BY'`�i DATE FINALED INSPECTOR INSPECTION RECORD OPERA710N DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade Return Air Steel Combustion Air Roof Deck Exhaust Fans O.K to Wrap F.A.U. Framing — Lff Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath (yp Drywall - Int. Lath d , 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 Neater 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 i2 gam Utility Notice (Gas) )'j, Q,6C� 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 12 rl CSP Utility Notice (Perm) COMMENTS: NOU-21-2000 13:43 WESTERN INSULATION 909 686 8?86 P.11/24 WON 4211 Latham deet, Riverside, California 92501 TeL R" ON -8760 FAX (909) 686.8786 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 I PHASE: STARLIGHT DUNES - 23773-4 LOT # : 7 SITE ADDRESS: 78.935 GALAXY DRIVE, BERMUDA DUNES, CA EXTERIOR WALLS, MANUFACTURER: JOHNS MANVILLE THICKNESS: 3 5/8 " R -VALUE: R-13 CEIL NGS_ TT SLOW MANUFACTURER: GREENSTONE THICKNESS: 10.3" R- VALUE: R-38 CEIUNQ- S: BATTS �SLOW MANUFACTURER: JOHNS MANVILLE THICK SS: 13" R- VALUE: R-38 EENERRAL. O CTOR- CENTURY HOMES BY: TITLE: DATE: INU UL i'IQN CONTRACTOR,: WESTERN INSULATION, INC. LICENSE NUMBER: 481278 BY: TITLE: PRODUC'T'ION M G DATE NOVEMBER 21, 2000 .