0002-447 (SFD)LICENSED CONTRACTOR DECLARATION
U) thereby 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
N co Prof�'siortafs Code, and my License is in full force and effect.
;14nse#, Lic. Class Exp.. Date
r` d t 7,i B 10t31120(
LU
oZ r-- Date/ Signature of. Contrast_' d — ;
O1�_
H C:) OWNER -BUILDER DECLARATION
J
HWa I hereby affirm under penalty of perjury that I am exempt from the Contractor's
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).
Ch () I am exempt under Section , B&P.C. for this reason
u)
CNJ Date Signature of Owner
O� `
Z WORKER'S COMPENSATION DECLARATION
CL
2 Z I hereby affirm under penalty of perjury one of the following declarations:
O () I have and will maintain a certificate of consent to self -insure for workers'
K W �= compensation, as provided for by Section' 3700 of the Labor Code, for the
J Q performance of the work for which this permit is issued.
n Q C) ) I,have and will maintain workers' compensation insurance, as required by
j U Q Section 3700 of the Labor Code, for the performance of the work for which this
L � Z permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
oo =) GOL..DZIN RACLS L'NS. - Nwc 5.1 ft'o-o
�C3
J
� (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 to the workers' compensation provisions of Section. 3700 of the Labor
Code, I s all f_o hwith comply with thosee slOris.
Date: J-� W00licant C_
Warning: Failure to secure Workers' Comp nsation 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 in pection purposes.
-�20
Signature (Owner/Agent) Date
BUILDING PERMIT FERMI 001,2.447
_
DATE / VALUATION 5175,679.20 LOT S TRACT 23773-4
JOB SITE
9-9+0 GALAXY DRIVE
APN
ADDRESS
r 5
OWNER
CONTRACTOR / DESIGNER /1ENGINEER
CCARei1I[DURIESUC
Swtir7JRY f' f ilk. i�L I.FJIi tAYit l i 2rd � F+ •
PO Rud. 3WO
IS35 SO. "D' .J 1.14.131 l', §TE. IF200
N.isW1~'O U BEAC H CA 96652
SAN SERNARDINO CA 9'24()k4.1 C:
(909)381.-6007 CF3.Llf 21 A0 (i�i
USE OF PERMIT
S7.NOLE F'AA41LY DWELI NG
Sr, D -LOT 5 FLAW 4ELBR PERNflT DOES NOT INCLUDE, FOOL OR
RLOCKWA:LLS. 75",4 PLAN CHE;CK.FV33 kkJi (l.' ON FOR NIUL'. IDLE
ASSUNCE OF SAME 1 ALAN TYPE
TRACT CONS R UC'3 PON1 3,400.00 SF
PORCHITIA`i:0 •• 8.00i SF
.
0ARA-U✓EJUACig OILY 633.00 sig
UST I: IA" ED COST OF CY?NNT1`eUM IGN
175,67,).20
PER WIT FEE SUMMA RS°
CONS1RUC ICIINFF.ir 101-000-415-000 3I305.50
111srLN r,f• F('11K FEES 1f}1-0110-439-;419 $1", )5
N.Mr-,i:W4T1`_`AL IM 101_0010-1411111 -000
ill CIMCAL FEc. 1.01•-00-426-wo Si6f) as
PLUMBING FEE 1.01-000-4:9-000 $162,50
;C'Y11C)PJC lidfYTlON FiT - k „Sl_O 101,-0 -2414M $17,4J
CRAIas71410 F01 101-000-423-000
DE VEL01I-ER i �i`v1PACT t'L>r
AKI 1N PUBLIC PLACES -10ISIC 701-A00-255-000
SI JB -T7, Y�t'A L., CC)N`�}`1Z(7C' ID .A. D PLA 10-117 K.
$3,60.09
L,,PSS PRI:?-P./'�ID X7EES •
$0.00
1'0 4.'AL PE,11ilt I FEES '00E NOW
RECEIPT
DATE
BY ,._:�
DATE FINALED
INSPECTOR
INSPECTION RECORD
pPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
,5et Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
— D'L1
Exhaust Fans
O.K. to Wrap
/—C-0
F.A.U.
Framing
2R—
Compressor
Insulation
��� ,6
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
12 111
POOLS - SPAS
BLOCKWALL
APPROVALS
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
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final 1�
Utility Notice (Perm)
SEP -2E-2000 10:41 ESI/FME
714 835 2619 P.02i02
ESIIFME, Inc.
Structural Eng/nears
1921 east Carnegie Ave., St 3 J
Date : 9-28-00 By : R.M.B.
Sarna Ana, Califomie 82705
Sheet —I— of 1.
Company: CENTURY HOMES
Client Job No. :
Address : 1535 South "D" Street, Suite 200
Project Name : Starlight Dunes"
San Bernardino, CA 92408
ESI / F M E Job No.: 9173
Contact: Gaorge
Project Eng.: RRW
Phone : (
PH.: (714) 261-1811 / Fox 261$506
=Phone Caweraadon =FWW M*'g
=~a a cnenrs =In -House MereWV
TOTr-i P.02
NOU721-2000 13:42 WESTERN INSULATION
909 686 8786 P,99f24
WESTERNINSULATION2INC*
4211 Latham Strad, Rl%nmlde, Callfbr[=iA 9250! '
TCL (909) 686.9760 Fax (9041686-8786
I SnATIQN CER'TIFICAT'E
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 - 23773.4
LOT # : 5
SITE ADDRESS: 78.940 GALAXY DRIVE, BERMUDA DUNES, CA
EXTEMOIl S1N, UA@
MANUFACTURER: JOHNS MANVILLE THICKNESS' 3 5/8 " R -VALUE., R-13
CEI 1 5• SATT BLOW
MANUFACTURER: GREENSTONE THICKNESS: 10.3' R- VALUE: R-38
CEMN-a-S BATTS BLOW
MANUFACTURER: JOHNS MANVILLE TNI SS: 13" R- VALUE: R-38
.9ENERL C-ONTRAM)R: CENTURY HOMES'
BY:
TITLE:
DATE:
lN2SULAjQj4_CQ Thi RACjQFl: WESTERN INSULATION, INC.
LICENSE NUMBER: 481278
BY:
TITLE:' PRODUCTION MAN
DATF NOVEMBER 21, 2000 -
n