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f LICENSED CONTRACTOR DECLARATION
!.hereby affirm under penalty of perjury that I am licensed under provisions of
'!.hereby
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
1
;za1 a t1— 01
Dat/7/-Z /7JSignature of Contractor `%"�� •
y
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.
Sec( ) I have and will maintain workers' compensation insurance, as required by
tion 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 1 1 +/� r Policy No. y e
1:,J1.1?uiV 1:;fiGAIE .RZI ..Vii..... iNV
(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 p visions of Section 3700 of the Labor
Codew� , hall forthwith comply tho?;rpro i61orfs.
Date. L4/Applicant r
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 property for in pection 'urposes.
Signature (Owner/Agent) . _• Date��j r
BUILDING PERMIT PERMI7�# PP�7�'Ra7�P
DATE 1 ,t VALUATION 81,37,726.20 LOT �+ TRACT •23773-4
JOB SITEADDRESS 7"45 GALAXY DRIVE'APN
836941i9Q310
OWNER
CONTRACTOR / DESIGNER / ENGINEER + +
. f ....y..,
+�,p „Y 1 LLC
J i i' 1i6- MiS LLC
p, � yQ t'� n Y� /� A g� .{ y
CE!"I ilJt��i` 1..['Ivii/ LL C4dSY; ,11LI �,{ laEv'
PIC) P10K. 5140
1535 SO. 1-Y" STREET, SIE. 9206
NfIEWPOitt'b1~A H CA !M62
SIAM BER.N.ARDINO LA 92408-
7 1 it
USE OF PERMIT
81NOLE FAMILY DW LLNO
U, �..,.
0,0 -LOT 8 PLAN 30B- f?1rfflxPI'r DOL -S NOT IMC UDE:POOL OR -
iii O "KWALLS. 7Y,14 PLAN C:1:WCK .FIX REDUCTION H Ok c11ftJ}. T1.P'.LE
PSSU:Pk!E OF SAAB PLAN TYPE
17 -ACT 40Ni!TRIUC T ION 1137i,V V SSB'
E'CA1G071ATf0 %0.01 15F
QA1tNJ1a.,/i;AKPdJRT 424MIJ SY
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5����fi4 .L•7`
C't�,NS'.1TftlTC.R'iON �'!t? 10J.-1)(}U-�1lf-t3i?E.► ST7�'.3Qf
PLAN 01411 CK 10 1 R 4c#2 rfl�
AVAN.xf/�k'^?t�l_410-��Y(I
•,,M- 1 11CAv Y�, iE� f%,114V01I-`1YNr +JVV S53, 0
S53,30
.I�l`£ 10i-+000-420.60 $
1'1.i, M81NU is PE (01-000419-000 $ I?•t. ;'.5
1 STRONA11 R�C?T'1't�hY P f i; _ ftt+.tib 1flP_nf)f1-7@P,11f1t1 P t'7
C'IfZAD11,'1C. 1471T 11,111
01,Vt1:Lt',•PC_,1ZTIViTINCPFEE $1,907,t)0
AXY tai PUBLIC PLA.(>._'t-.tH81L:'101-000-aSS-000 $94.,V2
Sf Jll-'I } t V� f: C)NSTRI_ -1110N ANi7 N4AN C'14Er(;K
D3 29459
'I'i?•I'&L PIL.R1VI.4"8'VP; CS 1)i1#:NOW
$3.2104.59
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
—0,0
Exhaust Fans
O.K. to Wrap
—010
F.A.U.
Framing
, OV
Compressor
Insulation
=/ _
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
/Q
Final
Final p
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final 2 of
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final I'? c
Utility Notice (Perm)
COMMENTS:
-2000 13:43 WESTERN INSULATION 909 686 8786 P.12/24
I UL , I
4211 Latham Stmt, Rfvmide, CaUforr" 42501
Tel. (909) 686.8760 Fax {909) 6664786
THIS IS TO CERTIFY THAT INSULATION HAS BEEN INSTALLED IN CONFORMANCE WITH
THE CURRENT ENERGY REGULATION, CALIFORNIA ADMINISTRATIVE CODE, TITLE 24,
STATE OF CALIFORNIA, IN THE BUILDING LOCATED AT:
TRACT / PHASE: STARLIGHT DUNES - 23773-4
LOT # 8
SITE ADDRESS: 78.945 GALAXY DRIVE, BERMUDA DUNES, CA
MIEBIQR WALL:
MANUFACTURER: JOHNS NMAAWILU THICKNESS: 3 518 ° R -VALUE: R-13
CEILINGS: BATTS BLOW
MANUFACTURER: GREENSTONE THICKNESS: 10.3" R- VALUE: R-38
CEILIRIGS: BATTS '<:
BLOW
MANUFACTURER: JOHNS MANVILLE THICKN S: Dl fit- VALUE: R-38
�$ENEF$AL Q)NTRACT®R: CENTURY HOMES
BY:
TITLE: `
DATE:
INSUL®-JObi CONTRACTOR: WESTERN INSULATION, INC.
LICENSE NUMBER: 481278
BY:
TITLE: PRODUCTION MANA
DATE NOVEMBER 21; 2000