0101-054 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter 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
Date f ".j Signature of Contractbr.
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
5
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
( ) I have and will maintain a certificate of consentto 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 iworkers' 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 Policy No.
(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,-L-abor
Code, I shall forthwith comply with!those.pr �sision?;
Date: �v «f Applicantrkers'
Warning: Failure to secure Wsation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cos%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 propertyg4for inspectiga_purposes. '
Signature (Owner/Age of Date,
BUILDING PERMIT PERMIT#
DATE VALUATION LOT�i ^�6 TRACT
ai#3.11.6.20 77 iitiit �
JOB SITE
APN
ADDRESS
OWNER
CONTRACTOR / DESIGNER / EN INEER
i�,(1I��,:kpvs�g�sy
WORLD)FIpa9_;r°q�ax+�', INC
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PAIM J.31i�»o:YrW %� 92260
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(760)5.68'195s SIA, 5028
USE ORRF!! PERMIT
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LOT 21,. ;MU. ,N 3A,SPD - Pk? MIT Xit'3ES SOT INCLUDE k3;..C�CK IYAJ,; S,
PCY:01, OR 'ifArNAYWAY AP4`jRilAtJ,H, i9°!-, PLAN C'Ie VX FEIK REDUC TIOk! FOR
MTiY.'I';f;f )2.'' f.S„11.iA14r,'E OF &hM1P'k'LAN T �F;.
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TRACT COMTRUCTION
se
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raw
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MECHANICA.1, FH
%:I fMTFt4{? F<h'4sir. R�1�•0 6'► -4 1"�-C1i1G $YM.07
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FEW, 10 1 -000-03-Ml- $20,09
1"F,9;3 PRE -PAU) MU11
$0.00
'VYCAL P.i iri9Tr 11�.:n'.gN .DU OW
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RECEIPT
DATE !r;
Bylk."
DATE FINALED
INSPECTOR
I r i
v49
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings 1� _
Slab Grade G
Steel
Underground Ducts
Ducts
Return Air
Combustion Air
Roof Deck
O.K. to Wrap
Framing
Exhaust Fans
F.A.U.
Compressor
Insulation t.� t1t�
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wail Firewall
Exterior Lath
Drywall - Int. Lath
Final 6— — —�
BLOCKWAI I APPROVALS
Final
— �
P06/—S iSPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test.
Electric Final
Waste Lines % 1 q�t9L
Water Piping
Heater Final
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
Sewer Lateral S
Sewer Connection _
O.K. for Finish Piaster
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final _
Utility Notice (Gas) 6
ELECTRICAL A' PROVALS
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 _ 7 & —
Utility Notice (Perm)
JUL
WESTERN INSULATION 9 L.P.
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: SUNFLOWER 1129623/PHASE 1
LOT # : 27
SITE ADDRESS: 79516 MORNING GLORY CT. LA QUINTA, CA
EXTERIOR WALL
MANUFACTURER: JOHNS MANVILLE THICKNESS: 3 5/8 R -VALUE: R-13
CEILINGS: BATTS BLOW
MANUFACTURER: GREENSTONE THICKNESS: 10.3 " R -VALUE: R-38
CSCE L�BATTS BLOW
MANUFACTURER: JOHNS MANVILLE THICKNESS: 13 " R -VALUE: R-38
GENERAL CONTRACTOR: WORLD DEVELOPMENT, INC.
BY:
TITLE:
DATE:
INSULATION CONTRACTOR: WESTERN INSULATION, L.P.
LICENSE NUMBER: 794484 ;
BY:
TITLE: PRO.WC N MANAGER
DATE JULY 10, 2001