0101-055 (SFD)Y "LICENSED CONTRACTOR DECLARATION
I hQreby affirm under penalty of perjury that 1, am licensed under provisions of
,Chadte<<s (commencing with Section 7000) of Division 3 of the Business and
:Professionals Code, and my License is in full force and effect.
Lictnse # Lic. Class Exp. Date
Date'- ` x Signature of Contra,'v' -••� "{"
` 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). r
O f 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 370,0 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 6y
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' compen5tion-provisions of Sect1o0•,.37,00.of:.the Labor
Code, I shall forthwith comp j� with those provis'I sw
Date:Q � o(, wf;'r APPIicCnt �-~-.
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!f•r.Jlyspeetion-pD,rposes.
Signature (Owner/Age t:'_. ._� - Date" t5"° —.
PERMIT#
BUILDING PERMIT
DATE+ VALUATION LOT
TRACT
a _.
2A
JOB SITEAPN
ADDRESS '
�
79•':5: ^ .RKY. ..��'�:� (s MIDDY MUM,^..
, 6049� 141
OWNER
CONTRACTOR / DESIGNER / EN INEER
- r
WO RTJ.3 a V]<WWvffiW°1`, INC
7.4- 33,L+`-.!• 51.1.V'%A..S 111; BUTTE 103
a d:kkt47 ?i�".f C s +0
kyEiC i��^SI:'�'k
: C4
92260
USE OF PERMIT
O- .17; TWI&,'Y ;I±YWE'U tr70
"Ia.n M, l�l:AA Ali% SYD - 3�Fi1^:MI-A' 13t:7.�'13o NOT Ilal.i.L`DY, 81—OCt�'Pldt�LLSY
' 1'O(% OR t �R)'�'I �',�lY APPROACH, 73% PLAN f'°I,4i�CK FEF REDUCTION ION FOR
. • . ,
Y . 14,
fS11i)ii.,7IP Y 1=31ANICE OFSx MIE P.L Al2 TY'P ..
TRACT C01-bMilCTIDN OF
I .
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y�y„���rr�p tttt�� ��••��ss ++yy�� con
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f:�
._.D•.a„�'pbi`�•�a7VT..'{I
C:O'NST tUCTIO11 F= 101-000-436.000 r7n.so
PY., W CHECKME 101-000-09-318 $163.69
�EC 4141C; -A1,, _ 101-000-421-000 $PIB.SU
L'!tO,f
`�
,%f ;''r --',rte--. . t
i' i AL l0r10. 101-000-420--000
PTAYM iNQ FEE 101-000-419--000
��,s u cf lca l'iOra � RES;D 141-000-241 -•000 ' $:3.x'2
:
011.01140 FSS 101.000-423.0003 $20.0
p
4.LbYLOia.H3�A:l��atW`:�"FUi.,9ti�0t1
?ih
G113= Z'+ Y°t 3 C:
$3,273.0
LESS PRE PA1iRS
$0.00
_ r a
i
RECEIPT
DATE /.� `
BY71 +'
�'��'
DATE FINALED
INSPECTOR
•
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings
Slab Grade
Steel
_ _
��
KI
Underground Ducts
Ducts
Return Air
Combustion Air
Roof Deck
--it (Z
_
Exhaust Fans
O.K. to WrapF.A.U.
3123
C��L
Framing
Insulation
c J (9,
/ lJ�_I (-�L
Compressor
Vents
Fireplace P.L.
Grills
Fans & Controls
Condensate Lines
Fireplace T.O.
Party Wall Insulation
Party Wall Firewall
Exterior Lath
_
Drywall - Int. Lath
Final ZJ-� _6� �"
BLOCKWALI. i,PPROVALS
Final
i
% E=
POOL'- 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
Sewer Connection
- fj
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
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
Utility Notice (Perm)
JUL-19-2001 15:42 WESTERN INSULATION 909 686 B7B6 P.11/19
7
AVE
STERN INSULATION, LoPs
4211 LadWm Street, Riverside, Callfornla 92501
Td. (909) 686.8760 Fax (909) 686-8786
iNSiULATION 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 X129623/PHASE 1
LOT 9: 26
SITE ADDRESS: 79517 MORNING GLORY CT, LA QUINTA, CA
EX RIO W LS:
MANUFACTURER: JOHNS MANVILLE THICKNESS: 3 5/8 R -VALUE: 8-13
CEILINGS: BATTS SLOW_
MANUFACTURER: GREENSTO THICKNESS: 10.3 " R -VALUE: R-38
COLING BATT BLOW
MANUFACTURER: JOHNS MANVILLE THICKNESS: 13 " R -VALUE: R-38
GENERAL CONTRACTOR: WORLD DEVELOPMENT, INC.
BY:
TITLE:
DATE:
INS LAT ONCONTRACTOR: WESTERN INSULATION, L.P.
LICENSE NUMBER- 794484
BY:
TITLE: PRQ U ION MANAGER
DATE JULY 1P, 2001
Certificate ofOccupancy
Cit 01 La Ouir ta
Cl
Buildin and Safety Department,
This Certificate issued pursuant to the requirements, of Section 109 of the Uniform Building Code,
certifying that, at the time of issuance, this structure was in compliance with the various ordinances
of the City regulating building construction or use. For the following:
BUILDING ADDRESS: 79-517 MORNING GLORY COURT
Use Classification: SFD Bldg. Permit No.: 0101-055
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL
Owner of Building: JIM DAN LLC
r
Address: 74-333 HIGHWAY 111,SUITE 103.
City: PALM DESSERT,CA 92260
By: GARY HARTMAN
Date: 8-7-01
Building Official
POST IN A CONSPICUOUS PLACE