0101-052 (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
Professiorials Code, and my License is in full force and effect.
License # Lic. Class Exp. Date.
Date, :! `^ -��' Signature of Contract6irr
A
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 '
( ), 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.
( ) I have and will maintain workers' 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.
3T Al JZ FUN D} 2flS�393 4
(This'section heed 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,,,l„should become
subject to°the workers' compensation provision>ef"Section 3700 of the Labor
Code, I shall forthwith comply with those provis 0
Date:
Warning. Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work.for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for insRgction.purposes.
Signature (Ownerl4ge fll", - �''" Date
BUILDING PERMIT PERMIT#
DATE VALUATION TRACT
JOB SITE
APN
ADDRESS
i 9 &'211.) Md3R.Rii)NG :7L0RY (,,'O'U t 0'
604-472-004
OWNER
CONTRACTOR/[ / EN (NEER
74 { 333 HICK 'bpl A -Y 11 z „ 2102” 'E 103
74-333 HW`!'' 111 ME 103
��.?uL1L U "Ava, CA 92260
PA1.M ]YRUMT CA. 92.260
5028
I
USE OF PERMIT
; l, 24 PLA74,11PLA. SF'D . PERMIT 1 OV; NOT INCY..UVE }3I..w1; W.LLS,
POOL OR Da.1VF$*AY APP110ACfl, /5hr$1'I.AN CexlICK F'6O,�r' ,.R.RIr UCT'.ION FOR.
�i'E',3t i'lhl,� ➢S;:i:1A.��l�".�. CJ3" :i��A�+?�:.P�}...AAi 't°iCF�.
r
=t`t'ar`1t:'�i�31'R�3�I�N.o1:0fD:E90 JF
PORCiIPPa TIO 65.00 S3+
'v.4'}4a�tl :fia-e.J.'ipi.P'L,15.t t( 'y! 14,94-6.00
'
=Wl'.rAA01W W`rf OF 0DIrKTRUCA1.0M
.1.29.061,
14RNMY". SUMMARY
- COMPa"RUC'1'IONM79 101-D00-418•000 �5a3.,4�6
*IA33[n\LF 101^400O439-313 $�1
�'t�C�fiAN1Cr1�,i� 3C►1^dJt3�}=�l�C1-G1(}Y) �t,0.0U
I, t:".i
MSC RIC:.AL "M 101-000.420-000 g121.66
i r
PLOMR RMJ FER 101.000-419-000 $144,5il
S'XI«O'NO MOTION FEE - M10 101-000-2441-000 $12.93
ie. a fE ti 401 -000-423-ON $20.00
177 _V
171YAN,.E IPLeR IMPflCT N.f;fE $3, tr7.Oa
— -1
,TJ' -`rCf A.f. CRfiN4z.3f.L1.AOTICM Mr.) 14 -AN CrA:TL(%
RECEIPT
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS MECHANICAL APPROVALS
Set Backs
Forms& Footings
2�� underground Ducts
2�� Ducts
Slab Grade
Steel
�l i'`9 Return Air
2 �5 Combustion Air
Roof Deck
=&A N2 Exhaust Fans
O.K. to Wrap
c3 0 Fd�C F.A.U.
Framing
Compressor
Insulation
I_� ` Ventszliz
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wali Firewall
Exterior Lath
Drywall - Int. Lath
�-1
ps00� ice(\�,
1
3 V
Final
Final �,
��G��
�J�
` �
POOLrj - SPAS
BLOCKWA- L AW PROVALS
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
/ oar G��"` Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
Sewer Lateral
_ O.K. for Finish Plaster
_ Pool Cover
Sewer Connection
_
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
Z.
e�
ELECTRICAL APROVALS
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
O► �" '
Final
f
Utility Notice (Perm)
_�
JUL-19-2001 15:41 WESTERN INSULATION 909 686 8786 P.09i19
WESTEDRN INSULATIONS L.P.
4211 Latham Street, Riverside, Callfomla 92301
Tcl. (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 #29823/PHASE 1
LOT#: 28
SITE ADDRESS: 79520 MORNING GLORY CT. LA QUINTA, CA
-------------------------------------------------------------------
EX ERIOR WALLS:
MANUFACTURER: JOHNS MANVILLE THICKNESS: 3 5/8 " R -VALUE: R-13
CEILINGS: BATTS BLOW
MANUFACTURER: GREENSTONE THICKNESS: 10.3 " R -VALUE: R-38
CEILINGS: S BLOW
MANUFACTURER: JOHNS MANVILLE THICKNESS: 13 " R -VALUE: R-38
GENERAL CONTRACTOR: WORLD DEVELOPMENT, INC.
BY:
TITLE:
DATE:
INSULATION NT CTO WESTERN INSULATION, L.P.
LICENSE NUMBER: 794484
BY:
TITLE:4JULY,2000l
MANAGER
DATE
rl.
REGISTERED INSPECTOR'S WEEKLY REPORT
JON TANDY
37630 Medjool Ave.
Palm Desert, CA 92211
Office (760) 772-7192
Fax (760) 772-7193
Pager (760) 776-3338
TYPE Of
INSPECTION
PERFORMED
❑REINFORCED CONCRETE TRUCT. STEEL ASSEMBLY
❑ POST TENSIONED CONCRETE ❑ ASPHALT
❑ REINFORCED MASONRY ❑ FIRE PROOFING
❑ S'.0.p
THEIR
t ��
JOB LOCATION 6 ^
Q ro
REPORT SEQUENCE NO.
TVP F STRUCTURE�.v
2f ao- 6t ,' S V'{� PtO
PERMIT NO.
D
( o
DAY OF WEEK
MATERIAL DESCRIPTION J�
J
ARCHITECT
INSPECTOR-
V
HRS. CHARGED
ENGINEER
ASSISTANTS
MRS. CHARGED
SUB
INSPECTION GENECO TRACTOR WD-OL,L I6 tel) (c ' CONTRACTOR S-A AAA"6&C-9-
DATE C-
o&S LC R LCA LJ e.t ,� i� C,
C)
a, 6 AS , QGOTES
64 P
•s- �� 3L� oLs
COPY SENT TO CLIENT ❑
CONT UED ON NEXT PAGE ❑
PAGE OF
CERTIFICATION OF COMPLIANCE
I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF Md
KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE
NOTED. I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED
PLANS. SPECIFICATIONS. AND APPLICABLE SECTIONS OF THE
GOVERNING BUILDING LAWS.
�GNA UbRi OF REGISTER ��CTOR„ T �
DATE REPORT REGISTER NUMRFR