0101-056 (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•thei Business and
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
Datex Signature of ContractQt -
L/ T", t `� • wa
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.
( ) 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:
Cartier Policy No.
SIT. AV R, Yrull D
(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' compensatio rpuisiens, _5)Betiorr370'fl"Ysf the Labor
Code, I shall .forthwith comply With thdse provisi s.�-
Date: r 1— +' 3 f Applic 7St J a .p,
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 o�ginspection purposes.
`�
Signature (Owner ge� I Z ��" Date
BUILDING PERMIT PERMIT#
• Rte.
DATE VALUATION LOT TRACT
JOB SITE
APN
ADDRESS
794U1. WO; ,t:i IG MORY MUM,
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OWNER
CONTRACTOR/DESIGNER/EN INEER
W :3AB' LPX
WORIM :DEVE OP t� .W, WC
74-333 TZ31 AY ) 11, U"tM W3
'74., 333 HVIY I k) MIT, 103
PALM DDIMUC. CA 92260
PALM DEbTlPff CA 92,2160
„
USE OF PERMIT
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TRACITC014STRUCTION Z190.60 OF
POR.0 liftex'f'i't3 650-00 SRI
0ARAGEICARPORT (1819 1066,80
1
M1;'.I?7D COST OF @: 7MIRUCiTION
129,261.30
PFRUnTEE SUMMARY
CCYN 9TP,UC.TI A �� Uw 101_00041x_000 1744,50
RAN C.I'WiC YEE 101 -:OW -39-310 $153.46
00
34=31 AN IC.A L FER 101-000-4-21-000 $60,00
Pa' 101 -000-420-CSW $121.66
PLUM I1 O FER 1101-0010-419VNO $144.50
STMONG MOTION FEE a SMSID 101 -.00 )-id 140M $12.93
OR DIWO I &R, 10I_000_4t"' i_000 510,00
D1?%'rZiD.V'L0RlMPACf IFL
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RECEIPT
DATE`
Bye/j//
DATE FINALED f ! INSPECTOR
((tt`
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�•I1.I`.Y'
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
Set Backs
Forms & Footings
Slab Grade
Steel
Roof Deck
APPROVALS
/
n'1 Fj KI
"!�
ZExhaust
MECHANICAL APPROVALS
Underground Ducts
Ducts
Retum Air
Combustion Air
Fans3(�
O.K. to Wrap
Framing
Insulation
_
�[`� '—
_ 1-7
F.A.U.
Compressor
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall -Int. Lath
14021V-
f-) (—? r�
•
Final
Final
POOLS - SPAS
BLOCKWR s.L
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
_I
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
Gas Piping
Gas Test
Appliances
_�� Q�`"�
_
Pool Cover
Encapsulation
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)
t
JON TANDY
37630 Medjool Ave.
Palm Desert, CA 92211
Office (760) 772-7192
:SPECIAL• Fax (760) 772-7193
REGISTERED INSPECTOR'S WEEKLY REPORT Pager (760) 776-3338
EOCTION
EP
❑ POST TTENSONED CONCRETE ?O ASPHALTSTEEL ASSEMBLY OTHER P•ORMED ❑ REINFORCED MASONRY ❑ FIRE PROOFING
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JOB LOCATION
Sa. oe2-a l o6-40ce Lk Ln Qu t kms.
REPORT SEQUENCE NO.
7 E OF S RUC URE�U j
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PERMIT NO.
IINSPECTOR
v' it 0
:DE �
DAY OF WEEK
MATERIAL DESCRIPTION2 j
J K� V `'
ARCHITECT
7
HRS. CHARGED
.I-�
ENGINEER
ASSISTANTS
HRS. CHARGED
INSPECTION GENERAL J� � SUB ]
DATE CONTRACTOR �� 4�. U l% - .- CONTRACTOR
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CONTINUE N NEXT PAGE O
PAGE OF
CERTIFICATION OF COMPLIANCE
I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MY
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.
NAURE
F REGISTERE I
PECTOR
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�d 17S
_
ATE
6FIREPORT REGISTER NUMBFR
JUL-19-2001 15:43 WESTERN INSULATION 909 686 8786 P.12i19
WESTERN INSULATION L. Ps
4211 IAUuun Street, Riverside. CalifOrRls 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 #29623/PHASE 1
LOT 26
SITE ADDRESS: 79521 MORNING GLORY CT. LA QUINTA, CA
EXTERIOR WALL
MANUFACTURER: JOHNS MANVILLE THICKNESS: 3 5/8 R -VALUE: R-13
CEILINGS: BATTS
MANUFACTURER: GREENSTO
CEILINGS: BATTS
MANUFACTURER: JOHNS MANVILLE
BLO
THICKNESS: 10.3 " R -VALUE: R-38
BLOW
THICKNESS: 13 " R -VALUE: R-38
GENERAL CONTRACTOR: WORLD DEVELOPMENT, INC.
BY:
TITLE:
DATE:
INSULATION CONTRACTOR: WESTERN INSULATION. L.P.
LICENSE NUMBER: 794484
Ole
BY:
TITLE: PR ION MANAGER
a. DATE JULY 11% 2001
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