0101-051 (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' Bu§iness and
Profes tnt Is Code, and my License is in full force;:and effect. yh:•
Licerl,' L_ic. Class - Exp. Date
Datet �f Signature of Contractol°�-_7.
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).
( ) 1, as owner of the property, am exclusively contracting I. 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' compensationinsurance carrier & policy no. are:
Carrier Policy No.
STATF. FUND
(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 Labor
Code, l shall forthwith comply withJthose'proyisions.
Dater - , _ >; Applicant
Warning: Failure to secure Work re si•Compensation covera`geis 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 37_06
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 personupon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant
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 isnot 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 prope y for inspection u poses.- -
Signature (Owner/Agent)�'"Datet
BUILDING PERMIT PERMIT//
,
DATE ;: VALUATION LOTTRACT
Ail 29
29612.
JOB SITE
APN
ADDRESS
7.9-5,241MORDINGGdOPYCGUIrl'
�&N-EE72A01�
OWNER
CONTRACTOR/DESIGNER/EN (NEER
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74-339 1�i:GHWA�,Y• I I a ► RUM, , 103
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P.-'JIM.DPIRI "T f,`% € 22610
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, PALM D:9YMz CA' 92260
(7 (10)568-2195 5 .,.
-
CBIR 5028
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USE OF PERMIT
LOT 291 P AT4 ZP.#, 5 . t'E'f.X IT =ZSNt'.T MCLUDE BI,,CXK •flJ;r IIS, ,
FOR'
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TR.AtT tuO MST'RY3L"`I'ION By
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11'10 `AINMW COU OF CONSWRUC~ '@;CaN
0014 3TRUCTIM WE 101.000.418.0001
PLAN C k1W,1C?S.X, 1:01-X10-439-318 $163 a
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TSI.?,SNW33O FrIn W1»0€111,'419.000 Std3.WY
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0FVZI.,O.PFJi, IMPACTPES $i,�D[�7.itfe ,,.,
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TOTAL PKROM PNES VVY.,
RECEIPT
DATE f
BY
yy,,
DATE FINALED
INSPECTOR
INSPECTION RECORD
--,OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
e A_Z "
Underground Ducts
Forms& Footings
I (may
Ducts
Slab Grade
I �3t
Return Air
Steel
I!;
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
�� Zt ���
F.A.U.
Framing
3,3o T..JEC
Compressor
Insulation
(,� / (D ��
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
-
Y
Drywall - Int. Lath
u!
Final
Final
I
POOLS - SPAS
BLOCKWALL IaPPROVALS
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
I qia
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
�_
Pool Cover
Sewer Connection
Gas Piping
_
Encapsulation
Gas Test
Appliances
Final
COMMENTS:
Final
00-1
'
�U✓
Utility Notice (Gas)
Z
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
) 131
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Q — —
Utility. Notice (Perm)
U-
JUL-19-2001 15:41 WESTERN INSULATION 909 686 8786 P.08i19
WESTERN INSULATION, LLP.
4211 lAtham Street, Riversldc, 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 #29623/PHASE 1
LOT # : 29
SITE ADDRESS: 79524 MORNING GLORY CT. LA QUINTA, CA
-----------------------------------------
EXTERIOR WALdS:
MANUFACTURER: JOHNS MANVILLE THICKNESS: 3 5/8." R -VALUE: R-13
CEILINGS; BATTS
MANUFACTURER: GREENSTO THICKNESS: 10.3 " R -VALUE: R-38
C ILE INGS- BATTS BLOW
MANUFACTURER: JOHNS MANVILLE THICKNESS: 13, R -VALUE: R-38
NERAL CONTRACTORS WORLD DEVELOPMENT, INC.
BY:
TITLE:
DATE:
INSULATION CONTRACTOR: WESTERN INSULATION, L.P.
LICENSE NUMBER: 794484
BY:
TITLE: D CTION MANAGER
DATE 1Uj,,f IP, 2001
,
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