0101-057 (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
04
W. Pfofessionals Code, and my License is in full force and effect.
C)
=)- ch' -�-, . License #: Lic. Class Exp. D -ate
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F_ N' '4 %
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C:) Dat Signature of Contra6ori_*
C:) OW . NER-BUILDER DECLARATION
LLI I hereby affirm under penalty of perjury thatJ am exempt from the Contractor's
Q_
License Law for the fbIlowing reason:
Z 1, 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 with licensed
• contractors to 'construct the project (Sec. 7044, Business &'Professionals
Code).
ce) I am exempt under Section B&P.C.Jor this reason
LO
C\J Date Signature of Owner
ON
0)
CL < WORKER'S COMPENSATION DECLARATION
Z
C) I' hereby affirm, under penalty of,.perjury one of the following declarations:
u') < Cc
0 1 have and will maintain a certificate of consent to self -insure for workers'
N
X W LL — compensation, as provided,' for �by Section 370d of the Labor Code, for the
0 _J < _J performance of the work for Which this permit is issued.
IM _J
< I have and will maintain workers' compensation insurance; as required by
O ()Section 3700' of the Labor Code,- for the performance of the work for which this
U-) -permit is issued. My workers' compensation insurance carrier & policy no. are:
It Z Carrier Policy No.
cb: ftAll MIND,
< (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,
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' comperXsalionTrovisions of Section 3700 of the Labor
provisions.
Code, I shall forthwithcomp witA,th�ese
wit
Date (nt
Warning: Failure to secure WorZ6rs'-Compensation aDvexage is unWwful and
shall subject an employer to criminal penalties and civil fines upTo_f100,000, 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.
_11. 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 inspgptien- poses.
Ar
Signature (Own <:
000 r/A Pn, Datei t
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 0101-W7 TRACT
.24
JOB SITE
APN
ADDRESS
79-52-SMORMNO iryR.ORY C_Ovflal 6-04-072-f9A
OWNER CONTRACTOR/DESIGNER/EN INEER
jrmmk4 lit! = WORLDDEV'k. h1TYWrWK,.
1),, sunl i o 1 74-351H.-VIII'llaytim ..
PADA Dr -HER -T C% .9 260 PALM DWSURX CA, 92260
USE OF PERMIT
RN_ (REFAMLLYDWO-UNG
JA)T 24, PLAN RA, SIVE) - PERMIT DOES N(Yf INCLUDs. HLOCK WALLA
1100- 1, ORDPJVrWNAYA.RPR0A1:,.'K 75% P14N CHUX RE REDUCTION FO It.
MULTIPLf?, ISSUANCE 00 UMV, PI,AN TYPY.
'flux? I�OHMIKWMINN Z,5 10. 0 0 3F
URAOFICA MWORT (3 n,
NSHIWATED COST 011 COASTRUCROA
C
CaNSTRUCHON TIVIN
I DllvOOG-43 6.000
rd, I.
FRE
101-000-421-000
101.000-420-000
PLUMP INO)PRE
101-000-419-000
D
STRDNO, MOTION FFIF, - RURMID
101 -OW -2411-000
$14,491
0- RADWO F1219
101.000-423-000
$20.00
PIELOPU IMPACT YVaY,
_q
RECEIPT I DATE
X , -WO K)FLq4
I
TOTAL PERMr FRES DUE NOW
DATE FINALED IINSPECTOR
C
D
_q
rr
J
DATE FINALED IINSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs _
Underground Ducts
Forms & Footings
/���
Ducts
Slab Grade
!�
Return Air
Steel
Combustion Air
Roof Deck
3 �-7
(���
Exhaust Fans
O.K. to Wrap
faZ�
pep{_
F.A.U.
Framing
�,�
t_f=0aC_
Compressor
Insulation
/�-123
���
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall'- Int. Lath
G( tom-
1 ��_/N�2�
- !
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
I 1�3
�'—
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pansr—zv
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
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
rWd
ofe 010-1
Utility Notice (Perm)
-
JUL-19-2001 15:43 WESTERN INSULATION 909 686 6786 P.13i19
v 'y
WESTERN INSULATION, L.R.
4211 Latham Street, Rlvcraidc. California 92501
Tel, (969) 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 #: 24
SITE ADDRESS: 79525 MORNING GLORY CT. LA QUINTA, CA - - - - - - - -
EXE O W LL :
MANUFACTURER: JOHNS MANVILLE THICKNESS: 3 5/8 " R -VALUE: R-13
cc IL_�S.
BATTS BLOW
MANUFACTURER. GREENSTONE THICKNESS: 10.3 " R -VALUE: R-38
m -Al.
�SATTSBLOW
MANUFACTURER: JOHNS MANVILLE THICKNESS. 13 " R -VALUE: R-38
GENERALCO T A TR: WORLD DEVELOPMENT, INC.
BY:
TITLE:
DATE:
S LATO C N R CTO : WESTERN INSULATION, L.P.
LICENSE NUMBER: 794484
BY:
TITLE: PR U ION MANAGER
DATE JUL 1 P, 2001