0101-050 (SFD)J
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
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
43867
Date "' fLJ Signature of Contractor.
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 maihtain.a certificate of consent -to self-insurdkfor workers'
compensation, as provided for by Section 3700 of the Labor Co%e, for .the
performance of the work for -which this permit is issued.
( ) I have and will maintain workers' compensation insurancd; 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'.
sum. FW41)
(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 mariner, 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 U0.0 -of. -the Labor
Codec I shall forthwith comply with those provisio C"
Dater • roti' i.ai Applicant !" `
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 fo�inspeeticfposes.
Signature (Own `r?AgAt) _ �W """" a Data
BUILDING PERMIT PERMIT#
DATE VALUATION LOTTRACT
JOB SITE
APN
ADDRESS
OWNER
CONTRACTOR / DESIGNER / ENGINEER
'74,,333 HIGHWAY' 3.11 p NL33TM, I (YN
74-333 HWY Il i Era"! 02
PAW D_W1WJ' / ;r# 92260
1%AL" Duff' ' CI 92260 ,
5028
USE OF PERMIT
WT3U;11, 4 AD, SPI) PERMIT IVES NOT f`t4:'.LUDEt�BLOCK W.ri ,]L -Sy
�'�)OI, i?� �ZdI`hf'�i.�',�`4."./ai.F��F�•�'iAGk�. :.s'IO is )..a!1�Ax +::°.��5°:re. F��:a:, Ftl?.,Crf.frvT�®9�i ECMG�. '
W,1ULTIPLFi(K)U-AJ4CE OF SAME PLA -14 TYPX
TRACT CONSTRUCTION ZzA4 ,00 OF
PCa4tZHIPAT30 IZ.OU SP,
h�:�`�INATED COST OF CONMIM,71TO,�.`'d
.1. 9„,296.-60
j7y t�9�'�,}�y+(�ff y� ��Yf �'}'ryg ,q'p�}j
.U-.17u�L'�['Y,EA.N.� 7 F P.91:71.Vi.1 AR r1
[
CON3`kRUC`I'109 FEE 101 Q000 -416i,00 , ri qm, ,_T
PL -%W CHLIVIK FEE,
Mrsewl kNICKI MIF 1.091-000 121.-000 �9� a®,.
K>4iW940 FIVE 101.000.419-000 $163.73
RO110 H01I0N PrO, • RRSTr: 101-000.241.000 313 97 y:
'�`
l .
� ;1 n I
GRADING IFF 10140-423-000 520,00
tY i 1 t -J
t�N;+9'ELOPI*M IMPACT i1`f�.i/
i.J
SUB -TOTAL C":CY4MTXT1'G'.rJ01s1'AA.TDPI" C'RE .`�
T.: d r-1RF,_i 19:D `FU a
0,00
n.
RECEIPT
DATE/
By �
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
I INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
/ l3/_
Underground Ducts
Forms & Footings
I3 /
Ducts
Slab Grade
�/� gf
Return Air
Steel
f_� 3) �9�
Combustion Air
Roof Deck
Z,r� ��-
Exhaust Fans
O.K. to Wrap
r� �t�L
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wail Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALIL 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
i'— �����
I r
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateralyi
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS: -
Final
Utility Notice (Gas)
ELECTRICAL
APPROVALS
Temp. Power Pole
Underground Conduit
1 �31
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G. F.I.
Smoke Detectors
Temp. Use of Power
�� Q
Final
jZ/
Utility Notice (Perm)
7UL-19-2001 15:41 WESTERN INSULATION 909 686 8786 P.07i19
WESTERN INSULATION 9 L.P.
4211 1,atham etreec, Riverside, 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 #: 30
SITE ADDRESS: 79528 MORNING GLORY CT. LA QUINTA, CA
EXTERIOR WALL
MANUFACTURER: JOHNS MANVILLE THICKNESS: 3 5/8 " R -VALUE: R-13
CEILINGS BATTS �BL
MANUFACTURER: GREENSTONE THICKNESS: 10.3 " R -VALUE: R-38
CEILING BAITS BLOW
MANUFACTURER: - JOHNS MANVILLE THICKNESS: 13 " R -VALUE: R-38
GENERAL O A : WORLD DEVELOPMENT, INC.
BY:
TITLE:
DATE:
INSULATION CONTRACTOR: WESTERN INSULATION, L.P.
LICENSE NUMBER: 794484
BY:
TITLE: P O CTION MANAGER
DATE J Y 1 P, 2001