0101-058 (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 o the Business and
:Profssionals Code, and my License is in full.force and effect.
License # Lic. Class P. Exp. Date u� ,.yyq�•
..Dated j Signature of Contractq r��
. W
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).
as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business &'Professionals
Code). t
(`) 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..
(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 provisionsof Section 37D0•of the Labor
Code,I shall forthwith comply with tFjpse pro ons.
Dater - r�
Applicant/r 4 C
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 td ---
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 enteCupon
the.above-mentioned property for iins�pecttioa,purposes.
Signature, (Owner/Agan • re - Dated
' BUILDING PERMIT ' PFRMiTN .;
DATE VALUATION LOT 0>�J'S^�. TRACT '
JOB SITE
APN
ADDRESS
NIHA:9Z.iM0 07-10m, COURT,
+&M-0 724NN
OWNER
CONTRACTOR / DESIGNER / EN INFER
3' NI DAN* LR. 0 .
WORM DEVEt_✓0P >I�e'�"�'��.3t
�•4n3 33 XRQ'r •%'4VrA.Y 9 `11, STATE 103
"74-333IMY f I M, X03 '
CA 92260
PALM.DDTn.r CA 92260
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USE OF PERMIT
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18,21 PRE -PAM FEESN
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RECEIPT
DATEBYy
/ ,
DATE FINALED:
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Zt"f
_Underground
Ducts
Forms &Footings
Ducts
Slab Grade,
�2.
__f�
ReturnAir
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
c3(Z7
��-$3�
F.A.U.
Framing
Compressor
Insulation
C,+C�y
����
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
_
���
�j'G�
Final
POOLS -SPAS
BLOCKWQ �L A�'PROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
_ 23
I
C
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
_
Pool Cover
Sewer Connection
Gas Piping
Gas Test
C/
Encapsulation
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.FA.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
7UL-19-2001 15:43 WESTERN INSULATION 909 686 8786 P.14i19
WESTERN INSULATION$ L.P.
4211 Latham 3troet, Rivrreide, CoWomia 92S01
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 #.: 23
SITE ADDRESS: 79529 MORNING GLORY CT. LA QUINTA, CA
------------------------------------------------------------
EXTERIOR WALLS-:
MANUFACTURER; JOHNS MANVILLE THICKNESS: 3 5/8 " R -VALUE: R-13
CEILING$ BATTS BLOW
MANUFACTURER: GREENSTONE THICKNESS: 10-30 R -VALUE: R-38
CEILINGS: BATTS. BLOW
MANUFACTURER: JOHNS MANVILLE THICKNESS: 13 " R -VALUE: R-38
GENERAL CONTRACTOR: WORLD DEVELOPMENT, INC.
BY:
TITLE:
DATE:
INSULATION CONTF
tACTOR: WESTERN INSULATION, L.P.
LICENSE NUMBER* 794484
BY:
TITLE: PR ION MANAGER
DATE JULY 1P, 2001