0101-049 (SFD)~��----r`�`--`-�-~--'--�----^----�--�-�-=-�-~-`
LICENSED CONTRACTOR DECLARATION
| hereby. affirm under penalty oVperjury that | mn licensed. underprovisions of
��'Ohopte,n (commencing with Section 7000) of Division 3 ofma Business and `
'Professionals Code, -and'my License is in full force and effect.
' uoen,ge # ucClass) Exp. Date
`
Signature of C
e, 'ontraotof
OWNER -BUILDER DECLARATION.
| hereby affirm under penalty oxperjury that |umexempt from the
License Law for the following reason: .
( `) |, as owner ofthe property, mmyomployees with wages as their sole
compensation, will Uothe work, and the structure ionot intended o,offered for
sale (Sev.ro44. Business mProfessionals ooum).
( ) |, as owner of the property, am exclusively contracting with licensed
ovntnamnm to vonot,vm the
project (Sec. 7044. auuin000 m Pm/ooaiona|o
Code).
() |amexempt under Section .aaPo.for this reason
_________
Date Signatuneo,owno,�
- '
..
WORKER'S COMPENSATION DECLARATION
| hereby affirm under penalty of perjury one of the follo�ing goo|amuiono
()| have and will maintain acertificate ofconsent m self -insure m,wnmoo�
compensation, as provided m'uy Section 3700 of the Lobo,�Codo, for the
performance o/the work for which this permit iaissued. `~
( ) | have and will maintairf:womos'oomponaation inoumnoo, as required by
Section 3700 of the Labor Code, for the performance ofthe work for which this
permit is issued. my wn,m»�' compensation insurance oamo, & policy no. are:
Cartier � Policy No.
'
' WYATEMND
(This section need not mecompleted xthe permit valuation isfor $1OOlmm|oxo.
( ) | certify that inthe performance ofthe work for which this permit ioissued,
| oxan not employ any person in any manner oo as to u000mo subject mthe
workers' compensation laws v/California, and agree that if| should become
subject to the workers' compensation provisions of Section
Date{-��./=� Applicant
Warning: Failure tosecure Workers' compenoco/nnoovomggnsvn/am*m and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition tothe cost ofcompensation, damages aoprovided for inSection 37o6
of the Labor Code, interest and attorney's fees.
IMPORTANT Application. ivhomuymade tnmeoi�oo,oxBuilding and Gmety
for o permit subject to the conditions and eomohono set forth on his
application.
1.Each person upon whose behalf this application iamade & each person au
whose request and for whose benefit work ioperformed under o,pursuant to
any permit issued aoaresult oYthis uppU0000nagrees to, & Shall, indemnify
& ov|u harmless the City m LuQuinta. its officers, agents and employees.
2. Any permit issued as a result of this application becomes nun and void if
work is not commenced within 180 uoxe from date o, issuance o/ such
pennit, or cessation of work for 18Odays will subject permit to cancellation.
|oertify that | have read this application and state that the above information ix
correct. I agree to comply with all City, and State laws relating to the building
construction, and xamuy authorize rep,00vn*atwou of this City to amo, upon
the above-mentioned property for inspection
Signature /
PERMIT #
BUILDING PERMIT.
DXT VALUATION LOT 0J.tJJ_(M0- TRACT
JOB SITE
APN
OWNER
CONTRACTOR / DESIGNER ENGINEER
CA 92260
PALM DMMT CA 92260
USE OF PERMIT
UM
TRACT CONSTRUCTION 2,100-00 2F
PORMPATIO SF
(WRAGOCARRO RT
CONSTRUCTION T111 101 -OPO -418-000 S744.�O
PLAN CHEM M 8 315146-
MWHANICAA, FEW, 101400-42-1-000 U0.02
%.;1 M
WXCIVICAJ, FEE *14160
PLUMBNO ME 101-000-419-000 4144-50
0 ID
TOUL DONUT FUSDAV& NOW
DATE
INSPECTION RECORD.
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
f 3o �
Underground Ducts
Forms & Footings
(30 _ _
Ducts
Slao Grade
Return Air
Steel
(3p —
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
�`�Z
F.A.U.
Framing
Zg �g�
Compressor
Insulation
Lr 12 (��
Vents
Fireplace P.L.
Grills
FireplacwT.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
cow m.i IMMOT�S
ov—
Final
Final
POOLS - SPAS
BLOCKWALL APPkOVALS
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 cT ���
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
Sewer Lateral
�L
O.K. for Finish Plaster
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
Utility Notice (Perm)
REGISTERED INSPECTOR'S WEEKLYREPORT
JON TANDY
37630 Medjool Ave.
Palm,: Desert, CA 92211
Office (760) 772-7192
Fax (760) 772-7193
Pager (760) 776-3338
TYPE OF
INSPECTION
PERFORMED
❑ REINFORCED CONCRETE
❑ POST TENSIONED CONCRETE
❑ REINFORCED MASONRY
RUCT. STEEL ASSEMBLY ❑
❑ ASPHALT MZTHER Is�
❑ FIRE PROOFING t4"'e-z?-4G�
JOB LOCATION-�^
CI�Q (�11 tql
o c
Q C
REPORT SEQUENCE NO.
TYPE OF STRUCTURE I0w'
b- L -
PERMIT NO.
D E 0
DAY OF WEEK
MATERIAL DESCRIPTION
ARCHITECT
INSPg9jgjgp.
HRS. CHARGED
'^
ENGINEER
ASSISTANTS
HRS. CHARGED
DATE CTION
L
GENE- CONTRACTOR E3 {e e . ` QlJ lCONTRACTOR
SUB
RA d�►' �� �j�
-10-p LLGAM&
l� ®
-S - /
P C�tt4j C419ou'
L . .
COPY SENT TO CLIENT O
CONTINUED ON NEXT PAGE O
PAGE OF
CERTIFICATION OF COMPLIANCE
I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF Md
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.
l.�
SIGNURE OF REGISTE INSPECTOR
o - -rr-3 z) &a -i7S
ATE . REPORT REGISTER NUMBFR
JUL-19-2001 15:40 WESTERN INSULATION 909 686 8786 P.06i19
•
WESTERN INSULATION, L.P• �e
4211 Latham Sone[, Rlvuside, 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 #: 31 '
SITE ADDRESS: 79632 MORNING GLORY CT. LA QUINTA. CA
------------------------------------------------------------------
EXTERIOR WALLS:
MANUFACTURER: JOHNS MANVILLE THICKNESS: 3 5/8 " R -VALUE: R-13
CEILINGS: BATTS cBL01i
MANUFACTURER: GREENSTONE THICKNESS: 10.3 " 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 CONTRACTOR: WESTERN INSULATION, L.P.
LICENSE NUMBER: 794484
BY:
TITLE: PR TION MANAGER
DATE JU 1 P, 2001