0101-059 (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
Profe�sionals Code, and my License is in full forde and effect." -
12M Ito'(
Date Signature of Contractor
OWNER -BUILDER DEdCARATION'
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) 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 (Se�. 7044, Busines's & Professionals Code). �1-1 I .
( ) 1, as owner of the property, am exclusively contracting with licensed
contractors -to construct the project (Sec. 704 4, Business & Professionals
I am exempt under Section B&P.C,- for this rea[kn
Date Signature of Owner
WORKER'S COMPENSATION DECLARATION
I hereby affirm -under penalty of perjury one- of the following, declarations:
I have anl�,Wlifl maintain a cihif�lcate of co'n'sent to self -insure for workers'
compensation 'a's provided for. by-Sectioh 37.00 of the Labor Code, for the
Perfori�ance of/the work for which'this. permit is
),,1 -have and will maintain workers' compensation . insurance, as required by
Secti'�6 - kd of the Labor Code,'for the performan6e- of the work for which this
permit' is'issued. My �tork&s' compensation insurance carrier & policy no. are:
Policy No.
(This section need not be completed if the permit valuation is for $100.00 or less).
I cehify that'in the performance of the work for which this permit is issued,
1, 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
tion provisions of
'_tate: Applicant�?
Warning: Failure msecure vvomom Compensation coverage munlawful and
,.,shall subject onomployo,mcriminal penalties and civil fines upm$1m0,00n.in
addition mthe cost compensation, damages aaprovided for inSection o7V6
vfthe-Labor Code, interest and attorney's fees.
IMPORTANT `xpp|manonioxooeuymoupmmon��v,mpui|uinuan.Sa��
hu,a povn� subject e� m �ho conditions and nu� n iono m� forth on his
application. ' .
1 Each person.upon whose behalf this application ismade & each person at.
whose request and �,whose Unnexnwnmiopodonnadunder o,pumuantm
any po,muissued anaresult u,this oppnootonagrees to, & shall, indemnity
& hv|u ho,m|nao the City of La Qvinto, its onicem, agents and emp|oyeea.
`
2. Any permit ieauoU as o result o/this application becomes null and void if
wv,x is not commenced within 180 uoyw from date o/ ioovonuo o/ such
it, or cessation ofwork for 18Odays will subject permit to cancellation.
| certify that | have read this application and state that the above information is
correct. | agree to complywith allCity, andState laws relating mthe building
.'�onstruction, and hereby authorize represetUative,s.o0his City to enter upon
nameKJwn ,
BUILDING PERMIT
��TE VALUATION _0 LOT TRACT
JOB SITE
OWNER
CONTRACTOR DESIGNER EN61NEER
74-33,.3 1131OKWAY 11 It, SUrM- I Q3
74-333 103
RALM MMMC. A: 922Z0
PALM.D. SEKT, CA 92260
Mff 5028
USE OF PERMIT
P00,1. OR. DIUVEWAT APPROACH, '"56 PL&N CHECK MR RMUCT ION FOP.
TRLACT CON90TRA", 4510.00
Poll 77.00 SP,
GAR A.0EMA -OW (g 114630
MEIC"WWWAIL. ME $98,50
STIZONO MOTION F ID 101 .41 J
0.
RECEIPT
DATE
DATE FINALED
INSPECTOR
* . ,
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
�J
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings
_
�_
Underground Ducts
Ducts
2
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap�L1
ce-
F.A.U.
Framing
-! l
(—'gst
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
J-1
Drywall - Int. Lath
Final
rLL
Final
POOLS -SPAS
BLOCKI�.=iIPPROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
23
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
_l
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Qa/
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G. F.1.
Smoke Detectors
Temp. Use of Power
Final
�-
Utility Notice (Perm)
_
weerrincare OT,uccupancy
City of La Quinta
Building and- Safety Department of
This Certificate issued pursuant- to the requirements of Section 109 of the Uniform Building Code,
certifying that, at the time of issuance, this structure was in compliance with the various ordinances
of the City regulating bui/ding construction or use. For the following:
BUILDING ADDRESS: 79-533 MORNING GLORY COURT
Use Classification: SFD Bldg. Permit No.: 0101-059
Occupancy Group: R3 Type of Construction: VN Land Use Zone: RL
Owner of Building: JIM DAN LLC Address: 74-333 HWY 111 STE 103
City: PALM DESERT -CA 92260
-� — By: GARY HARTMAN
Date: 7-29-01
Building Official
POST IN A CONSPICUOUS PLACE
JUL-19-2001 15:44 WESTERN INSULATION 909 686 8786 P.15i19
WESTERN INSULATION, L.P.
4211 Latham Street, Rivcrslde, 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 #: 22
SITE ADDRESS: 79533 MORNING GLORY CT. LA OUINTA, CA
IRXTER R WAL!`S:
MANUFACTURER:
C ILE INGS=
MANUFACTURER:
-CEILING
MANUFACTURER:
JOHNS MANVILLE
BATTS
GREENSTONE -
BAT
JOHNS MANVILLE
THICKNESS: 3 5/8 " H -VALUE: R-13
BLOV.IL.�
THICKNESS: . 10.3 " R -VALUE: R-38
SLOW
THICKNESS: 13 " R -VALUE: R-38
GENERAL CONTRACTOR:- WORLD DEVELOPMENT, INC.
BY:
TITLE:
DATE:
INSUL TION CONTRACTQR_: WESTERN INSULATION, L.P.
LICENSE NUMBER: 794484
BY:
TITLE: P D TION MANAGER
DATE JULY 1 P. 2001