0101-048 (SFD)LICENSED CONTRACTOR DECLARATION
I he by 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
Dat , ' - Signature of Contractor "=-Z -K -^-
OWNER-BUILDER DECLARATION��w~��
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 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.
V'1'ATE Vii, 0090-J-99
(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 provisions of Section OA -of the Labor
Code„I shall forthwith comply with those5provisions.
Date: r t- —!` � Applicant %~"".. _ y *°e'” - �K
Warning: Failure to secure Workers" -Compensation coverage Is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and.Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to,'& shall,, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit. issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.-_.._
Signature (Owner/Ag'eni),ip]�� Dat
BUILDING PERMIT PERMIT#
DATE VALUATION LOT„{,. TRACT
2 9623
JOB SITE
ADDRESS
APN
%, YlRd �lty nth p U +.1�t py T�`��gy [•
'B+"�"''s.W' J.v,�-S!�.R'�69 NQ (11- .fdQ.B. SaMb/.fK,b
,tf4n dYNq 11tT
�:iR7"N'•N 7eL^i.si+'$
OWNER
CONTRACTOR/DESIGNER/EN INEER
11141)" Lal
WORLD 3: �E47ELC►PMvW'�hI1,, INC
?4 11, 10115.103
744 333 ,H"4 Y I ] 1 TIF 103
J?;ChIA TIRMW CA 92'.260
PALM TUiMERT CA n.260
USE OF PERMIT
L:SSf7SJd:.+1•=`d.'..T7n.T9.Y.l,:✓�L .7.J!➢Q.t�,A,�d.+•1.4tS 4'e
'
'WT 3;k F AW 3A, 3VV-1-•'VR.91T DOES'NO':f' 1NC1,UDE SLOC'T �l'Nsf:t
POOL OR DIRN'tWAY .A.Pf`iY,OACK VIA K.44 C.fW.K FFFI F4-RIOUC'i`ION FO'R
I-ALI 14"11 LF 1SOUANCE OF SAME K,AW TYPE,
I
TRACT COMTRAIC-fION 010100 V
Pta3dG.:1•iIPATIO 17ZOO S1�
: �r'�,'1, l.1A,TED C°OYE OF C`•ONSTR`d'd(MON
149,716.20
PIER 101.000.418•'900 SPA4,50
P'L,la7 CIMCK i+' IE 101-000-439-318 $170.:16
YWHAN1CALI MR 101-000-421-000 M.50
W..1?d �'IlUCA4 ftp 9 f92 • A?CY. M 1 L? -1X1 9 :1 i�. f1
PLUMBING RX 101-001.419-00;} 51333.15
ST14ONG E.40T101M . It ' 11a 10'1-000-;24$..0043 $14..T1
MA3?M FSE 101-000.11.23-000 $220,00
A�1f.'�/4s,1.�7F1!:.19. iAQ1y#R.�S` ;� S1p9tfA.f10
M;6•�'CY'.1°X, COATSMIMMO14? AQ) PLA N"^.C'��
1=52 FR&PAIDM113'�!S
Z'MAL PIKIRM �' 11126 lA•93'PYRY
RECEIPT
DATE J /
BY r y
DAT FI ALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE INSPECTOR
OPERATION DATE INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
X30"'S
Underground Ducts
Forms & Footings
)
Ducts
Slab Grade
/
Return Air
Steel
1
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
g�2$ copHl<
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
(Q
Final
Final
_
POOLS - SPAS
BLOCKWALL ROVALS
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
l� ���
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
ILL 5 -4f( �(
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas).
ELECTRICAL
APPROVALS
Temp. Power Pole
Underground Conduft
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)
JUL-19-2001 15:40 WESTERN INSULATION.,
7
k1
re
WESTERN INSULATION, L.P.
4211 latham Street, Riverside, Calllbmia 92501
T id. (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#:
32
SITE ADDRESS:
79636 MORNING GLORY CT. LA OUINTA, CA
EXTERIOR WALLS:
------------------------------------------------
MANUFACTURER:
JOHNS MANVILLE
THICKNESS: 3 5/8 " R -VALUE: R-13
CEILINGS:
BATTS
BLOW
MANUFACTURER:
GREENSTONE
THICKNESS: 10.3 " R -VALUE: R-38
CEI
BATTS
SLOW
MANUFACTURER:
JOHNS MANVILLE
THICKNESS: 13 " R -VALUE: R-38
GENERAL CONTRACTOR:-
WORLD
DEVELOPMENT, INC. s
BY:
TITLE:
DATE:
'
INSULATION
CONTRACTOR:
WESTERN INSULATION, L.P.
LICENSE NUMBER: 794484
BY:
TITLE: PR U ION MANAGER
DATE JlJrLVrIP, 2001