0101-047 (SFD)LICENSED CONTRACTOR DECLARATION
I Yi ieby 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
743667 D
bate �t Signature of Contractor'`
OWNER -BUILDER DECLA TION
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 df 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.
STATE P41140 4X09'.59:3 D'a
(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 3700 of the Labor
Code, I shall forthwith comply with!those.provisior n --
Date:ApplicantrY"�`�
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/Agent) fns ` j Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT.TRACT
JOB SITE
APN
ADDRESS
79-540 .G4LAH GP:Gdd♦{iJy
OWNER
CONTRACTOR / DESIGNER / ENGINEER
vh
3..DMT LLC
�71
?33 tt31 1;Ali 117 ) DU^a
74.333 FIINY I'll STLE 10
PALM. DIM CA 92260
"MRS'
DRSERIX CA'9460
5026
USE OF PERMIT
r
'FRACT CONSTIVI (:TION %230.OD at:
PORCHIPAIC 212.00 Sig
t' I.A.RAPHICARk'OTIT (S�)
ESir`MA:)JIM COST OF C0NurRL}'MON
i M*rli.' .i .'E iiTaP
PLAN CHECK l'tf£ 101_00(..•439_318 $65469
IMECKANIM, FEE 151-000.421-000
101-000.420-000
11111tKIRINO YEE 101.000.419-000 $103.15
-
STRO1`I{3MO`1'10311 FEE =' 4ieESID 1101-000-24t-000 $13.92
011.P1,DT%tO FRF. ' 1G?1-; ia, ' pti5ly $4100
7
f ➢Ji't�'�t31q�S`. 3%�i' L(V'i 1?"I'uE `� d,9t37.0►3
t i i �._ i
.Y,L
•
S P-: O A'+L CE INKRUCM0,14 AND PLAN Cf. CK
IMS PR!,,,;F?A1D JFFS8
$0,00
TOTAL Flom., ?E"M MIN NOW
$3,764,51
RECEIPT
DATE 9
BY,�
DATE FINALED
INSPECTOR
INSPECTION RECORD
R OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
.BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
)
Return Air
Steel
`
Combustion Air
Roof Deck
Zp 2
C�"�
Exhaust Fans
O.K. to Wrap
�� !C�
F.A.U.
Framing
�Z3
�, �..g�
Compressor
Insulation
Z
���
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
1
Y(
�-
Drywall - Int. Lath
l..j
P
6e>`s6C
—
Final
BLOCKWALIL APPROVALS
Final
POOLS - SPAS
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
Waste Lines
Gas Test
Electric Final
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
H
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
Final
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 �le;/ET
Temp. Use of Power
Final
b _
Utility Notice (Perm) ,
COMMENTS:
WESTERN INSULATION, L.P.
4211 Latham Street, 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 #: 33
SITE ADDRESS: 79540 MORNING GLORY CT. LA QUINTA, CA
------------------------------------------------------------------
EXTERIOR WALLS:
MANUFACTURER:
CEILINGS:
MANUFACTURER:
JOHNS MANVILLE THICKNESS: 3 5/8 " R -VALUE: R-13
BATTS C�Bt
GREENSTONE THICKNESS: 10.3 "
CEILINGS: BATTS BLOW
MANUFACTURER: JOHNS MANVILLE THICKNESS: 13 "
GENERAL CONTRACTOR: WORLD DEVELOPMENT, INC.
BY:
TITLE:
DATE:
INSULATION CONTRACTOR: WESTERN INSULATION, L.P.
LICENSE NUMBER: 794484
BY: 4�7 - ..._.
TITLE: P56DTION MANAGER
DATE jUW 1 P, 2001
R -VALUE: R-38
R -VALUE: R-38