0101-061 (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
Professionals Code, and my. License is in full force and effect.
Licensei' Lic. Class Exp. Date
.S'
74
.. Y4'Rd
Date « �. ;'� Signature of Contractor/^'"��^-^,'"`�
OWNER -BUILDER DECLARATION
1• 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
() I am exempt, under Section B&P.C. for this reason
Date, f Signature of Owner
a 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.
OTATZ FM*
(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 imany 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 withthomprovisiens.,.
DaterI Applicant J" �
Warning: Failure to secure Workers' Compensation coverage`ts �pinlawful and
shall subject an employer to criminal penalties and civil fineVp.to,$100,000, in
addition to the cost of compensation, damages as providei9-for in Section 3706
of the Labor Code,'interest and attorney's fees. a
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize represeptatives-of this City to enter upon
the above-mentioned property for ins e'Etio purposes.
Signature (Owner/�Apge t)-� t " `? Date^t
BUILDING PERMIT PERMiT#
DATE VALUATION LOT TRACT
JOB SITE
APN
ADDRESS
�tL q pit y WI g �y �+ YA p
`* I.�'^ry`"Ji. 1t+rJ.�'�.C�d:S'JY Re'f,S' g Y FAM COUXT'
aRt y �y l�5 i g
.47'04-072,•\ 4
OWNER
CONTRACTOR / DESIGNER / ENGINEER
im, D.47 11Z.,
WC)i.T.3 DEVEWPMEW, WC
74.333HIORWAY !'11. rLf',�..T 103
74.33 11WY 1 13 SIE 303
'PALM DESIMT CA 92260
PAUMDRIMIXT CA 92260
USE OF PERMIT
P..OT P, lz ,.A.X 1A,, .53- F - P RMI f' 1 at?+ES NOT INCLUDE 8 fifesK' Ww.;1.;,,
POOL Oft DRlVZW'AY- AMt0A,014. 75% PUN C;!•?RM FE PT:.ftE,0VCTKA4 FOR.
1,PF.`d'tP;,E1' ,LANCE OF :'AME PIAN TypL.
9`RAM ir%i'd' S WCTION 2,610.00 SY
POR01911A TIO / 74.00 SY
G AIAwchRFOR'ir (OF) 1 MffS.")
'A. CC�STOF�'O.�i^�'�'�"A�'U�"�`ON -;.-;
�•�4I~,eE�.adD
py$ y'�y/�$��j.}�T,�]�,,�(hgy��::S'..`,"
I03QC300-4I8-00o ADA• SO
-� I
PLA.,R CHBCKC Poi. 1.03. -000-14 39 -;i l s $1i17..3►5
-^
2 tnl�r tJlGtli9 01 -000-121 � 000 $9950
1PILEMIRICA], HIM, 101.000-420-000
P',laIMB' 11 0 'fix: 101.00041 9d.000 siC,"'m
Sn7TRCt`^Ny�fq&XdiOT10441FE-�;i4NID 11±y011-ODO•�2(1
d41-'tC�'�}'0 �$1'4.9"F
GRAI 1'I G§*A.�.iU
DEVELORR !MPACT FM $1,907.00
.I.rFUIR Sg.L4..L._P.9UAu 12F s
WOO
RECEIPT
DATE
BY, r
DATE FINALED
INSPECTOR
INSPECTION RECORD
;.OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set backs
Underground Ducts
Forms & Footings
`
Ducts
Slab Grade
2
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
t,l (-Z_
F.A.U.
Framing
L
Compressor
Insulation
g —�
Vents v
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wali Firewall
Exterior lath
Drywall -Int. Lath
Final I o/
- / �� ��
Final
POOLS - SPAS
BLOCKWALL
APROVALS
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
_
2
Heater Final
Water Piping
-I
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
Sewer Lateral
O.K. for Finish Plaster
Pool Cover
Sewer Connection
_ _
�_
Encapsulation
Gas Piping
-
Gas Test
%3
Appliances
Final
COMMENTS:
Final 01
Utility Notice (Gas)
ELECT
RICA iL AOPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
410,
Smoke Detectors
Temp. Use of Power
Final
Utility Notice
(Perm)
JUL-19-2001 15:45 WESTERN INSULATION 909 686 8786 P.17i19
WESTERN INSULATIONS L.P.
4211 Letham street. Riverside, Califomia 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 #: 20
SITE ADDRESS:. 79541 MORNING GLORY CT. LA QUINTA, CA
F1cTERIOR WALLS: - •
MANUFACTURER: JOHNS MANVILLE THICKNESS: 3 5/8 " R -VALUE: R-13
CEILINGS: BATTS BLOW
MANUFACTURER: GREENSTONE THICKNESS: 10.3 " R -VALUE: R-38
CEILINGS: BATTS BLOW
MANUFACTURER: JOHNS MANVILLE THICKNESS: 13 " R -VALUE: R-38
GEN RALONTR CA TOR: WORLD DEVELOPMENT, INC.
BY:
TITLE:
DATE:
INSULATION CONTRACTOR: WESTERN INSULATION, L.P.
LICENSE NUMBER: 794484
BY:
— TITLE; �PR TION -MANAGER - r `
DATE JULY-1 P, 2001 -