0101-046 (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. ;
License # Lic. Class Exp. Date
31627
pate f _ } 4 �� Signature of Contracto..rf
OWNER -BUILDER DECLARATION
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).
O.' 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.
STATE FUNLI
(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 shalljorthwith comply Wi Aheseeprovisions.
Dater
Warning: Failure to secure Workers' Comp nsation-coverage-is-^Alawful 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..l 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 propefor inspection urposes,;
IA
Signature (Owner/ genu f 5"' Dat"' •�
= BUILDING PERMIT PERMIT #
DATE VALUATION LOT 41101_D4? C
TRACT
414,9116429) '44
'79673 '
JOB SITE
ADDRESS
APN
79-SS44- M01MING Gl.O..D"RY CQUfftr' _
std►4t •�J 1Z-i�C
OWNER J
CONTRACTOR/ DESIGNER/ ENd INEER
�t`,C�:1'1A.4 LLC
TNdl Irl � �'W CA. 592260
PA1.,14J,)&
CA
9U.60 ,
(y(,p)3>;?n935
rna
507'6. .
,
USE OF PERMIT
LOT 34, PLAN $A. SPO • P,t?1•; ,IT DOES NOT INCIX.0Z I1I.f3M 't%ir"A'i.1. T.
.
r
TRACT CON12:''k fi.0, CTIONi :010.00 Sig
J
P0J11VCWTWr1.O` 8?
0AIt.M#Mr°tiRs`'ORT (P) 12,400
- t
,L�p•'q�q.1�,R esy�'•aq 8 �,,�y�p+ {�a 7�y4 �! � f[q�,�.r@y
'F.c!Jldf1tF13b.Y�r.,&��O V10178 Q�.tL• �.`d,�l'`!.l'.F:
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
)
Underground Ducts
Forms & Footings
_
Ducts
Slab Grade
I
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
f
F.A.U.
Framing(23
Insulation
C0�'ay�
3 �� so-
Compressor
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APROVALS
PQOLS -SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
1
�_( (,
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
Sewer Lateral
Sewer Connection
_r
O.K. for Finish Plaster
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
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
JUL-19-2001 15:39 WESTERN INSULRTIUN ?"a n yby bbb U(tsb r.e3�i
WESTERN
INsULATION2 L.P.
4211 Letham Street, Riverside, CaMMia 92501
.Tel. (909) 686-8760 Fax (909) 686-8786
INSULATION CERTIFICATE
INSULATION HAS BEEN INSTALLED IN CONFORMANCE WITH
THIS IS TO CERTIFY THAT
THE CURRENT ENERGY REGULATION, CALIFORNIA ADMINISTRATIVE CODE, -TITLE 24,
STATE OF CALIFORNIA, IN THE BUILDING LOCATED AT:
TRACT / PHASE:
SUNFLOWER 1!29623/PHASE 1
LOT 11 :
SITE ADDRESS:
34
79544 MORNING GLORY CT. LA QUINTA, CA
_E,XTERIOR WALLS:.
MANUFACTURER:
JOHNS MANVILLE THICKNESS: 3 5/8 " R -VALUE: R-13
BATTS BLOW—
LCEI INQS;
MANUFACTURER:
GREENSTO THICKNESS: 10.3 " R -VALUE: R-38
CEILINGg•
BATT BLOW
MANUFACTURER:
JOHNS MANVILLE THICKNESS: 13 " R -VALUE: R-38
GENERAL CONTRACTOR: WORLD DEVELOPMENT, INC.
BY:
TITLE:
DATE:
INSULATIO14 CONTRACTOR: WESTERN INSULATION, L.P.
LICENSE NUMBER: 794484
` BY:
TITLE: P U ION MANAGER
DATE JUL 1P, 2001