0101-062 (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.
LicFert.`# Lic. Class Exp. Date
«c"
Date1�� "t �� Signature of Contract
,.. ,V -
r OWNER -BUILDER DECLARATION T
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.
21'2 D-111''lIWD
(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 f
subject to the workers' compensation provisions of Section 3 0-of'fhe Labor
Code, I shall forthwith comply with those,(i•�.visions""-'�
Dater r �•.��>Applicant -4'`,`.
Warning: Failure to secure Worke s'^Gompensation 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 yfor inspection purposes.-'
Signature (Owner(/Ag not �+�'"'Dat aw
BUILDING PERMIT PERMIT#
DATE VALUATION LOT ;�%. TRACT
JOB SITE
APN
ADDRESS y,,� aaiy�p�� p �{,Y�pg ,Cf y,,-�j
•d"-'± ...4G7. ✓'.C64\ tbY' �+�i OY0.1. 'i.i0li.i:A
p,� /!�.�b �, �,y
604-0-72-W4
604-4>! Y.ln'"W4
OWNER
CONTRACTOR/DESIGNER/EN INEER
JKDAN, LIX11
W0XX DEWQ:A: ?1,.MIT, INC
PA"M TIRISEIRT CA 922-60
PALM 1) a-MIXF CA _92M
(760)5— a-2995 ILO
USE OF PERMIT
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POOL f7aC31VnfY.APPYY6�ii75% PLAN CHECK FE, REDUO104 FOR
�
tNPI(IZ 1rIU'1N'CZ O 1AMF, StKN TYPE.
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TRACT COpl;S'P.R:1x.'�°!'TON 2,2:30,00 SY
POIZ..641P E'Il i 212." SAN'
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XWI,tMAI COSTOT+ L'4;iRGYRTJt71,10N
CONSTRUMMI FEE, 10', -000-418-000 S77%39
ib"14 CHECM ",*1,, 101-000-439-318 $163,68
MAC,�9••gl.,�ulp��ivp`,ALr�L;lEE
g101��(Jly0-11-it1-000
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d2.5: C RJ M.t" , RGI:+ 7 01-000-420-000
PL.'t3Y+4NAG MR, lUl �rif,?i1n41 =OL1U $143. i�
S11'R0140 M.DTIO*N ATZ ; MRIIa 1 r71-f5t1f1-:?42 �dQf} e%93
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t.' NAAfiKH3O3r'fN:E IMAM -423.000 $zmo
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WVR'€... PER IMPACT Pl?, ,
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LESS PRE -PAM MIPS
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�r�� Pa4r�•4i
RECEIPT',
DATEBY/'{
4
DATE FINALED
INSPECTOR
^b
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
��� (y
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
3 I �.i �r—�v(
Exhaust Fans
O.K. to Wrap
cf �3
F.A.U.
Framing
l I `23 �„r�Z
Compressor
Insulation
s`� ����
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wali Firewall
Exterior Lath
Drywall - Int. Lath
1_le
Final
Final
POOLS -'SPAS
BLOC ALL APPROVALS
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
12� ��
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
Sewer Lateral
N_l�
O.K. for Finish Plaster
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
_ _
Gas Test
Appliances
Final
COMMENTS:
Final
�/m� /� (�
Utility Notice (Gas)
l
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Loan Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
G
Utility Notice (Perm)
` "
JUL-19-2001 15:45 WESTERN `.INSULATION. r 909 686 8786 P.18/19
WESTERN INSULATION 9 L.P.
4211 Latham Street, Riverside, Celitbmia 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 #:
19
SITE ADDRESS:
79645 MORNING GLORY CT. LA QUINTA, CA
EXTE R WALL !
MANUFACTURER:
JOHNS MANVILLE THICKNESS: 3 5/8 ", R -VALUE: R-13
CEILINGS:
BATTS �^ BLOW
MANUFACTURER:
GREENSTONE THICKNESS: .10.3 " R -VALUE: R-38
CEILINGS:
BATT S BLOW
MANUFACTURER:
JOHNS MANVILLE THICKNESS: 13, R -VALUE: R-38
GENERAL CONTRACTOR: WORLD DEVELOPMENT, INC.
BY:
TITLE:
DATE:
INSULATION CONTRACTOIR: WESTERN INSULATION, L.P.
LICENSE NUMBER; 794484
BY:
TITLE: P U ION MANAGER
DATE JUL 1 P, 2001