0101-045 (SFD)LICENSED CONTRACTOR DECLARATION
I h6by 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
Prof6sionals Code, and my'License is in full force and effect.
License # Lic. Class Exp. Date
%
A143 36 7
ate Signature of Contracto
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) 1, 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).
1, as owner of the property, am exclusively contracting with licensed
Ct
contractors. to construct the project (Sec. 7044, Business
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:
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.
l.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 Js issued; My workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
MAT 9 YOM
(This section need not be completed if the permit valuation is for $100.00 or less).
Ir 1(-).I certify that in the performance of the work for which this permit is issued,
["shall not employ any person in any manner so as to become subject to the
workers"6ompensation laws of California, and agree that if I should become
subject to the workers' compensation provisions of Septi n' V% the Labor
,/Code I shall forthwith comply withithose provisions 00�
Date:'/ Applic
Warning: Failure to secure Wor Jrs'"Com'pensation coverage-is-CfZw,ful 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.
I., 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 v ' oid'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 purUo es.
Signature (OwnDate A
r/Agen
tT
BUILDING PERMIT PERMIT#
DATE VALUATION LOTM• t TRACT
OAN
JOB SITE
APN
ADDRESS
79_548 MWOPIM140 GrU)Nly MUM,
72-M5
OWNER
CONTRACTOR DESIGNER
JIM, DAN TIC
74.323 AIM VIM] 1I,.-ST_7rrK 10.1 -
74-333 IT -WY I I'll ZTE 10,,E
RALM. VIMMURT CA 0260
'.P.1�4AWDESTMT CA 92260
C!BUO 5=8,
USE OF PERMIT k:
UYAr 35, 'PLAa4 AA, SPI), • P&RMT DOE.53 NOT 3i CLV)1F, 81,CICK VG>,LE,4-
K06 Oil DRIVEWAYAPPROACH,
TRACT CONSTRUV"T 11CAN 4100.00 SF
PORCHIPA110
G&RAGINCAIPORT (0) 14,366.80
E4 511KA"roW coh-1, OF COMMU(MON
mhlq clik"Ic V&Z 101-000-439-M $614.96
ME,CHMICAt nt 101 _C100.421.000
EUXTRI(A't. f'HE
PlIUMBINO VIM t 101-1000-419-000 $144.50
STRO'NO MOTIONFEE - RENO 101-0004241-000 $12.9310
71.1
1101-000-423-,0001;10,
V5119-11M.'AL CONS"MUCT109AND P7. AN'
624 4S
LUM P)RE-PATDOX,
'rarAL Tym-, _-uow
t*04.45
[RECEIPT
DATE
BY
DATE FJNAZ
INSPECTOR
10161:1=1011reml
0
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
I 1 i C.47_ -S
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Z\ 23
Exhaust Fans
O.K. to Wrap
�� ej
F.A.U.
Framing
Insulation
Compressor
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
G—
11
Drywall -Int. Lath
i�'*"T 7
CpW►c�v C rc�e�
Final
Final
POOLS - SPAS
BLOCKWALL 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
(-� l� ���
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
N
Pool Cover
Sewer Connection
�_
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
s
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 (Penn)
JUL-19-2001 15:38 WESTERN INSULATION 909 686 8786 P.02i19
WESTERN INSULATION, L. P.
4411 Latham Street, Riverside, California 92501
Tel. (909) 686-8760 Flax (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 1129623/PHASE 1
LOT #:
35
SITE ADDRESS:
79548 MORNING GLORY CT. LA QUINTA, CA
------------------------------------------------------------------
EXTERIOR WALLS:
MANUFACTURER:
JOHNS MANVILLE THICKNESS: 3 5/8 " R -VALUE: R-13
CEILINGS:
BATTS LOW
MANUFACTURER:
GREENSTONE THICKNESS: ' 10.3 " R -VALUE: R-38
CEILINGS:
�RATT-----BLOW
MANUFACTURER:
JOHNS MANVILLE THICKNESS: 13" R -VALUE: R-38
GENERAL CONTRACTOR:
WORLD DEVELOPMENT, INC.
BY:
,
TITLE:
DATE:
INSULATION CONTRACTOR:
WESTERN INSULATION, L.P.
LICENSE NUMBER: 7944 4
BY:
TITLE: RATkCTION MANAGER
DATE jwLY IP, 2001
REGISTERED INSPECTOR'S WEEKLY REPORT
JON TANDY-
37630 Medjool Ave.
Palm Desert, CA 92211
Office (760) 772-7192
Fax (760) 772-7193
Pager (760) 776-3338
TYPE OF
INSPECTION
PERFORMED
❑ REINFORCED CONCRETE STRUCT. STEEL ASSEMBLY
❑ POST TENSIONED CONCRETE ❑ ASPHALT
❑ REINFORCED MASONRY ❑ FIRE PROOFING
❑ S P
�COTHER
C
JOB LOCATION I
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REPORT SEQUENCE NO.
/fsyRUCTURE 2 `� Q
PERMIT N0.
DATE
DAY OF WEEK
MATERIAL DESCRIPTION
1� -3 pf o a
ARCHITECT
INSP.EST9il--
=� ~ `
HRS. CHARGED
•7-�
ENGINEER
ASSISTANTS
HRS.CHARGED
INSPECTION
DATE
L SUB
GENECONTRACTOR Lk 0 6--� es -lab ( CONTRACTOR act, I e- Lj
¢� 0
�.3
S AAs
[A TES
COPY SENT TO CLIENT ❑
CONTINUED ON NEXT PAGE ❑
PAGE OF
CERTIFICATION OF COMPLIANCE
I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF Mfr
KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE
NOTED. I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED
PLANS, SPECIFICATIONS. AND APPLICABLE SECTIONS OF THE
GOVERNING BUILDING LAWS.
SIG ATU OF REGISTOWD INSPECTOR
19 D (
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�((7 D d-' L ✓ 'J
OAT F REPORT
REGISTER NUMBER