0101-063 (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
IV 3 212C
Date t�`'' ��Signature of Contraet5-
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).
() 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.
(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 Sec,QP 3700.of the.,Labor
Code, I shall forthwith comply with those_ I ov,' 'oTt
Date:' =.- Applicant
Warning: Failure to secure Workers' Compen sa ibn,.coverage lawful and
shall subject an employer to criminal penalties and civil fi esup to, X00,000, in
addition to the cost of compensation, damages as provided for in Seolion 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/��Arg' .It f Date t
BUILDIWPERMIT PERMIT#
DATE VALUATION LOT f �� j _Qj,Ky TRACT
01,04/2m. 9;.1' .9'^17Ait 30 181 2,1462:1
JOB SITE
APN
ADDRESS
*79,B49 XQ"MG ('§1,Q7ZY COX Igr
4504$47.24"4
OWNER
CONTRACTOR / DESIGNER / EN (NEER -
MAN 11.1c
'11901UX� DEVE�'.0p:hM4Z llq'c
74.333 ;E 10,11W AY 'l 11, OUTIM 103
74-333 Ji'W'Y 111 S°f". 103
WJ lm DESS '1' CA M60
PAL:M.TZTZES"FA.V'r CA 92260
I
USE OF PERMIT
MWOU s2c�ll:Y 3 ? � L L31tiTt3
i pYr 1% PLAN tWl, SM - ;fiCs'RMIT D06,S, NOT t':3CLU0X' Wtr;.,K VALLS,
F001, OR i3WVWAY .APPRO.f1CK 75"A PLN14 CHLC K THEE PIC. DUCTION FOR
A1UL1'➢.BIf;E ISS"iJ.€-`�iXZ OF SAME,PLAN TYPR
TRACT Mda'Pi1.L1'C TI01•a 2,100,001
D+`p+Oq'€ty.Gpi11`K�'ec/"�,TICt 655.000 Sty
+ate q
(,FYyf61Fy!i.-t;� C.(•:,L�,P0W (O m"366,80
l..
„-•j
,,,TI
F90NM".ED r:d: Arr O!1' C01191 1J(."'£J.4:):r"+F'
YR 'iE `AWAI
C(yNS1RUdTIOD D73 101-000-419-000 pf$g
1FLKN CHECK FFIF, 101-000-439-318 "18 $1151.46
I"1-; %-J
11AECHA1A1CCAL WE 101..000-4".1-010 Soma
i 4.0 TRIC Al YRR, 01-000-420-000
FI,Uik19FldO FrM 101.00IOA19.000 gtAti.:SfD
t i
31'?ZG1A8£t MOTION FEE - >u. ID 101-13(D0-• W 1. -000
(OR":►I"AO M 101 a000.425.000 �2r1,gC`
DEVELOPER IMPACT FLY, 00
SUD-TOTAL COMSTR1iCY1;`TON AW�f��:C.%1.4 �';�3b9"�CUI
$3,1m,.05
1.eF:c.'c PREPAID FIM
UM
TUM prJULU 'IM9 DUE, -NOw
RECEIPT
DATE/-- %
BY.,� jt,
DATE FINALED
INSPECTOR
4
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
1
Underground Ducts
Forms & Footings
Ducts .
Slab Grade
_
Return Air
Steel
Roof Deck
�_ ,�
! ��
�Cm�
Combustion Air
Exhaust Fans
0. K. to Wrap-���—
F.A.U.
Framing
fj�j
'
Compressor
Insulation
g
���L
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wali Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Iscoc�ii
Final
tivPOQ
Final
r _
�.S -SPAS
BLOCKWAIPROVALS
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
_
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
(p �¢
Pool Cover
Sewer Connection
_
C9'
Encapsulation
Gas Piping
Gas Test
Appliances
G
Final
COMMENTS:
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
TI
Utility Notice (Perm)
v
7UL-19-2001 15:45 WESTERN INSULATION 909 686 8786 P.19i19
WESTERN INSULATION, L.P.
4211 Latham Btreet, 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#: 18
SITE ADDRESS: 79549 MORNING GLORY CT. LA QUINTA, CA
-------------------------------------------------------------------
gXTER10R WALL
r
MANUFACTURER: JOHNS MANVILLE THICKNESS: 3 5/8 " R-VALUE: R-13
CIEILINCu%'BATTS BLOW
MANUFACTURER: GREENSTONE THICKNESS: 10.3 " R-VALUE: R-38
CEILINGS_ BATTS BLOW
MANUFACTURER: JOHNS MANVILLE THICKNESS: 13" R-VALUE: R-38
GENERAL CONTRACTS WORLD DEVELOPMENT. INC.
BY:
TITLE:
DATE:
IRlcl a ATlnlu (_nNTROCTOR: WESTERN INSULATION, L.P. -
TOTAL P.19 .
4
SPECIAL INSPECTION SERVICE
REGISTERED INSPECTOR'S WEEKLY REPORT
JON TANDY
37630 Medjool Ave.
Palm Desert, CA 92211
N
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 QTHER
❑ REINFORCED MASONRY ❑ FIRE PROOFING (W
J08 LOCATION j 9 /� . Mo `e j1 1Nc 64O� �' � d
. / J �`� V � oTFj
REPORT SEQUENCE N0.
T OF ST UCTRE *
o t g ����
ERMIT NO.
DE (
0
DAY OF WEEK
MATERIAL DESCRIPTION
ARCHITECT
\\JJ\\
HRS. CHARGED
(- ( ^' C, AO
ENGINEER
ASSISTANTS
HRS. CHARGED
INSPECTION GENERAL SUB
DATE CONTRACTOR CONTRACTOR14o
e�
p
6> Ep-VCS � SC bq t V
C L o, G I Y-. Y i�
L' Ln 1 N
COPY SENT TO CLIENT ❑
CONTINUED ON NEXT PAGE ❑
PAGE OF
CERTIFICATION OF COMPLIANCE
I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MY
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.
IGNA URE OF REGISTERED S ECT R
���
ATE REPORT REGISTER NUMRFR