0103-010 (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
D e- Signature of Contractor
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.lfo`r,t1l n
Date e 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
Sion 3700 of the Labor Code, for the performance of the work for which this
permit is4issued. My worker' 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 Section 3700 of the Labor
Coder I shall forthwith comply with th[ose„pT6vi'sions.
Date: rr -t _, s Applicant
, � rr
Aarning: Failure to secure Workers' Compensation 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 for insp ction purposes.
Signature (Owner/Agent)'`°_ Date.
' t
1�.
BUILDING PERMIT PERMIT#
DATE VALUATION LOT TRACT
JOB SITE
ADDRESS
APN
"19 -SM 140trNI'iltG COIL01ey r-oul
604-072,
OWNER
CONTRACTOR /•DESIGNER /ENGINEER,
74.334 HWY 111 9'd'H 103
7433 4 Vii` 'i p 1 U, IR 103
PALM rPx+VERr (A 92260
PA7sM.DE.S1rRIr CA 922,60
(760)5684931 ("B119- 5028
USE OF PERMIT .
M''..i'',IXTEPAIMY `f'DWY Laj,,'NG
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sus - Lori , E,,LA.,.K :2k ma.miT utmw'» Nur mmum. P.vacr:.
WA1.UOICKWAPPRO.ACH IANEWA.Y �a
MAR®�
TRACT CCONSTA15(:' IUN .?„100.00 OF W, r
Y Q
3�0'),CCHIPATIO SY �✓
X65.00
p
R
Z�°'.I'�tM.' I'D (,`O9:.r 021' C-010i71t1Gft.”" ON
C'•C=fid `,r1..8 ' 113 FEE 10111000-4118-000 x'743.50
PLAW CH1r,Ci~<.Ful E 101-000-439-1318 $613.86 f'
IMT Wif'aIRc"Ay.1i, 101-17001•00£1 !S60.00
F;: ECTRICAt, "M M-000.420-000 $171.66 `
KAMM FEE 101-000.419.000 SAM,%
.'i'I� .40 MOT)014 FIX, - RUSID 101 -OW-241 -000 $13.:43
ORADING, I;Ela. 101.000.42:3.000 $1410M
DMa,t;7112AW1Afi.".'A' P'l� �3,9(t7.110
111M ,-4 OTAL 001,411,M) 1,411,M)C'MOV AI T) P1:.AV ('Wt; K 4
X11 PR&FI,ADYI � S $0.00
av
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RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
�� z
INSPECTION RECORD
• OPERATION
DATE
I INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
Set BacksUnderground
Forms & Footings
Slab Grade
MECHANICAL APPROVALS
Ducts
Ducts
Return Air
Steel
Combustion Air
Roof Deck
_
Exhaust Fans
O.K. to WrapZ
Q _
F.A.U.
Framing
Compressor
Insulation
�_ �'
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wali Firewall
Exterior Lath
Drywall - Int. Lath
9
Final
f�0/ _
Final
POOLS - SPAS
BLOCKWALL
PP ROVALl
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
�z('J�j
Heater Final
Water Piping
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
-
Appliances
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
Utility Notice (Perm)
WESTERN INSULATION, L®Po
. `P, 4211 Latham 8tizet, Riverside, Californi'92501
Tel: (909) 696-8760 Fax (909) 686-8786 `
y
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 #25691/PHASE 2
LOT #: 38
SITE ADDRESS:79584_ MORNING GLORY CT. LA QUA INTA CAS
EXTERIOR 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: BATT 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 NUMBE :794484
BY: -
TITLE: P 0 TION MANAGER _
DATE AUGUST 10, 2001
-'_._ �, :. �.ry. •._. �..� ,i�' fir.-i+.��. _ _ -
TOTAL P.19
FSPECIAL INSPECTION SERVICE
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 TRUCT. STEEL ASSEMBLY O �'I fop `
❑POST TENSIONED CONCRETE O ASPHALT �oTHER
O REINFORCED MASONRY ❑ FIRE PROOFING // ```
JOB LOCATION �J
REPORT SEOUENCE NO.
TVG 0 5 UC
�
P RMIT NO.
DA
6`
DAY OF WEEK
MATERIAL DESCRIPTQN__� � O� � � �
ARCHITECT
IN 0
HRS. CHARGED
CV+w`TMc
0 �`�)v�4V
ENGINEER
ASSISTANTS
HRS. CHARGED
INSPECTION
DATE
GENERAL ( 10��`n
CONTRACTOR �(J �U &eu
CONTRACTOR
EPc,J1CS eUQ (N&
-E- tn-(-E�S- CAP
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COPY SENT TO CLIENT D
CONTINUED ON NEXT PAGE 0
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.
SIGN TUBE OF REGISTE9ka INSPECTOR
-171181-0 (04c(�S
CIATEIPF REPORT REGISTER NUMBER
La
City
Building and Safety Department
This Certificate issued pursuant to the requirements of Section 109 of the Uniform Building Code,
certifying that, at the time of issuance, this structure was in compliance with the various ordinances
of the City regulating building construction or use. For the following:
BUILDING ADDRESS: 79-564 MORNING GLORY COURT
Use Classification:' SINGLE FAMILY DWELLING Bldg. Permit No.: 0103-010
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL
Owner of Building: D F PARTNERS, LLC
Building Official
Address: 74-333 HWY 111 STE 103
City: PALM DESERT, CA 92260
By: DANIEL P. CRAWFORD JR.
Date: 10/4/01
POST IN A CONSPICUOUS PLACE