0001-195 (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
'7�13£�"r �' •:I� � ' �1�I331f2Gf
'Date Signature of Contractor 1
OWNER -BUILDER DECLARATION' '
I hereby affirm under penalty of perjury that'l 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.
( ) .1 have and will maintain workers' compensation insurance, as required by
Section 3.700 of the Labor Code'for the performance of the work for which this
permit is issued. My workers' compensation insurance carrier` & policy no. are.
CarrierPolicy No.
�.,, r� r , rocs
1.
-994
(This section need not -be completed if the permit valuation is for $100.00 or less).:
(yc� I certify that in the performance of the work forwhich 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 shall forthwith comply with those provislon97—
Date: -' Applicant
Warning: 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 inspection purposes.
Signature (Owrer/Agent) V-1 Date 3.
PERMIT #
'BUILDING PERMIT 6.�
DATE �%�
}
�, VALUATION S137.04 J10 LOT 3� TRACT 91 .
JOB SITE
%1�-6A'.Il�l>Zl'11ft�t�s ���rtP.R�[ CO�I f' ,
APN 664-072-005ADDRESS
'
OWNER
CONTRACTOR / DESIGNER / ENGINEER
r
HIMY ��''yy 1
!, .i..%1.4�''V •4��.f�isV '
}},, ((�� ^�1 • 'j' A j'� }� er
FV•Y 11.1,.,!! i.11: iY i�11..�.C'1`l�S�'� �,;. .I.l�t�.+ :.
74-3-13 RWY1 11 �SE 103
74-333HWY IIii S71 101
PALM UL:SEXT CA 922151)
P.AIAvt DESEPT CA 9271(10'' .-
Gil,# 502,5
USE OF PERMIT
S.iA1OU .FA.NifL Y DWEj ,tai ;,
SP—D-LO i 36 PLAN 3F3 - P [I&WT DOES xVO.i• INU:UDE,BLOCftiWALU OR -
RP001..35%PLA14
P001.35% PL A14C1H) ;G.K .Ft::H Iii is oi3(:'9` t.'3N ON IVIU.. d ii U 1.15SUANCE OF ,
SAME PLAN 'ME
),1ZP1�..i \.�Ji'uJa),c.iiti..€AiJiV t,��.>i�i,�%` •
ti:Aki lea".i Jc,ilti3° )iZ`.i 13!}.t)I) 3
_ I
15'S ST. A i1:J.4. COST T 9 f.,
lspli eel'a FFE, SUMMARY,
C;-C� IS', RUCL;t'1(, 0 J7.1 101-000-418-000
>�r:,n tt► c'6�t C3z. I?1 1()1-000,430.31 t3
LILE:srt CALIF 101-000.42"00 $142.15
PLUA4131:t O FEE 101-0100-419-000 $161.75
..STRC1hTFi jyli)e'{'Gi FE &!,. R4�aIi9 i(!3 -%j )fh ti3-(Jf1Ci ^¢'j. , fSl
ORAD N0,, F011 101-000-423-000 V0.00
D.e VOQIIDPG� 111T.1k l FUR
A (' I.N.PUBLICPLACES - lttswi3;'101-000-255-000
$T.!B-)rrrAJ, CONST1tUC-1,' 0IN ANE) PLAN CHECK
V 'P0 9
a.ISS .['RE-PA18.�;FS
50.1
`fl"O4,r'9l.rPV�A ..! FEES ,DRJs N\7W
S3,376 91
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
t 'Z 00
Return Air
Steel
7, ^ m-00 (
Combustion Air
Roof Deck
00
Exhaust Fans
O.K. to Wrap
.-L!57..ft
F.A.U.
Framing
S - g- eDjo kp
Compressor
Insulation
s - to
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
y • .
Drywall - Int. Lath
Final �
Final z
BLOCKWALL APPROVALS
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
`
Underground Electric
Underground Plbg. Test
Final I
I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
-Z - t ( -Qp JJ
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
FuQures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm) (, • tZ. -s>a
COMMENTS:
VIiTESTERN INSULATION, IN•C e
4211 Latham Street, Rim. -side, 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, cOCATED AT:
TRACT ! PHASE: WILD FLOWER.-.- TRACT # 25691
LOT# 36
SITE ADDRESS: 79604 MORNING GLORY COURT.
EXTERIOR WALLS:
MANUFACTURER: Johns -Manville THICKNESS: 3 5/8" R -VALUE: R-13
CEI Lmci ; BATTS , BLOW -
MANUFACTURER: Johns -Manville THIrkNESS: 13" • R -VALUE: R-38 >
CEILINGS: : BATTS BLOW "
MANUFACTURER: Greenstone THICKNESS: 10.x° R -VALUE: R-38
-r'---------
GENERAL CONTRACTOR. WORC.D DEVELOPMENT
LICEN,SE-.NUMBER:'
BY:
TITLE: -
DATE: O o
INSULATION CONTRACTOR: WESTERN INSULATION, INC.
LICENSE +UMBER: 481278
BY: ,
TITLE: P ' ObUCT ON MANA
DATE Ma , 7.000 01
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epart�»ent t� t
This Certificate issued pur r '
suant,+to1,t'he•7requirements.of Section. 709 of the Uniform 'Building Code,
k x tiMS ti...
certifying that; at the thhe of issuenc_e,: this structure was-in c6 rip/iance,' with the various ordinances
of the City'regu/atingbui%ding cons#suction or use.-, For. the fo/%wing:
BUILDING ADDRESSt `79?.,04 MORNING :GLORY COURT
Use Classification: •SFD
►• Bldg. Permit No:.0001-195
P - T
Occupancy -Group: v ` � .
P Y: R=3/U-1: :ype of Construction': VN Land'Use Zone: RL
_ ' ' •Y 4 a?.,•FAR Ri � 3 ' ...
Owner of Building:` JIMDAN D ILO
C Address: •74-333 HWY 111 STE 103
City: PALM' DESERT, CA 92260
�• By: GREG FOX •
Date: 7-21-00
Building Official
4' J,�:POST IN A CONSPICUOUS' PLACE`