0001-194 (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
11`N;1�� 10 y
/ate 7 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).
( ) 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.
( �",Xhave 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 , ",.f. ,., ,; Policy No. Yr a �r ♦ rN.
A I. ATL a .,
_ aR_)
(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 pr6vlons of apgc ion 3700 of the Labor
Code, I shall forthwith comply with those Vouisions. L'
,,Date: /' f - ''"Applicant � _ „% �• i
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-igspection purposes.
S` ignature (Owner/Agent)- _ 1` �_- Date
BUILDING PERMIT PERMIT#
SISt1.1 1?J.E
DATE VALUATION t) LOT J+� 3 G TRACT
JOB SITE
ADDRESS d'! lf.C+i.i�iY�CS�1M �s�IAJYC3' l_VUjKLGDCY�3l7/14W,14Y
OWNER
CONTRACTOR / DESIGNER / ENGINEER
,ff�J!I&T
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y 1333 ;t i'�' x 3 I i ;�`I t: 10.4
.1 IW I I 1811103
VALM, tsls #;65°f (' � 42200
1 Af, 1 ial SI:1�+' i'A W20
f7�n'►�iyKd?qSi t°!it,>i :?t;+�3
USE OF PERMIT
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RECEIPT
DATE
I BY I T' p
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Z - 'Lz . Bp
Ducts
Slab Grade
'L - Z-'3-ruO i
Return Air
Steel
z - z -E- -w
Combustion Air
Roof Deck
_'C3 _gyp
Exhaust Fans
CK to Wrap
F.A.U.
Framing
1r- %-C%b
Compressor
Insulation
_mp
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
_ Z� .,�
Drywall - Int. Lath
1
MEE
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
-0Q
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
. Z t .jib
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.1.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm) co
i
SRN INSU_ TT . iNCs
4211 Latham strc-et, Riverside, California 92501 r^ y
Tel. (909) 686-8760 Fax (9091686-8786
WSULAT101T CERTIF'ICATE
A ,
STATE OF CALIFORNIA, IN THE BUILDING LOCATED AT:
TRACT / PHASE: x WILD FLOWER - TRACT #, 25691
LOT# 35 s r
SITE ADDRESS: 79624 MORNING GLORY COUR; .
-------------------------------.-------------.-r----'--•-------
EXTERIOR WALLS:
MANUFACTURER: Johns -M nville THICKNESS: 3 518 R -VALUE: R-13
.CEILINGS: BATTS BLOW
MANUFACTURER: Johns -Manville THICKNESS: --13" R -VALUE: R-38
CEILINGS: BATTS IBLO
MANUFACTURER: Greenstone THICKNESS: .10.3" R -VALUE: R-38
GENERAL CONTRACT®WORLD' DEVELOPMENT
LICENSE NUMBER 4
...TITLE: Y 1.1, &�l
DATE: . 2 O V —
F.
INSULATION CONTRACTOR: WESTERN INSULAT' 10N, INC. '
LICENSE NUMBER: 481278 -
TITLE:PR DUC ION MANAQt
'r DATE May 23, 2000
r
Ceupancy.
�Certii
Citvbf La uinta
Building and. $atety'DePaitihent. ��� �F
This Certificate issued pursuant, to- the requirements -of ;Se'd4i if409 of the'Uniform Building Code,
certifying that, at the time of issuance, this structure 'was *m coi»p/iar'ice with the various ordinances =
•+C(p .
of the City regulating building construction or use. For the f&11600@;
BUILDING ADDRESS:. } �' 79-624 MORNING,GLORY COURT,, `
Use Classification: SFD ,i ..
Bld§.-jPermit No.. 0001-194 >
Occupancy Group: R -3/U-1 _ type `of Construction: . VN. ; .".Lund Use Zone: RL
.. S • , _ v,
Owner of Building: JIM DAN D LLOC Address: , 74 333. HM "111 STE• 103 =a
r 'City ; PALM;DESERT,'CA 92260 it `;�
S .1� ' • , A• 'fib
By. 'GREG FOX
Date: 7.21-00
Building Official
14.
t°
i� POST IN A' CONSPICUOUS PLACE, ;'
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