0001-192 (SFD)LICENSED CONTRACTOR DECLARATION
I heron affir%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
Dater I Signature of Contractor J
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 e..•r
,�.f., a o •r.„.,„�= Policy No.
S 5th?3,
X0 ,� 1 93!
(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
;ode, I shall fgrthwith comply with those proaisionsl _�.'
/Date: A 1 ° 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
spection,purposes.
Si1� gnature (Owner/Agent) �J f• Date
PERMI
4-
BUILDING PERMIT l40)1 d1i,1
DATE � �' VALUATION SIV C-4' 2.W1l LOT 33 TRACT
E I)-$14GJ !�'ti3 1V�rVir taR.r�lt11 ll l Lit
APN liJ
:96 %i .1645
ADDRESS
ADDRE
OWNER
CONTRACTOR / DESIGNER / ENGINEER
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._'At.M IMISEICY CA 912641
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USE OF PERMIT
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�3,37i1.�1
i
RECEIPT
DATE
B
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Z - j - ' "
Ducts
Slab Grade
S7 -00 kv
Return Air
Steel
_ y
Combustion Air
Roof Deck
--X3-6:0
Exhaust Fans
CK to Wrap
-7-0-60
F.A.U.
Framing
_t5_-6
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
C_- it - co
Drywall - Int. Lath
Final
Final:
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
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
t - I r
Heater Final
Water Piping
Plumbing Final "
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
o L -@ 0
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final d?Jto
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) 4 •'-V .ao
COMMENTS:
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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.
Llcanse43.7 9Ic. Class Exp. Dafe,31%2W
Date 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.
( ) 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:
Camer STATE FUND Policy No. 1509393-99
(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
Code, I shall forthwith comply with those provisions.
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 Festrictions 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, Indemnity
& 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/Agent) Date
tLZ
BUILDIN91P70 PERMIT,p
UUU
SA2 5 2000 VALUATION LOT TRACT 25691
JOB SITE
ADDRESS
APN
OWNER
CONTRACTOR / DESIGNER / ENGINEER
JIM DAN D LLC
WORLD DEVELOPMENT, INC
74-3333 Ir* Y I I 1 S-17 103
74-333 IrWY I I I SU 103
PALM DESERT CA 92260
PALM DESERT CA 92260
(760)568-2955 CBL# 5028
USE OF PERMIT
SINGLE FAMILY DWELLING
POOL.75%PLAN CHECK FEE REDUCTION ON MULTIPLE ISSUANCE OF
SAME PLAN TYPE
TRACT CONSTRUCTION 2,230.00 SF
PORCH/PATIO 50.00 SF
GARAGE/CARPORT 780.00 SF
ESTIMATED COST OF CONSTRUCTION
137,042.00
PERMIT FEE SUMMARY
CONSTRUCTION FEE 101-000418-000 $772.50
PLAN CHECK FEE 101-000-439-318 $163.20
MECHANICAL FEE 101-000-421-000 $98.50
ELEC�1RiCAL FEE 1u1-WU-d "UU si4z.is
PLUMBING FEE 101-000419-000 5161.25
STRONG MOTION FEE - RESID 101400-241-000 $13.70
G RADMIG FEE 101-000-423-000 $20.00
DEVELOPER IMPACT FEE S1,907.00
ART IN PUBLIC PLACES - RESID 701-000-255-000 $92.61
SUB -TOTAL CONSTRUCTION AND PLAN CHECK
$3,370.91
LESS PRE -PAID FEES
$0.00
TOTAL PERMIT FEES DUE NOW
$3,370.91
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
SEP-20-2000 14:17 WESTERN INSULATION _;.+' 909 686-8786 P..12/12
rovN •
WSTERN INSULA'T'ION, INC.
4211 Letham BU=t, Riverside, CMINOrt" 92501
'tel. (909) 686.8760 Fax (909) 686-8766
INSULATION C TIFICA
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 PHAS : 26691 Phase 1
LOT # -,33
SITE A 78684 Moring Glory Court
La Qulnxa, CA
EXTERIOR WALLS:
MANUFACTURER: John Manville THICKNESS: 3 6/8" R-VALUE: R-13
CEILINGS- BATTS LOW 1
Greenstone THICKNESS: MANUFACTURER: ,3" R-VALUE: R-38
CEIL.INSS:ATTS - BLOW
MANUFACTURER: John le THICKNESS: 13" R-VALUE: R-38
GENERAL CO_ _ TRACICOR World Development
LICENSE NUMBER:
BY:
TITLE:
DATE:
1NSQj= CONTRACTOR: WESTERN INSULATION, INC.
LICE NUMBE - 481.278
OFFICE MANAGER
TE
Certificate of Occupancy
City of L.a Oyinta
Building.and Safety Dep'a.rtm-ent
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=664 MORNING. GLORY.000RT
. Use Classification: SFD Bldg. Permit No.: 0001-192
Occupancy. -Group R=3 Type. of Construction: VN 'Land Use- Zone: RL .
Owner of Building: JIM DAN D LLC Address:. 74-333 Highway 111 St. 103
City: Palm Desert, CA 92260
By: Greg Fox
l d Date: '10-26-2000
Building Official
POST IN A CONSPICUOUS PLACE