0001-184 (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
-74380
Z. Si natuie of Contractor
OWNER -BUILDER DECLARATION i
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). '
(.) 1, as owner of ,the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code). - e t ,^, '
O I am exempt under Section B&P.C. for this reason
Date Signature of Owner'
WORKER'S COMPENSATION DECLARATION,
I hereby affirm under penaltyof•perjury one of the following declarations:
() I have and will maintain a certificate of consent to. self -insure for workers'
compensation, as provided fog by Section 3700'of the Labor Code, for the
performance of the work for which this permit is issued.
(Q)il 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 .'1'.AI'l PUN t Policy No ` .i 509:393-`99
(This section need not be comple'ted.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-Seection•3700 of the Labor
Code, I shall forthwith comply with',those prov_isionis,,,,Z
116ate: • - ( .. uy Applicant
Warning: Failure tc secure Workers' Compensation, coverage is unlawful and
shall subject ari employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation; damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees:
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will`"subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
\Signature (Owner/Agent) ° Date s �'
.
/- - BUILDING PERMIT PERMIe;i►f,�
DATE //J,< oU'VALUATION '��'�eJJ,rf�' LOT TRACT
JOB SITE S• -ti -97 MORN:QA'ti G GX.1'C R1 C1OU,t: i
ADDRESS
APN RM -072,005 �
OWNER
CONTRACT1OR /DESIGNER/ E�NiGIIN{�EER •'
CONTRACTOR
ID``
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1+i,3��3'�i•'W 'iii. ST 103
'i�13iiHt�i'tIiS:i'G;03
PALM 1ANEK`!• CA 92260
i A..IM DESl Err CA 9'2260
f ?tit)15cyi$-2955 CBLA 5028.'
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USE OF PERMIT
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.A.KT fN P(JUM PLACES-12t:'StC 701-000-255-000 $127.23
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$0.00 '
''xTaTA*PE3M1`.i"FiIJk;S'DUE NOW
RECEIPT
DATE
BY �
DATE FINAL ED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
3 t S-0
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
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 I
I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
2 -' % —
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
.20""
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
, e Q. 06
Appliances
Final
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 U14
Utility Notice (Perm)
COMMENTS:
,t
WESTERN INSULATION2 INC.
4211 Latham Street, 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: WILD FLOWER - TRACT # 25691
LOT# 25
SITE ADDRESS: 79687 MORNING GLORY COURT.
-----------------------------------------------------------------------
EXTERIOR. WALLS:,
MANUFACTURER:. Johns=Manville THICKNESS: 3 5/8" R-VALUE: R-13
CEILINGS: BATTS BLOW
MANUFACTURER: Johns-Manville THICKNESS: 13'' R-VALUE: .R-38
CEILINGS:. BATTS BLOW
MANUFACTURER: Greenstone THICKNESS: .10.3" R-VALUE: R-38
GENERAL CONTRACTOR: WORLD bEVELOPMENT
LICENSE NUMBER:
BY: -
TITLE:
DATE:
INSULATION CONTRACTOR: WESTERN INSULATION,, INC..,
LICENSE NUMBER: 481278
BY:
TITLE: P ODUC ION MANAGEFQ
DATE May 23, 2000
Certifica to . of Occu anc
R.A
• o obi
City, of La'. Quinta
Building.a'
nd Safety Department �,�oE.ti° y
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=687 MORNING GLORY COURT
Use Classification: SFD Bldg. Permit No.: 0001-184
Occupancy Group: R-3. Type of Construction: VN Land -Use Zone: RL-
Owner of Building: JIM DAN D LLC Address: 74-333 HWY 111 STE 103
' City: PALM DESERT, CA. 92260
By: KEVIN M.: HIGGINS
Date: 6-1-00
Building Official
POST IN A CONSPICUOUS PLACE