0001-190 (SFD)iljly LICENSED CONTRACTOR DECLARATION
Thereby 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 # ' •' r Lic. Class, Exp. Date
i.7, a I. t2.C4
<j
Date" ! -r. 5~� c"L) 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 constructthe project (Sec. 7044, Business &' Professionals
Code). y.
() I am exempt under Section B&P.C. for this reason '
Date r " 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.
1411 1 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:
Cartier- c,.,. Policy No: •"' - ' r
(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 sous to become subject to the
workers' compensation laws of California, `and: agree that if I should become
sul)ject to the workers' compensation provisionslof •Section 3700 of the Labor
C6de, I shall forthwith comply with those provision
1kate: `^'Applicant— <' -t Via-"
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..) agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
thefabove-mentioned property for inspection purposes.
gnature (Owner/Agent) "� �- Date
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BUILDING PERMIT
PERMIT#
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DATE e VALUATION 59.24.12.49..80 LOT.
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APN 604-072405
ADDRESS
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PALM .DEIISE:R`C' CA 92260
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RECEIPT I DATE I BY/ 7%4: F- .-• -\ • DATE FINALED I INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms &FootingsDucts
Slab Grade
.t
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
L, �j9
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & 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
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
IQ .v
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
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
- sx
WESTERN INSULATION, 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# 31
SITE ADDRESS: 79704 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
k
MANUFACTURER: Greenstone THICKNESS: 10.3", R -VALUE: R-38
---------------------------------------------------------------
GENERAL CONTRACTOR: WORLD DEVELOPMENT
LICENSE NUMBER: T
BY:
TITLE: `
DATE: .
INSULATION CONTRACTOR: WESTERN INSULATION, INC.
LICENSE NUMBER: 481278
BY:
TITLE: ODUC ION MANAGE"'
DATE Ma ,,2000
Certificate of 'Occupancy �.
City OfLa Quinta
s
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: 79-704 MORNING GLORY COURT
Use Classification: SFD Bldg. Permit -No.: '0001-190
Occupancy Group: R-3 Type of Construction: V N Land Use Zone: R L
Owner of Building: JIM'DAN D LLC Address: 74-333 HWY 111 STE103
City: PALM DESERT, CA. 92260
By: KEVIN M. HIGGINS
o
Date: 06-30-00
Building Official
POST IN A CONSPICUOUS PLACE
I