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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.
License # Lic. Class Exp. Date
72311-11 A r�
Date _'2 �`=�jSignature of Contractor �• �^._„�_. -
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that/l am exempt from the Contractor's
License Law for the following reason: /1
( ) 1, 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). c,
( ) 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 Policy No.
:�`CA'i"C.�`17tti,`iT '
(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 rovfisions.'`
Date: '"I // !? Applicant �`+�✓�-1 r-
Warning: Failure to secure Workers' Compensation Coverage is unlawful and
shall subject an employer to crlm nal penalties and civil'fines up to $100,000, in
addition to the cost of compen'sation, 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 �,4
inspZz
sees.
Signature (Owner/Agent) '��Date
BUILDING PERMIT PERMIT#
DATE VALUATIONLOT "02-055 TRACT
,�. • I lam• �+� $�7g,6s9.�o .50 1
JOB SITE t APN
ADDRESS !i1- 1 Ci.ili) ii � iEiY' i�v Y 7615- 92-01.1
OWNER CONTRACTOR/DESIGNER/ENGINEER
Jal DAN D, LLC WO"O D DEVELOPNIEN , WC
713-:120 CALLS ESTADO, 91.04 PO BOX 13287
LA QUINTA CA 92253 PALM DESERT CA 92255
(1n0}7-71-5571 CBL# -5025
USE OF PERMIT
LOT 50, 'PLAN 1A, SFD r''is WiT DOFS Nar iNCIuPJr ui.cK'*'.1i/ALL
OR POOL PLAN CHECK ME RFDUCFD 75^/8 FOR. ltiil'AMPL E, 13SUAN'CE
Or SAME PLAN TYPE.
'M C r CONSTRUCTION 1,287.00 SF
QAR.AG6fC..9.R.F>0Wf 456.00 SF
1,STt;1'IATED COST OIF CONSTRUC1':1OIV
P ERAITT VEE E SUMF MRN'
COMS” 1'13I;CTION FTI:'
101-000.413-{ir10
$549.50
%'II.=..M4 ("HECK PE9
101-000439.318
$115.92
MEaW41C.4.1-i-;,1}
101-0004214000
947.013
CLEG'1 ICAL FIEN ,
101-000-420-000
$102,67
PLUNI[BINO FEE
1014300•419-000
$133.50
STR(GNG MOT ION FEE - R981 0
101-000-241.000
$7.97
0412 _t DING. F118
1.01-000-123-000
$20-00
M- R.Ah"IRUCTURE FE
227'•1100-443-3:12
$t.7' v9
SUB-TVFAL CONIrMUC1' ON AND PLAN CHE",C ;.
USS Pit? -.Pc` ,1 D FEES
TOTAL PERMIT FEES DUE NOW
DATE I BY /,A I DATE FINALED I INSPECTOR
79,�i )9.50
S2,750.05
S0.(i/v'
82,7511.0:
INSPECTION RECORD
OPERATION
DATE
I INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backsaq
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
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 Pibg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Qi
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.1.
Smoke Detectors
Temp. Use of Power
Final — 2—T11.27,
Utility Notice (Perm) Q
COMMENTS:
APR -30-99 FRI 07:22 WESTERN INSULATION FAX NO, 9096868786
WESTERN INSULATION, INC.
4211 Latkam Street, Riverside, California 92501
1909) 6$6-8760
(809) 686-8786 ram
INSULATION CERTIFICATE
P. 07
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; THE SEASONS VILLAS TRACT #:28019
LOT#: 60
SITE ADDRESS: ",,78-185 CLOUD VIEW WAY,, LA QUINTA, CA
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EXTERIOR WALLS:
MANUFACTURER: JOHNS -MANVILLE THICKNESS: 3 5/8 R -VALUE: R-13
CEILINGS : BATTS BLOW
MANUFACTURER: GREENSTONE IND. THICKNESS: 10.3" R -VALUE: R-33
Where inaccessible for Blown Insulation: BATTS BLOW
MANUFACTURER: JOHNS -MANVILLE THICKNESS: 13" R -VALUE: R-38
GENERAL CONTRACT08 ,
LICENSE NUMBER:
$Y:
TITLE:
DATE:
WORLD DEVELOPMENT, INC.
INSULATION NT TOR: WESTERN INSULATION, INC.
LICENSE NUMBER: 481278
BY:
TITLE: 7rodUCtion Mane
.DATE: APRIL 30. 1999