9902-060 (SFD)LICENSED CONTRACTOR DECLARATION
PERMIT# "
1d
I hereby•affirm under penalty of perjury that I am licensed under provisions of
BUILDING PERMIT j
-
Chapter 9 (commencing with Section 7000) of Division 3 *of the Business and
DATE VALUATION LOT "Ole TRACT
W^
Professionals Code, and my License is in full force and effect.
m) ch
License # Lic. Class Exp. Date
SOB SITE
APN
LU i
i. 7 i3
'?
ADDRESS
78-195 UOUD VIEW WAS'
769.792.012
OWNER
CONTRACTOR / DESIGNER / ENGINEER
r_. r`
Z r`
/ = �
Dater-, - Signature of Contractor—
C:) 0 r.-
o
DECLARATION
rr>, r n *r r: r t
I—•
J-/ 1 �
W W
OWNER-BUILDER
I hereby I f m the Contractor's
n 1�
Jll�l "^A% VI LL.�
i1tY1t�Y r1 +tir.T�r nn►aa>,rT n rr�
t'�".,,/►\4V ,V li Ali liVl il'IL.aV 1, llv4
` ~
affirm under penalty of perjury,that am exempt
;8.1 �� Cf11.I,% 1r5iAC1r), i 0d
Pig f9r lX 132$1
N
License Law for the following reason:'
LA QUINTA CA 92253
PALM DESERT CA 92255
Z
( ) 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
'�l-?5?! t'l3I,iI 5028
USE OF PERMIT
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
V mr!l 4: VA 111x! V #)%0411 1 111412
Code).
�
() I am exempt under Section , B&P.C. for this reason
f r77 Sl. PLAN 2AR, SFC) - PERMIT LXXV3 Nr. 1T INCLUllE E3Lrx_1K WALL
N
0N
Date Signature of Owner
OR POOL. PLAN CHECK FEL; REIAXTI) 75°. R'f
FOR ULTIPI.E ISSUANCEi
0,
d Z
WORKER'S COMPENSATION DECLARATION
OF SA14i1't PLAN TYPE
O (r
I hereby affirm under penalty of perjury one of the following declarations:
H0
() 1 have and will maintain a certificate of consent to self-insure for workers'
X w U-
compensation, as provided for by Section 3700 of the Labor Code, for the
CRAC"1 CtiNS1'KI►CTi(1N 11,403,00 SF
O J Q
C3 4
performance Of the work for which this permit is issued.
K)RCIIIT'ATIO i84 W V.
U
( ) I have and will maintain workers' compensation insurance, as required by
GARAGOCARPORT •193.00 SF
0 U QSection
3700 of the Labor Code, for the performance of the work for which this
insurance &
it LO H
Z
permit is issued. My workers' compensation carrier policy no. are:
11*
aol �
Carrier Policy No.
0
STATE 1•zrW)
FX 11M AT ED COST OF CONST RUCTION
88.292.90
(This section need not be completed if the permit valuation Is for $100.00 or less).
PERMIT FEE SUMMARY
( ) I certify that in the performance of the work for which this permit is issued,
CONS37RUCTION RE 101-000-11181100 5590.00
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
PLRN C'MCK F11 101-000-139-318 KN f13
subject to the workers' compensation provi'sions of Section 3700 of theaLabor
Code, I,shall forthwith comply with rovlsl s.
�
MECHAN(CAL FES 101-000-421-WO $53.50
4'1:
�
>Date:« Applit
ERCAL Fii -000-20[l0
ithiosae
. "
=.n`—�`
Warning: Failure to secure Workersf Compensation co rage is unlawful and
PLUNfBINO FEE 101-000-419-000 51;9.51
'PION
shall subject an employer to criminal penalties and civil fines up to $100,000, in
STRONG si( FEE - RES(D 101-040-2,11-000 58.433
GRADING FEE, 101-1X10-42__-3 C" S?t).t10
addition to the cost of compensation, damages as provided for in Section 3706
4uof
the Labor Code, interest and attorney's fees.
INFRA.`i'CRtJ0'URH FEES 225-000443-312 S.J��rZI.53
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
�I -1UTAL CONSTRU(. HON AND PLAN CHECK
& 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
LESS PRE-PAID FFE.-,
$0-00
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.
`NOTAL PERMIT 1' EF.S DUE NOW
$2.981.45
1 certify that I have read this application and state that the above information is
U
'
correct. I agree to comply with all City, and State laws relating to the building
r\
construction, and hereby authorize representatives of this City to enter upon
! 1 l
!
the above-mentioned property for-inspection purpose
�C IP
DATE
BY / J r
DATE FINALED
INSPECTOR
Jf�� Date =�
t
Signature (Owner/Agent)
t
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
_g —
Exhaust Fans
O.K. to Wrap
— —
F.A.U.
Framing
Q
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
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Z r(,�
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 APIPROVALS
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
rFinal ;
-Utility Notice (Perm) .
COMMENTS:
APR -30-99 FRI 07:23 WESTERN INSULATION FAX NO. 9096868786
WESTERN INSULATION, INC.
4211 Latham Street, Riverside, Californim 92501
(909) 686-8760
19091686-9786 Fax
IN ULATI(I CSF TIFICATE
P. 08
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#: ; 51
SITE ADDRESS: r78-195 CLOUD VIEW WAY, LA QUINTA, CA
-----------------------------------------------------------------------
EXTERIOR WAL_LS:
MANUFACTURER: JOHNS -MANVILLE THICKNESS: 3 5/8 " R -VALUE: R-13
CEILINGS � BATTS BLOW
MANUFACTURER: GREENSTONE IND. THICKNESS: 10.3" R -VALUE: R-38
Where inaccessible for Blown insulation: BATTS BLOW
'MANUFACTURER: JOHNS -MANVILLE THICKNESS: 13" R -VALUE: R-38
-------------------------------------------------------------------------
GENERAL CONTRACTOR:
LICENQF nit innRGR.
BY:
TITLE:
DATE:
WORLD DEVELOPMENT, INC.
INSULATIONC-ONTRACTOR: WESTERN INSULATION, INC.
LICENSE NUMBER: 481278
BY. CQ1L,
TITLE: Pro ctionMager
.DATE: APRIL 30, 1999