9902-061 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm urljer 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
r43967 Q i`
DateK ;�� ; Signature of Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that'] 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). r
(.) 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
permii is.issued. My workers' compensation insurance carrier & policy no..are:
Carrier' Policy No.
S A'f A t'ND
(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 rovlsl ns.
PY P� ,P,,�
Date: •-'�(*Applicant— �/
Warning: Failure to secure Workers Compensation co era`ge is unlawful and
shall subject an employer to criminal penalties and civil ries up to $100,000, in
addition to the cost of compensation, damages as`proVided for in Section 3706
of the Labor Code, interest,-a'nd 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.
?.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 --q%
BUILDING PERMIT PERMIT#
DATE r J VALUATION LOT 99112-061 TRACT
A. r (17. C? (' $93=11.9.90 52 . 28019
JOB SITE
APN
r�
ADDRESS 78-205 .LOUD VONYWAY
749-792-013
01.3
OWNER
CONTRACTOR/DESIGNER/ENGINEER
rr+ 1 DANT 0 L I r
J►111 r N .laW
rilr�DyrD Bctt 'r f�[ 11.�'C'hP1'� TI IC
YY •✓.t !.'s Y aiL ,Y E,1tV !v
78420 CALLE F,9iADO3, 9 I
PO BOX 13287
LA VI.t1NTA Cil. 92253
PALtIM DGSEff CA 92255
(760)771-5571 CU4 5028
USE OF PERMIT
C AIC'f.0�. VA AAI(.' )�\tba.i.ttvl#
f.(i S2, PLAN 3A, St D - PERMIT DOES WC T' WCLil(5tW Ri,,OCK WAII
Olt POOL, :PLAN CHECK FEE REDUCf.Z0 `;'595 FOR MUL.T1`111.13 FSSUA14C'F
OF SAi\VF. PIAN TYPR
'P.12.ACC CON3YR(JCI'f0 N 1,532.00 V
PORCWP, T( 35,00 SF
(JARACYWC,ARPORT 413.M Sr.
M NIATIi,3) CONT O:Ii CC3NSITR€TCUOINT
PERIMT P+EESv:1KltIARY
C'OAis'i RUCT10.14 F.FIC 101-00"118-004 56 i M.50
SLAM C.HECK.Pi~t 10.1.000-435-318 IZ$,53
MECKANICAL FEW 101-000421-400 W.M
FEL.E6 rRICAL F;.hE 1(1}.-11011-420-000 $117.78
PLI] 03INCf FEF: 101-000.419-000 $133.50
STIWNO (\MOTION FEE - RESID 101-000-241-000 $9.31
O ADINO FF1 101-0m-,123-0(20 $,' 0,00
I NFRAVRUCTUR113 FEE 225-000-443-3421,5084.12
800-:Y_)TAJ_- COrlS1Rr ff'at ION AND PLAN CHECK
S3,! 59 Fla
W., , ry� 3�� 7 1 1" H ; 4
LW.,
-. 1.11;.7 .i.tV:�-' 111. r'L1Ai
4'11 PHI
dYw.V1J
TOTAL, P`KtZit[ri' FELS DUE 1YO%W
$3,1.59.84
GY'
V,
1
RE� IP
/i
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
5
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
—/O --TT
Exhaust Fans
O.K to Wrap
—(L—
F.A.U.
Framing 3 /
23
Compressor
Insulation
Vents
Fireplace P.L.
Griffis
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final [o
BLOCKWALL P OVALS
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
4
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
—9,
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 — 5
Utility Notice (Perm) / ri
COMMENTS:
APR -30-99 FRI 07:23 WESTERN INSULATION FAX NO 9096868786
WES'T'ERN INSiTLATION t INC.
4211 Latham 8traet, Riverside, 04fornla 92501
(909) 6"-8760
(909) 686-9786 Pas
INSULATION CERTIFICATE
P. 09
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#: L52
SITE ADDRESS: 78-205 CLOUD VIEW WAY, LA QUINTA, CA
----------------------------------------
EXTERIOR WALLS:
MANUFACTURER: JOHNS -MANVILLE THICKNESS: 3 5/8 " R -VALUE: R-13
CEILINGS : BATTSBLOW
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 CONTRACT
LICENSE NUMBER:
BY:
TITLE;
DATE: 4r�6
WORLD DEVELOPMENT, INC.
INSULATION CONTRACTOR: WESTERN INSULATION, INC.
LICENSE NUMBER: 4$1278
BY: 1
QL� lhvlvr��
-TITLE: Production M ager _
DATE: APRIL 30, 1999
Certificate of Occupancy
City of La Quinta
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:
Use Classification: SFD
Occupancy Group: R 3
78-205 CLOUD VIEW WAY
Bldg. Permit No.: 9902-061
Type of Construction: VN Land Use Zone: RL
Owner of Building: JIM DAN D, LLC
Building Official
Address: 78-120 CALLE ESTADO #104
City: LA QU1NTA, CA 92253
By: STEVE TRAXEL
Date: 10-12-99
POST IN A CONSPICUOUS PLACE