9908-068 (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
743867 B Lu 0194
A `
Date , g Signature of Contractor-
OWNER-BUILDER
ontractor
OWNER-BUILDER DECLARATION
I hereby affirm under penalty of perjury that I'ani 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).
() 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.
(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 Firovision z* .
JD t _,L& •. `"(� Applicant
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. 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 ir>spection,purposes.
VSignature (Owner/Agent) `. ` i Date
BUILDING PERMIT PERMIT"0114)68
DATE osmi 1 "VALUATION �j��y� � LOT TRACTJOB
SITE
ADDRESS 78-2.�rLOW) �'Irlff.l� T4�'A1
0'
APN
7694102, 016
OWNER
CONTRACTOR / DESIGNER / ENGINEERT.
-gTIft; f77J11<i9';NP `� �?ne��
AXJ'��'rts '�
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78f 120 CYA UZ, %S ADO, f; I rM
7,84,20 i:ALL.E .F. TA130,1364
1,,A QUIWA, A, CA 91253
4A C;,4114TA CA 92223
CM -0 WIN
USE OF PERMIT
:yd+ .. LOTSJ, PLAN JiR" P&g1-%41T'AD0k_ i'�OT ZNEi1•`LTt. R ).00C �.H.0 Cj�
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c:it%,F�fi�H:•:I��.r1'N'i 1'i�1a.
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410RCi1/PATW,) 35..00 150
GikRAtiYF,li`:ARKJ_,tT 483-010 SF.
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trMART FEE SUM.T%trtiRY
CO2V; 1RUCTJ(0'N ,t,,hE J 01 •Gi(?tJ-4•:i 8 -ti ) 902,50
PLAN MrN FRI 4004P-31.8
7';l
W.C.1-11►T`dtCAL FE- ' srt 'CF - t"'1.400 � �•
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PC:USai.ItVc Fa,' 5133.50
KWAIJO N4070 ON F't~.F - RESUD 101.41n(041^0 $9,11
GRIND= I t�i•�!t)t1-42�' f� ��r�.of�
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�\`3.030
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' [FSS PRETP1111) FEESES
TOTAL PERAUT FEVS Yro; E NOW
�z,���..IZ
RECEIPT
DATE
BY
DATE FINALED
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 Farts
O.K. to Wrap
e _ 5'7,
F.A.U.
Framing
A0 . (i- _ Q S IF
Compressor
Insulation
• _ _ 9 X—C
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wail Firewall
Exterior Lath
Drywall - Int. Lath
d -2.4 - $
Final
Final
L7,1(4,1 XY I
POOLS - SPAS
BLOCKWALL
APPROVALS
steel
Set Hacks
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
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 S 7
Encapsulation
Gas Piping
Gas Test
(y
Appliances
Final
COMMENTS:
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) 2Zy
DEC -08-1999 11:25 UESTERN INSULATION 909 686 8786 P.04/10
WESTERN INSULATION, INC.
4211 UUm m Street, mwmide, CaUftrx& 92001
(909) 686.8740
(909) 484.8784 F=
INSULATION CERTIFICATE
THIS IS TO CERTIFY THAT INSULATION HAS SEEN INSTALLED IN CONFORMANCE WITH THE
CURRENT ENERGY REGULATION, CALIFORNIA ADMINISTRATIVE CODE, TITLE 24, STATE OF
CALIFORNIA, IN THE BUILDING LOCATED AT:
TRACT/ PHASE: SEASON VILLA -PHASE III TRACT #:28019
LOT#: 55� 1
SITE ADDRESS: r<_78-235 CLOUD VIEW WAY,_LA QUINTA, CA.
EXTERIOR WALLS:
MANUFACTURER: JOHNS -MANVILLE THICKNESS: 3 518
CEILINGS: BATTS BLOW
MANUFACTURER: JOHNS -MANVILLE THICKNESS: 13"
CEILINGS: ' BATTS BLOW
MANUFACTURER: GREENSTONE THICKNESS: 10.3"
GENERAL CONTRACTOR:
LICENSE N UMBE .
BY:
TITLE:e_
DATE: l ,2, S `Z T
WORLD DEVELOPMENT
R -VALUE: R-13
R -VALUE: R-38
R -VALUE: R-38
INSULATION CONTRACTOR: WESTERN INSULATION, INC.
LICENSE NU ER: 48 8
BY:
TITLE: rodu on ana e
DATE: DECEMBER 8, 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
78-235 CLOUD VIEW WAY
Bldg. Permit No.: 9908-068
Type of Construction: VN Land Use Zone:- RL
Owner of Building: WORLD DEVELOPMENT, INC.
Building Official
Address: 78-120 CALLE ESTADO, #104
City: LA QUINTA, CA 92253
. By: STEVE TRAXEL
Date: 12-16-99
POST IN A CONSPICUOUS PLACE