9908-069 (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
74W7 .- ��--/ i,it�li3
�p to .-,"/r 5, Signature of Contractor �c
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 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.
U 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:
Carver 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,',l shall forthwith comply with those provisions�/
Date:` a `IApplicant
=�
(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 inspectioryurposes.
,-�jgnature (Owner/Agent) Date
BUILDING PERMIT
PERMIT;,�
DATE awl"VALUATION a^ojgZ." LOT
TRACT 2180It9
JOB SITE
ADDRESS 76.245 �.°LADUA.D V All i'�� h
APN Y69-792-07
OWNER
CONTRACTOR / DESIGNER / ENGINEER
78- 1.20 CALLS. %.,yTt1DO, 17 i64
73-120 CMILY ), ES111ADi, U104
LA, Z;jtJIWrA CA 922S3
1.!lQUINTA CA 9212-53
USE OF PERMIT
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$139.5(3
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t..E�*.rS PRE PAIDFiTS
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RECEIPT
DATE
BY /�'
DATE FINALED
INSPECTOR
or
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Slab Grade
L
Ducts
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
(- Qrj'
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
b
POOLS - SPAS
BLOCKWAII'11
4POROVALS
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
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
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 ol
Utility Notice (Perm) 7i
I t
DEC -08-1999 1125 WESTERN INSULATION 909 686 8786 P.05i10
WE=STERN INSULATION, INC.,
4211 Latham street, Rlverdit, California 92501
(909) ago -Mo
(901696-8786 Ease
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: SEASON VILLA -PHASE III TRACT #:28019
LOT#:
SITE ADDRESS: C78-245_CLOUD VIEW 1NAY,`LA QUINTA, CA.
EXTERlQR WALLS:
MANUFACTURER: JOHNS -MANVILLE THICKNESS: 3 5/8 R -VALUE: R-13
CEILINGS : ATTS BLOW '
MANUFACTURER: JOHNS -MANVILLE THICKNESS: 13" R -VALUE: R-38
CEILINGS: BATTS BLOW
MANUFACTURER: GREENSTONE THICKNESS: 10.3" R -VALUE: R-38
FERAL CONTRACTOR:
LICENSE NUMBS
BY:
TITLE:
DATE: Z -!�;P 5'�C
WORLD DEVELOPMENT
INSULAT_I.ON CONTRACTOR_: WESTERN INSULATION, INC.
LICENSE NU BER: 481278
BY:
TITLE: Producildn M nager
DATE: DECEMBER 8, 1999
a
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
78-245 CLOUD VIEW WAY
Type of Construction: VN
Owner of Building: WORLD DEVELOPMENT, INC
Building Official
Address
City
By
Date
POST IN A CONSPICUOUS PLACE
Bldg. Permit No.: 9908-069
Land Use Zone: RL
78-120 CALLE ESTADO, #104
LA QUINTA, CA 92253
STEVE TRAXEL
12-16-99