0101-036 (SFD)LICENSED CONTRACTOR DECLARATION
1 -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.....-.....,
74,3867 B
Date Signature of Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjulyth fl 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.
( ) 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.
OTATE MUD 1500793-99
(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 agreefthat if I shoul6,,U o'me
subject to the workers' com ensation , rdZi ions of Section 3700 d(I'he Labor
Code, I shall forthwith comply with those,prinov sions.
Date: Applicant .X!' -Z;4 J'
Warning: Failure to secure w rk&s' Compensation cove`rege is unlawful and
shall subject an employer-t'�orr urinal penalties and civil fines up to $100,000, in
addition to the cost of corr"ipensation, 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 ilii t.City9'o`e ter upon
the above-mentioned property for>.I spec ion purposes! /j✓,
le
Signature (Owner/Agent)' J ��''ate
BUILDING PERMIT PERMT#
DATE VALUATION LOT TRACT
91 296 i'441
JQB SITE
APN
;ADDRESS r9-00 LNDERA,
OWNER
CONTRACTOR / DESIGNER / EN (NEER
1)1F PA%CK'ERN 3 WI
-w-oval)
74-333 1204Wli:f l 11, tRITY17 10.4
74-31.43 HI WY ? 11 UrE 1 W13
M:.M1 IA' i CA 92260
PALM, DXESI .'+ T CIA 92260
�;65f1�5r1� •2 5:1 { 3i S' 5028
USE OF PERMIT
SAMLE
337D-Y_'.•t• ! MKO ;RA, wo . Y`umn w..ui Nar .irim+al , s.,we . r
WALLS, POOL 0RDR1VKe'%VAY APPROACH.
PCMI HIP.ATIG 52.00.00.
0sM.R AMYC.AAZPORT (01) MI
,V
ti
P'L.Ail C'fIW9 M:.M 101-00 0.439-«418 U101.?7
MECIf-ANIu..atil. PEE, 101-000-421-000 $6,0100
I IJ,rz` TRI.€~'A. Tyr 101_000-42e1•1000 VAL14,39
PLUMBING Fra 101 -000 -419 -OW $t 0.1'4
S!'Pf:Y 10 NCYT1014 MB XESID 101-10,00-a4'i-000 $I.x tifi
�11��a1'� Ik�t� 1� i �I �D��i�? �d•��t� $,�r�.4tt
PJrilut?��t!.a}�1i.34IMPACT 3?x:'E �1,9t4'3.Gf3
It�f.e`�e� FIM -PAID S`TM3
x$0100
TUM, r"—wrFIRIENIS DVE NOW
RECEIPT
DATEj
BY
DE FINALED
AT
INSPECTOR
1. 111
. �( t�
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
�/ Zy �tr�%�
Underground Ducts
Forms & Footings,
Ducts
Slab Grade/
Return Air
Steel
Combustion Air
Roof Deck
f7ftzsic
Exhaust Fans
O.K. to Wrap
X23 ($��
F.A.U.
Framing
31 �� ��l�
Compressor
Insulation
oJlll�yz
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior lath
�
•
Drywall - Int. Lath
3�
_
Final
Final
!
POOLS - SPAS
BLOCKWA S.L
APPROVALS
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
Sewer Lateral
/gyp
O.K. for Finish Plaster
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas) �6//
ELECTRICAL
APPROVAL
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
SI �C
Final.
Utility Notice (Perm)
JUL-25-2001 15:18 WESTERN INSULATION 909 686 8786 P.06i11
WESTERN INSULATION, L.P.
4211 Lathrw► Street, Rivrrside, California 92501
Tel. (909) 686.8760 Fax (9091686-8786
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: DESERT FLOWER #29624
LOT # : 5
SITE ADDRESS: 79030 LADERA DR. LA QUINTA, CA
EXTERIOR WALLS:
MANUFACTURER: JOHNS MANVILLE THICKNESS: 3 5/6 " R -VALUE: R-13
CEILINGS: BATTS BLOW —
MANUFACTURER: GREENSTONE THICKNESS: 10.3 R -VALUE: R-38
CEILINGS: BATTS BLOW
MANUFACTURER: JOHNS MANVILLE THICKNESS: 13 "
GENERAL CONTRACTOR: WORLD DEVELOPMENT, INC.
BY:
TITLE:
DATE:
INSULATION CONTRACTOR: WESTERN INSULATION, L.P.
LICENSE NUMBER: 794484
01
BY:
TITLE: P D TION MANAGER
DATE JUL 25, 2001
R -VALUE: R-36