0101-037 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
,.Q' apter 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 1�� 11
Date Signature of Contractor
OWNER -BUILDER
I hereby affirm under penalty of perjuryAhat' I am exempt from the Contractor's
License Law for the following reason:�V
( ) I, as owner of the property, or,rhy 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
Section3700 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.
STAI'3l VWD i da3'.7
(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 agreeAliat if I.AoL�,Id�ecome
subject to the workers' compensation provisions of,Sectio�3700•,of-the Labor
Code, I shall forthwith comply with those ,.F�rovi�ions. a,;,s i4e*
Date: Applicant
�r✓"µ •'
Warning: Failure to secure Workers'A ompensationebverage is unlawful and
shall subject an employer to crinins 'at 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.
L1'r•
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 representativ"e`s of,this City to enter upon
the above-mentioned property for inspection purpose;s/,.:`�`''
Signature (Owner/Agent "-•' - -"r'` Date
-
X
BUILDING PERMIT PERMIT#
DATE VALUATION LOT TRACT
2,QZ24
JOB SITE
APN
ADDRESS
79411325 LiNDE.%2.iA.
-6W0'71-(X)5
OWNER
CONTRACTOR / DESIGNER / EN (NEER
74ro3,33MONWAY 1. 11, S M'E 103
74-33310HY 3I3 MY, 393
�3!'� : 3 � :4`! R �' � ` 22+ri 3
k1.4d..34 DR--SER'i' �.: A, 922E+0
�1 i3a5F �2� 5 5028
USE OF PERMIT
.13.1,0T (� Pi.,A14 10, fid. • PE) .Fi@iT ):JOSS. Nf. T INIC'AA)?, KD(.,;C
W.dJLL% POOL,OR D.4ti'i►EWAY .Ai')bROMI L 15% P[.,AN C:Me K ITZ
f EDUC71014 .FOR. A+Y4Z`i'1f,`GZ' 19SO.f1NCi., OF W,km.pgp3 'X YPI.E.
TRACT OONA,TRUC)`ItM 111M.001 O,Y
POPIGHM.talo 52.00
l'6;n'4'°rOdA`f"EDQMfOle .'t%NiEMYCI.a.i?E1
F
��5d163920
MUMMY WIMMMMARY
PLIA14 � HIW11C ME 101-000-439-318 $6nm
MECHANICAL 091 101.000.4.213 -000
1tiO4.J0—V00
21LJfX', S'f0.t'4.A1, FZF 1,Fli"`dA
P5,.sv 10440 R4 101-Osx - 19.000 SII�.25
Olt d' DIMCI Mi 3 01-t O-423•000 t24.fdtl
DLVELOPER IMPACT F ER �a,�3fl7.00
�Rd+[�".�✓^hJ.^.0.'L�Y�,.�Jk�d nYaAiM.S,.I �4TiW.t�.9:�A,'JA[(.+.Y����+(i.��wv'1y��jyCir�:t(:&�i^.�gw�^S]i'r�']'f�"�'',
7W�,1 .�(�'+.
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daG�fiiki' :C-Ih�i~�i i"S%{W�.4.'d•�r/:d4i
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RECEIPT
DATE f
BYE
DATE FINALED
INSPECTOR
f, f'
INSPECTION RECORD
3 OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms& Footings
Slab Grade
Steel
Roof Deck
jc)
% e__.E,tC
,�cLl
Underground Ducts
Ducts
ReturnAir
Combustion Air
Exhaust Fans
O.K. to Wrap
�_
�'�
F.A.U.
Compressor
vents
Framing
Insulation $ ` Y
3i� ���-�(
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final ` 7
�L
BLOCKWR sL APPROVALS
Final
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
Waste Lines '-Ise
Gas Test
Electric Final
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
Sewer Lateral _ ��
Sewer Connection �
Gas Piping
O. K. for Finish Plaster
Pool Cover
Encapsulation
Gas Test
Appliances
1
Final
COMMENTS:
Final( ) ! ;/zov
UtilityNotice Gas
ELECTRICAII 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 �� ? 01�
Utility Notice (Perm)
JUL-25-2001, 15:18 WESTERN INSULATION 909 686 8786 P.07i11
WESTERN INSULATION, L.P.
4211 Latham Street, Riverslde, California 92501
Tel. (909) 686-8760 Fax (909) 686-8786
INSULATION C19RTIFICATE
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 # 6
SITE ADDRESS: 79035 LADERA DR. LA QUINTA, CA
-------------------------------------------------------------------
EXTERIOR WALLS:
MANUFACTURER: JOHNS MANVILLE THICKNESS: 3 5/8 " R -VALUE: R-13
CEILINGS:
MANUFACTURER:
CEILINGS1
MANUFACTURER:
BATTS
GREENSTONE
BAITS
JOHNS MANVILLE
BLOW ..-
THICKNESS: 10.3 "
BLOW
R -VALUE: R-38
THICKNESS: 13 " R -VALUE: R-38
GENERAL CONTRACTOR: WORLD DEVELOPMENT, INC,
BY:
TITLE:
DATE:
INSULATION CONTRACTOR: WESTERN INSULATION, L.P.
LICENSE NUMBER: 794484
BY:
TITLE: P CTION MANAGER
DATE JULY 25, 2001
0
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