0101-035 (SFD)LICENSED CONTRACTOR DECLARATION
•:l 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'" i
74R'3867
Date Signature of Contractor
OWNER-BUILDER,DECLAFATION
I hereby affirm under penalty of perju�'Y` at I am exempt from the Contractor's
License Law for the following reason:
( ) I, as owner of the property; r 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.
STATE FUND 15 (0301.711%
(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 Californiao and agree" that i I should become
subject to the workers' compensationfvisions of Sectiop-3700 of the Labor
Code, I shall forthwith comply with thos provisions. r
Date: Applicant _4 r
Warning: Failure to secure -, C6Fi ensator coverage is unlawful and
shall subject an employeryto eflminal 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 & eacfi�'peraon 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§ of this City to enter upon
the above-mentioned property for iinspectiori purpos
Signature (Owner/Agent) '✓>•� jr� -° Date
BUILDING PERMIT PERMIT#
DATE/ ` VALUATION LOT /�}� j�,.1XQk''S TRACT
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JOB SITE
ADDRESS
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4�f1 -H37
OWNER
CONTRACTOR/ EN IINNEEER
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PALM DF.-S"Lk.T C A. 92260
PALS. D3:`ISSRT 01A 92260
.1028
USE OF PERMIT
SFI).JW' .4, MAN 4KA, SIM. v ii)MlI'! LaGM T,+J07114 C;i. U D9.8 LDCK
WAWA P001, CJS 1.' RIVEWAY A!'P11CIM-11. `74%PL A1.14 OaCK ME
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TRACT CONOTRUCTION
TORMPATiO 72.00 sy
IL��Yr OF COMMU ^FON
149,716,20
yy_Yyy ,�pgw3 ,V� �y �p ,p ,� gY�,.:�"�'1�Ilt�',F,:.'L�
R St -J AVXL4. YJ,CB� tAV.L'C.ILY9'.Pl�:t f.F.L 4
'
C'OMIT'Y UCTION FIM 101 -000-418-000 $314,50
PLIMi CHECK MIE 101-000-4.39--34$ $171.44
MECHANICAL1:+ eX 101.000-421.000 M.50
KIAU17(law ;A.1..:$'RE $1'r+lW
PL:U.idtllvY,41111a biF3�glyfR4?/Ot�ag�la3+nl�tOt(a3 $174,30
m�;;k �1�ev chtr�
'".�,�i.�'3i�vM' M+�.%i�1�r.N .�'2�,Y, IZ.�n�7.F.D 1.\I.8"'i?bJ#d'l..A�✓l ^000 Sm.."
MAP, Wo FES 103;«000425.000 �tOt�iGi
DWIiL,>±?'1>L?]'i!.IMPA&T FER $1,907.00
MOB- �J"fir M& C';0NITMUCT10.M.AND PLAN ''C'
TUFAL MMYT I" 6, .JYVE NOW
RECEIPT
DATE r
BY
r
DATE FINALED
INSPECTOR
i
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
(q �•-�
Underground Ducts
Forms & Footings
I
Ducts
Slab Grade
r(
Return Air
!�f
Steel
�'
Combustion Air
Roof Deck
��_ �F�+�
Exhaust Fans
O.K. to Wrap
Z\2�
F.A.U.
Framing
3!) Z e _DA`2 -
Compressor
insulation
3r l ��--�{
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wail Insulation
Condensate Lines
Party Wail Firewall
Exterior Lath
Drywall - Int. Lath
_
Final
Final
POOLS - SPAS
BLOCKWALL 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
Waste Lines
1 f �o f rffltW'C
Electric Final
Heater Final
Water Piping
/
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
, 1 %`
Pool Cover
Sewer Connection/'yam
���
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final 7 �%��—/
Utility Notice (Gas)
/ 6
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
UtilityNotice (Perm)
JUL-25-2001 15:17 WESTERN INSULATION 909 686 8786 P.05i11
WESTERN INSULATION, L.P.
4211 Latham Street, Rlvcrside. Cal fornin 925()l
Tei. (909) 686-8760 FaX (909) 686-8786
INSULATION CERTIFICATE
GENERAL CONTRACTOR: WORLD DEVELOPMENT, INC.
BY:
TITLE:
DATE:
INSULATION CONTRACTOR: WESTERN INSULATION, L.P.
LICENSE NUMBER: 794484
BY:
TITLE: Pja&,VtTION MANAGER
DATE JULY 25, 2001
n
INSULATION HAS BEEN INSTALLED IN CONFORMANCE WITH
THIS IS TO CERTIFY THAT
THE CURRENT ENERGY
REGULATION, CALIFORNIA ADMINISTRATIVE CODE, TITLE 24,
STATE OF CALIFORNIA, IN THE.BUILDING LOCATED AT:
TRACT / PHASE:
DESERT FLOWER #29624
LOT #:
SITE ADDRESS:
4
79040 LADERA DR. LA QUINTA, CA
----------------------------------------------------
EXTERIOR WALLS:
MANUFACTURER:
JOHNS MANVILLE THICKNESS: 3 5/8 " R -VALUE: R-13
CEILINGS:
BATTS -BLOW
MANUFACTURER:
GREENSTONE THICKNESS: 10.3 " R -VALUE: 8-38
CEILINGS:
�BATTS BLOW
MANUFACTURER:
JOHNS MANVILLE 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: Pja&,VtTION MANAGER
DATE JULY 25, 2001
n