0101-034 (SFD)t�. 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.
M License # Lic. Class r Exp.,Date r
74.18611 16:1 B
Date Signature of Conti
OWN ER-BUI LDERJECLARATION
I hereby affirm under penalty of perjuryy tKat I am exempt from the Contractor's
License Law for the following reason;/
( ) I, as owner of the property%o,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 ]UNT) 1,50' 0349
(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,,end agree that if I shouldr become
subject to the workers' compensation provisions of Section 3700 of�e(Labor
Code, I shall forthwith comply with those,�rovisions. � ✓
Date: Applicant ''-�-• ��—'`�� �'�
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer ttosc liminal 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 law`s`lelating to the building
construction, and hereby authorize.Lp*presentatives„of-thi City to enter upon
f''���
the above-mentioned property for-inspectionr purp.oses..,
Signature (Owner/Agent) 4N ^ Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT TRACT
JOB SITE
ADDRESS 'JyAYMRA
:]�NEER
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OWNER
CONTRACTOR/ GNER/Wp'.
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PALM :t`7, 3[:+SRU CA '2� 6,0
PALM ani D k'_�` Wf CA 922, 00
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USE OF PERMIT
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CONSTRUCTION FEB 101 _000 418_001 q Mso
P11AN 101 -000-419-318 $6m.Y9
MisC1 i`�'t11C FYF? 101-000-421-000 'M.30
9.1,803VIC L 101-000-420-000 $127.15
P11,13M1111P O FUte `101-000.419.000 1ti2.It0
uSy�(('yyECgOeeAy����pp9,tgMl�(1J7u,ION FX2 i TIiIS11) 101-000-241-000 $2.1.191
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RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
F INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings,
Slab Grade
Steel(IF
Roof Deck1
/ 1�3 <
23
"%-
C'�`
l.[_�
Ducts
Retum Air
Combustion Air
Exhaust Fans
0. K. to Wrap
F.A.U.
Framing
1t
C�r��b�
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wali Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
.135
Drywall - Int. Lath
.51-/ y
I��" z
_ —
Final �.
BLOCKWt.L.L /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
Gas Test
Electric Final
Waste Lines
r,'�p
_
�►�
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
Sewer Lateral
Sewer Connection
c�
O.K. for Finish Plaster
Pool Cover
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 t<
Final
Utility Notice (Perm)
JUL-25-2001 15:17 WESTERN INSULATION 909 686 8766 P.04i11
WESTERN INSULATION, L.P.
4211 Latham street, Rivcrside, California 92501
'fel. (909) 686-8760 Fax (909) 686-8786
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 1129624
LOT #,: 3
SITE ADDRESS: 79050 LADERA DR. LA QUINTA, CA
EXTERIOR WALLS:
MANUFACTURER: JOHNS MANVILLE THICKNESS: 3 5/8 " R -VALUE: R-13
CEILINGS*
MANUFACTURER:
CEILINGS:
MANUFACTURER:
BATTS (::::BLOW
GREENSTONE THICKNESS: 10.3 " R -VALUE: R-38
BATTS BLOW
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: !! CTION MANAGER
DATE JULY 25, 2001
�t
.tea ,F—
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: SINGLE FAMILY DWELLING
Occupancy Group: R-3 Type of Construction
Owner of Building: DF PARTNERS LLC
-r.--u, A-%
Building Official
79-050 LADERA
vIU
Bldg. Permit No.: 0101-034
Land Use Zone: RL
Address: 74-333 HIGHWAY 111,SUITE 103
City: PALM DESSERT,CA 92260
By: GARY HARTMAN
Date: 6-30-01
POST IN A CONSPICUOUS PLACE