0101-039 (SFD)LICENSED CONTRACTOR DECLARATION ,.
I hereby affirm under penalty of perjury that I am licensed ufider 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-
Date r Signature of Contractor `;Z -
—err•�r 1s7
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury,thatll am exempt from the Contractor's
License Law for the following reason: / /
r
( ) I, as owner of the property, oi, y 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.
31FA) R KIND 1 S09393-"_
(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 sho 1d become
subject to the workers' compensation pro�,Aslons of Sectio�3700;of/t ie Labor
Code, I shall forthwith comply with those; w>-sions.
Date: Applicant^ ••"'�--^'`!•
Warning: Failure to secure Wo,a s' e Compensation„coverage is unlawful and
shall subject an employer t cr.pilnal penalties and civil fines up to $100,000, in
addition to the cost of com�nsatlon, damages�as provided for in Section 3706
of the Labor Code, intepst 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 th's City to enter upon
the above-mentioned property for i spectio.n purpo ;.s
s
Signature (Owner/Agent) ' � •'� --- Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT ()10r _0'k-4 TRACT
Z149,7145.20 IR 2 f�6 ?A
JOB SITE
APN
ADDRESS
OWNER
CONTRACTOR / DESIGNER / EN61NEEER
J.qq' ,� .InCYA� 10,
IYIM) L4OVdNJ, INC
•x4-333 RMAWAY 11 !, f3UME 103
74-333 HWY 313 ME, 103
IPW..A4 DESER7 CA 92260
PALM,3aL,1MIR A' (34. 92260
0160)568,2955 CITB1'.4tl 5028
USE OF PERMIT
DWELLING
SO-UliT , P1a4 4A, o k?;MiT ~On 1O .tNCt.,LiH WCYVdLfn,
.Z
P00b O.R. DR11."EWAY k.p3ACH. 15% CJAN PHIWK F&E REDUCTIONFOR
M1.11.`i'YPIZ ISSUANCE CE OF SAMP, PhA13 TYPP,�
TRACT CONSTRUCTION 2314.00 o1P
P0RCiYPATIO ?2.06 SIF
f i':`I.A.RAGM,FaRPORT I,?40.0
HS,” ,1'1M:6:d I ) CM OF C�'1.E�1'A"�°�'t.I."t�'1'[ON
1. ,71.6.20
�r '��j t, H�gvej Q p
MMARY
CC.i1'lS: TIUCTION M?t 101-000-4,18-000
PLAIN CHECK 1rliE 101-000-439-318 $ti'1.d4
MECHANICAL L WE 101-000-421.000 S98.50
111.. MRICAL "M 101-000.41,20.000 $134.07
P11WARN10 Me 101.100fi?4,1 X9.000 S 1'74, S0
S'YRDWO MT 1014 FE -Z -MID 101-00 0-24.1-000 1.000 a 1.4.97
13kaxwo rf&°' 101-000.423-010 $20.00
OP—MC)PER IMPACT F82
MLY1.33-'?VCA1., [rONSTRISM131CSN A�3'fiP:tv�g��JL�3�,1��7'�G�ly�7FC11f.
AM M9
S01100
IV&:C L MUM I'.F EN .V VY, NOW Y9
ililo-+,334-59
RECEIPT
DATE l
BY
DATE FINALED
INSPECTOR
'r e�
�:
NO
INSPECTION RECORD
K
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
K BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
f IZYd�
Ducts
Slab Grade
I?j/ (
Return Air
Steel
I?j( 70iw
Combustion Air
Roof Deck
11%A
Exhaust Fans
O.K. to Wrap3�
f � H
F.A.U.
Framing
3`-js+C
Compressor
Insulation
` a3-4 Its- (�F
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
��Z$ • L'
Drywall - Int. Lath
Final L: ,('lam'
Final
POOLS - SPAS
BLOCKWA
L Af` PROVALS
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
LL��D (;QFC
Electric Final
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
Sewer Lateral y �—
O.K. for Finish Plaster
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
Utility Notice (Perm)
s—
JUL-25-2001 15:18 WESTERN INSULATION 909 686 8786 P.09i11
WESTERN INSULATION, L.P.
4211 Latham Strcct, Riversldc, California 92501
Tel. (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 #29624
LOT #: 8
SITE ADDRESS: 79055 LADERA DR. LA QUINTA, CA
EXTERIOR WALLS:
MANUFACTURER: JOHNS MANVILLE THICKNESS: 3 5/8 " R -VALUE: 8-13
CEILINGS:
MANUFACTURER:
CEILINGS,
MANUFACTURER
BATTS
GREENSTONE
BATTS
JOHNS MANVILLE
THICKNESS: 10.3
10.3 "
BLOW
THICKNESS: 13 "
GENERAL CONTRACTOR: WORLD DEVELOPMENT, INC.
BY:
TITLE: r
DATE:
INSULATION CONTRACTOR: WESTERN INSULATION, L.P.
LICENSE NUMBER: 794484
BY:
TITLE: Phi TION MANAGER
DATE JULY 25, 2001
R•VALUE: R-38
R -VALUE: R-38