0101-040 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury tha;.l 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's
s^9 v`O.l'D�i.IJ
Date Signature of Contractor
OWNER -BUILDER
I hereby affirm under penalty of perjuryJthat'I am exempt from the Contractor's
License Law for the following reason//`
( ) I, as owner of the property, o�%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 pFovided; 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 7UND IWP3_091
(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, 4�nd agree that if shpld;become
subject to the workers' compensation pro�`'�sions`of Secti .Ff3700 —the Labor
Code, I shall forthwith comply with those Pr visions.
Date: ADDlicant 1'2Ke1'--JJ
Warning: Failure to secure Wo`rkefs' Compensation, -coverage is unlawful and
shall subject an employer tofcrilnleinal penalties anAivil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, inter,e6i 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' -6f this City to enter upon
the above-mentioned property for inspection purposes>~
A. 9Ile
Signature (Owner/Agent) ¢ '"� �--Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 01,01-04D TRACT
JOB SITE
APN
ADDRESS 40 L ppDgg
0%4 0ryp=5
OWNER
CONTRACTOR / DESIGNER / ENGINEER
D FIPINRI MA LLC
'WOMID MVIM-OMEM SIC
/4-333 M011WAx "I 11, surn? 103
74••-333 HW°Y' I I 1 ME, I W
PJSiI4JK,DEXI!�� P CA 92260
1Pa/!I-✓AA.1e.l�,i�,21 CA 92260
(760)569-2955 C:B1,11 5028
,
USE OF PERMIT
SYD-LOT 9, Pl,"' 3A, PRRMIT DOES Nat =111M BLOCK NVALI.%
P001a Oft DktIeWAY APPR.CiACH, °�9S Y�Lt�1� t`'T�I4.G7? ��� FiLlii�I i'ti`Tte'�AI i<C3It
MU131KE ISSUANCE OF SAME k'I hN TYPE',
T'tL,AXT CONST 3R
J
GARAIMM:4`+4'3C:l;.RT (3F) 13g ' .Di1
/
h
S''lr ()It
'.sib `.►JVA[P3' Co
COND.3'Ai9CTION!+TF, 101-000-418-000 $'j' .50
PLAN C i,if,CK YX3 $163,60
143 �C1til�:Iv4].GA.3?I:E 101-000- r21-0010 542.3
3,ILW'TMCAL YEI; 101-000-420-000 $12!.15
P:I.°UAl1I'tMO;VE• 101.00041..94100 S162.30
STRONG .11401100, PRE, N RZSID 101-000-241-000 $13.91
0R,o-^•.f INa,MI 101-000.423.000 $20.00
1-)X '9Y,0PX''% IMPACT YZ �1,'�tP�.ttil
aST)IMMALCONiMMU ICOM -AM , ri
$3.,2't�A`'2.��1•1lf/F.t��
�C��u"��vvy�aArH [p.+,,�yyy` [��,gVpp•ppf(���
.I,td:.M�Ai .F"eG6G:/+.L"e?�M .C•JS�W
$0.00
`:%'0'1'.AL FERM ' FEE N �gUR 110W
12111-16
RECEIPT
DATE
DATE FINALED ;
INSPECTOR
'
1 JW
INSPECTION RECORD
OPERATION
DATE"
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
5' -
Set Backs
Underground Ducts
Forms& Footingsl/
_ (QC
Ducts
Slab Grade
Return Air
-
Steel
1 _� —
Combustion Air
Roof Deck
�1_t4
Exhaust Fans
O.K. to Wrap
Ce. 4—
F.A.U.
Framing
� +� � A
Compressor
Insulation
.3f t� r
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POO AS
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� lobes
Electric Final
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
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
_
F.I.
_
S
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
JUL-25-2001 15:18 WESTERN INSULATION
909 686 8786 P.10i11
WESTERN INSULA'T'ION, L.P.
4211 Latham Street. Riverside, C 9ifornia 92501
Tel. (909) 686.8760 Fox (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 # : 9
SITE ADDRESS: 79065 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 " Fl -VALUE: R-38
CEILINGS: c2f7721
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: P ION MANAGER
DATE JUK 25. 2001