0101-032 (SFD)i I 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.
License # Lic. Class Exp.,Date,
'74:3861 >
Date " Signature of Contractor
OWNER -BUILDER DECLARATIO
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:,,''�
( ) I, as owner of the propertya;or 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)..`.G'
() 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.
11T
pE TV SqUy (► y y
(This section need not be completed if the permit valuation is for $1,00.00 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 f,•,I� should become
subject to the workers' compensation pro4isu+ns of Sect4on 706 of the Labor
Code, I shall forthwith comply with th"•oos�e°Qrovldions!P -
Date: Applicant F A-
Warning: Failure to secure Workers9' Compensaii,6n coverage is unlawful and
shall subject an employer to qi final penalties aecivil fines up to $100,000, in
addition to the cost of compe6sation, damages as provided for in Section 3706
of the Labor Code, interest�and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to,_& shall, indemnify
,: • & hold harmless the City of La Quihta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 18C. days date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of�,thlp City to enter upon
the above-mentioned property for inspection purposes
Signature (Owner/Agent)' Date
�NILDING PERMIT PERMIT#
DATE VALUATION LOT '111 TRACT
iiD lt�AdF ('Tl 2 t < _41(I€e 1 2t7n 24
JOB SITE
APN
ADDRESS
V-070 LAVERA
OWNER
CONTRACTOR / DESIGNER / EN INEER
34.34:4 3'+ 1.11 WE '103
,?4. 333.1°'1WY I I I F1E,10.3
C?60)568.2955 MIX 15OU
USE OF PERMIT
LOT 1F vL.! N 11I SYD . PERM.1 P DO= 'NOT INCLUDE 81=9. •fld'AL
TkA T COOII`f'rR;UCTION OF
I �7kiC.lif +A IL1 ' K N't S
C`C3' f91?' ��b.1'e�`.I�AC'1'�{2��
.�.� t,E39�,t�
yy�fgyT�� .} �(?�q /�,� �.l3ei���'��•�'.
-
Pi,tf N Ok3f$XK FEE 1011.00c"1149-318 3kiomn
M.E.0WICA11FIRE 101-00 -421-000 $66.,50
`
VLECTRKIIAL I'ME 1 101-000-420-000 8110.91
101)) YRNG 1u 101-000-419-000 $14125
'as=0140'R!!i/,3`l' ON T'Zp • P -931D 101- DO.241-000 $12.71
GRAMM FFK T120AM
1' E111 .So PEP IMPACT nZ - �D,9tY1.11o?
Si1}3-WM CM"I .�,W01ION ARD In_fit' �'.x=
k$3,616.60
RECEIPT
DATEBY
6 (¢ jj
/"y a
D E AL O
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings.
Ducts
Slab Grade
�f'Q '
Return Air
Steel
Roof Deck
�
2 (��
Combustion Air
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
$��
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lathy
OSZTp 1 JC
(� 3 -2-
_
Final
Final
-Z- �_ _U (
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
Electric Final
Waste Lines
/_
J / J2) O( C�
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
Sewer Lateral
O.K. for Finish Plaster
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
1
Appliances
•
Final
COMMENTS:
Final
Utility Notice (Gas)
Dl�
ELECTRICAL O/PP�,OVALS
Temp. Power Pole
Underground Conduit
�1 J4a'L
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)
JUL-25-2001 15:17 WESTERN INSULATION 909 686 8786 P.02i11
WESTERN INSULA'TION9 L.P.
42 11 Latham Street, Riverside, 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 11: 1
SITE ADDRESS: ' 79070 LADERA DR. LA QUINTA, CA
------------•-----------------------------------------------------
EXTERIOR WALLAi
MANUFACTURER: JOHNS MANVILLE THICKNESS: 3 518 " R -VALUE: R-13
CEILINGS: BATTS BLOW
MANUFACTURER: GREENSTONE THICKNESS: 10.3 " R -VALUE: R-38
CEILINGS: BAT BLOW
MANUFACTURER: JOHNS MANVILLE THICKNESS: 13 "
GENERAL CONTRACTOR: WORLD DEVELOPMENT, INC.
BY:
TITLE:
DATE:
INSULATION CONTRACTOR: WESTERN INSULATION, L.P.
LICENSE NUMBER: 794484
BY:
TITLE: PR y TION MANAGER
DATE JULY 25, 2001
R -VALUE: R-38