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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 of the Business and
Professionals Code, and my License is in full force and effect.
License # p Lic. Class < Exp. Dated py/
Date Signature of Contractor
OWNER -BUILDER DECLARATION
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 property, 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 �$1 Professionals
Code). ✓
r%o
( ) I am exempt under Section y,B�&P. fQrth;reas. n
Date ✓),A nature
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. 'e
( ) 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. 1 J.3.09393-90
STATZ FUND'
(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,
kshall not employ any person io any manner so as to become subject to the
workers' compensation laws of California; and agree that if I should become
subject to the workers' compensation,provisions�of ection 3700 of the Labor
Code, I hall forthwith comply with these pro Tslons.a
Date: 5 � � & Applicant >'+� _
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
.work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize replesentatives of this City to enter upon
the above-mentioned property "r inspection purposes.
f �
Signature (Owner/Agent) i Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 014 TRACT
4 29623
JOB SITE
APN
ADDRESS
OWNER
CONTRACTOR/DESIGNER/EN INEER
'7`4.333 14WY 11 Z ME 1 03
74-333 HWY l 3 3 ME' 105
PA::.MDIP;SIE T CA 92260
PALM DESERT CA 92260
C160)568.2955 MA 5026
USE OF PERMIT
r
Sir2) - LOT 4, P$..AN 3A, PS 1 Y. DOESNOT ANCg::1,l.iii+: H LOClk6.
ViAl.,t MOUAPPRtJACH d)IUVE1A AY W—A PP�.t, H C HRCK IBEX REDUCTION a
-
Wk ISW1 .Nl ICF, 010 aF+ME P;I.AN TYPF—
TTdi�,. T CONSTRUCTION �3AUD SF �;����"a�
PORCHIECJ$ T1C3 4' � _" `.
GARAGUC )OAT tZTA, 'AM65.0 .i f.
F7t'.fi",TJ C3� CD2* cAld"`RIdC`4?F 149,716.20 <
AQTZEN S ummamy
CON•0Tit 'UC1`1ON fT12 10.1.000-418-000 $3.14.$3
�
Pf r C`I` WIrl FRE 101-000-439-318 �!70.3Te
: � t; iAaMC.Ala t��:E-. 1 C� D �Q3(3pRR? 1-Ot1i1
iayy M�.P�^ yy9922ttrr !!ee tln LL�� Qd9ltl�,§4
1.i:*�..'iRM'A' L 07 IV t'^il{pY.L6Y�i/t)4� $1341,06
1'LUMBYHO FEE 101 -M -419 -OW ,.. $163,75,
S'lTRONO MarION Fes,? - 311 ID 1.01-000-241-,000
GR.A9 DR3 ME l01 u�ri4O�i2.y�t1S1t� .� ' $%St,3t►
-STM-.'MALCON t.'iTM109AA;D'Pi:. KE` WX S1,323.15
110M, 73'.MU.5. Rr.'L:.E S D5/E NOW
RECEIPT
DATE 1
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings _ �_` '
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck_!�
O.K. to Wrap
�1�—Q�L
_ _
Exhaust Fans
F.A.U.
Framing
Insulation
_
�
Compressor
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
POOLS - SPAS
BLOCKWALL APPROVA S
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
15 �F
J.'157—
Heater Final
Water Piping
.
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
�'i
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)
RUG -10-2001 13:33 WESTERN INSULATION
909 686 8786 P.15i19
l
WESTERN INSULATION, L.P.
4211 Lath 'street, Rivcroidc, California 92501
Tel. (909) 686.8760 Fex (909) 686-8786
A
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: SUNFLOWER #29623/PHASE 2
LOT # :4___ __._ _ _
�
SITE ADDRESS: 79531_DANDELION DR. LA QUINTA, CA
EXTERIOR WALLS:
MANUFACTURER: JOHNS MANVILLE THICKNESS: 3 5/8 " R -VALUE: R-13
CEILINGS: BATTS �BLW
MANUFACTURER: GREENSTONE THICKNESS: 10.3 " R -VALUE: R-38
CEILINGS: BATTS BLOW
MANUFACTURER: JOHNS MANVILLE THICKNESS: 13-1 R -VALUE: R-38
GENERAL CONTRACTOR: WORLD DEVELOPMENT, INC.
BY:
TITLE:
DATE:
INSULATION_CONTRACTOR: WESTERN INSULATION, L.P.
LICENSE NUMBER: 794484
BY:
TITLE: PR ION MANAGER
DATE AUGUST 10, 2001