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y 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 -�7 Exp. Date`
24-1867 _ 8
Date-� ��Signature of Contractor
OWNER -BU ILDER.DECUARATION
I hereby affirm under penalty of perjury thatll am exempt from the Contractor's
License Law for the following reason: ,
( ) 1, 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 & 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
peimit is issued. My workers' compensation insurance carrier & policy no. aye:
Carrier Policy No.
• Si`.�.78 F'L'I�IiI ' IS03393.9&
(This section need not be completed if the permit valuation Is for $100.00 oi� 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, should become
subject to the workers' compensation provisions of Section 3700-of-ta Labor
Code, I,Shall forthwicomply with those prove Is ons. ;r ✓
Date -- %��" Applicant
Warning: Failure t ;secure W.ofk` e s 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 coniperisation, 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 representatives of this City to enter upon
the above-mentioned property ff/or,,,J pection purposes
Signature (Owner/Agent) �. -"`� Dates
BUILDING PERMIT PERMIT# `
DATE VALUATION LOT "024." TRACT
• I 1< •Cf % S791699.54) 49 28019
JOB SITE
APN
ADDRESS
78-220 D ;SERT FALL WAY
769-792-010
OWNER
CONTRACTOR/DESIGNER/ENGINEER
RM DAN D. LLL
WORLD DEVl;LOPPMENT, INC
X120 CALLS ESTADO, 4104
.PO BOX 13287
EA +QUINTA CA 92253
PALM. DESERT CA 92255
(760)771-5571 CELL# 5028
USE OF PERMIT
LOT49,PLAN 1A& SM - PI'sfWJT DOES N(1°f 1NCl.UT)l 43L0CK. WALL.
Sit pom. J'J.•111� Cid Cf: F'FF. I�TiD1J4 D 75°b.rt 1R 1Li�}l: f 11�1;E 1SSi}ANC£
OF SAA1R, P1,AN T'A`PE.
TRACT CONSTRt:r-"i`. ON l,xa'l.ti(i SF
1'0RC1VP f 14 66,00 SF
oARAGi�JCARPnR'C 156,00 SF
MIST ll�'1�A"1TE1) COST O CONSTIMIC"1: 0IN
PE1t2.11 IT FEE $1311 MAKY
CONS'IROC"1(ON b'FF 1014= 419-000 5549.5)
n,AN 643,:CK FU 101-000-4399 3.18 $11.5.92
'Nf1:<7W ANfCA1. FU 101-000-421-000 $470.00
kiLEC 11'RICAL FM 141-1,04-X120-000 $102.67
PLiJkWING', FEE 101-000.41.9-000 &W—V
ST t()Nt?•m0T! N FEE - RES.1D 101-000-241-000 $7.97
GRADING FEE 101-000-423-100 $20.00
P 'TRW TURP. FEE 225-W-443-342 Vii. 7 �.4ta
SUS R-fTAI. CONS'IRL.IC'1'ION AND PLAN CHECK
LESS PId&PA1D FEES
Ulwu
TOTAL PERNI.ff FEES DUE NOW
•
S2,754]1.05
G
REGEI T
ATE
BY /
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs e4 A
Underground Ducts
Forms & Footings V
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap, 3 —(2—`Z
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
"Int.
Drywall - Lath — -
Final
Final
POOLS - SPAS
BLOCKWALL AP ROVALS
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
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection 3— — (
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"(Perrn) . — Z-
APR -30-99 FRI 07:21 WESTERN INSULATION FAX NO, 9096868786
WESTERN INSULATION, INC.
4211 Latham Street, Riverside, California 92601
(909) 686-8760
(9091686-8786 Fax
INSULATION CERTIFICATE
P. 06
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: THE SEASONS VILLAS TRACT #:28019
LOT#; C49 _J
SITE ADDRESS: (78.220 DESERT FALL WAY, LA QUINTA, CA
-----------------------------------------------------------------------
MANUFACTURER: JOHNS -MANVILLE THICKNESS. 3 5/8 " R -VALUE: R-13
CEILINGS BATTS BLOW
MANUFACTURER: GREENSTONE IND. THICKNESS: 10.3" R -VALUE: R-38
Where inaccessible for Blown insulation: BATTS BLOW
MANUFACTURER: JOHNS -MANVILLE THICKNESS: 13" . R -VALUE: R-38
GENERAL CONTRACTOR:
LICENSE NUMBER:
Im
TITLE:
DATE:
WORLD DEVELOPMENT, INC.
INSULATION CONTRACTOR: WESTERN INSULATION, INC.
LICENSE NUMBER: 481278
8Y:
TITLE: ;P6rod:t1bonmiatn4a"Ire�r
DATE: APRIL 30, 1999