9908-074 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
H Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
Professionals Code, and my License is in full force and effect.
O :3 ch License # Lic. Class Exp. Date
0 LO i•lOatii is LLU
Offd
r- xh
oZ r- VDate 9 � Signature of Contractor �.d
CD 0
J U C:) OWNER -BUILDER DECLARATION.
W LU I hereby affirm under penalty of perjury that I am exempt from the Contractor's
U) License Law for the following reason:
Z_ ( ) 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 & Professionals
Code).
I am exempt under Section B&P.C. for this reason
N Date Signature of Owner
ON
rn
d z WORKER'S COMPENSATION DECLARATION
oZ I hereby affirm under penalty of perjury one of the following declarations:
LO O () 1 have and will maintain a certificate of consent to self -insure for workers'
X W compensation, as provided for by Section 3700 of the Labor Code, for the
00_J Q performance of the work for which this permit is issued.
Q U 4 A I have and will maintain workers' compensation insurance, as required by
O C) Q Section 3700 of the Labor Code, for the performance of the work for which this
LO
0)I— permit is issued. My workers' compensation insurance carrier & policy no. are:
Z Carrier Policy No.
C {•'!` t Tt• evil Lp ! rrtntnY tN•
ry sYi PA E. 1<VtY6J R.r+1'JYJ •.y.7'
VJ (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 should become
subject to the workers' compensation provjsions�offS
CSection 3700 of the Labor
Code, I shall fgehwitl�comply with those provision'
ate: 'J• GG Applicant
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
I addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
• correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the•'above-mentioned property for,i,nspection purposes.
,
VSignature (Owner/Agent) -s— ' Date
PERMIT#
BUILDING PERMIT
41101R.074
DATE �i �Igo VALUATION J%j.II9.r1% LOT �`� TRACT 41t{11•�
JOB SITE,,
ADDRESS tttr-I.2A f fES'1Vvlib T it E�e:LL I'� A
APN :s
69-702-.09
OWNER
CONTRACTOR/DESIGNER/ENGINEER
%in,iot . Jiltl`1tt t nook�ll7hi•i' f0.ii'1
t •Ji'Y.Ap.J t,. x1..7 �'�Jt Itltl.l s / � ti •�.
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,t;• iN CAI U-,' rr or-LAExj, rt #Oi
8-120 CALIX ;E5 tlt k i. 1604
1.11 QUINTI:. t -'A 911.1.253.
LA t,3t.31t' TA CA 922.53
s7fAA771 •S +71 5(1711
USE OF PERMIT
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01•" SAW.'' PLAN TYPE.
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i.tAltl�,.s.tt1(,t�.1i.1'EaR`1' d1i,l.t+tJ :1i'
Zv1"rT1\0$ 10'7P;;+Yl ?'V'4Q'N' 1'%V
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MARY
CONSTRVC710N H,- M-M-4194MID $612.51?
u1 kN 414r `K VVF 101-060.4311.118 11: -1.4
Y1t; HANICAUTIE xAf t11?E7-Z'.1 t3vQ 553.
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Tl`i'!I'AL lyfi:Rfh IT 1+1;E% DUE, N(:+VF
SC,"2.12
RECEIPT
DATE
BY
I
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 d - —
Exhaust Fans
O.K. to Wrap v _
F.A.U.
Framing - fS S7
Compressor
Insulation . ( _ Q
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath �O a
Drywall - Int. Lath
Final
Final (
BLOCKWALL A P OVALS
POOLS - SPAS
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
Encapsulation
Gas Piping
Gas Test y
Appliances
Final
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) Z
COMMENTS:
L l
DEC -08-1999 1128 WESTERN INSULATION 909 686 8786 P.10/10
viii TERN INSULATION, INC.
4211 Latham Street, Riverside, CaMrWa 92601
19091696-a9f 0
(9091586-s7i61�aa
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: SEASON VILLA -PHASE III TRACT #:28019
LOT#: C-48
SITE ADDRESS: 78-230 DESERT_FALL 1AIAY, LA QUINTA, CA.
EXTERIOR WALLS,
MANUFACTURER: JOHNS -MANVILLE THICKNESS: 3 5/8
CEILINGS, BATTS BLOW
MANUFACTURER: JOHNS -MANVILLE' THICKNESS: 13"
CEILINGS: BATTS BLO
MANUFACTURER: GREENSTONE THICKNESS: 103"
GENERAL CONTRACTOR:
LICENSE NUMBER,
BY; Z4
TITLE:_S
DATE: 1 g
WORLD DEVELOPMENT
R -VALUE: R-13
R -VALUE: R-38
R -VALUE; R-38
MULATION CONTRACTOR; WESTERN INSULATION, INC.
LICENSE NU BER: 481278
BY:
TITLE: Produc&n Ma ager
DATE: DECEMBER 8,1999
0
TOTAL P.10
Certificate of Occupancy
City of La Quinta
Building and Safety Department
This Certificate issued pursuant to the requirements of Section 109 of the Uniform Building Code,
certifying that, at the time of issuance, this structure was in compliance with the various ordinances
of the City regulating building construction or use. For the following:
BUILDING ADDRESS:
Use Classification: SFD
Occupancy Group: R 3
78-230 DESERT FALL WAY
Bldg. Permit No.: 9908-074
Type of Construction: VN Land .Use Zone: RL
Owner of Building: WORLD DEVELOPMENT, INC.
Building Official
Address: 78-120 CALLE ESTADO, #104
City: LA QUINTA, CA 92253
By: STEVE TRAXEL
Date: 12-16-99
POST IN A CONSPICUOUS PLACE