9908-072 (SFD)CV 11J
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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 3 of the Business and
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
Date J S Signature of Contractor J
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 & Professionals
Code).
()
lam 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
StIcIn 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:
Camey'; 4 Policy No.
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(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 prov�sions`of_Section 3700 of the Labor
Code, I shal)jforth_wi h comply with those p�ovlsloris.
f�• . p.e
Date: `� / )Applicant-
Warning:
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 herebyauthorize representatives of this City to enter upon
the above-mentioned property fo.inspection-purposes.
�s,'Ignature (Owner/Agent) S �-• - Date
BUILDING PERMIT PERMIT
DATE VALUATION�94).gf) LOT ` 46 TRACT a'3tfjfip�
JOB SITEAPN
ADDRESS 9-2a?t3DN,t9.ER ,F'ALk.WN't
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OWNER
CONTRACTOR/DESIGNER/ENGINEER
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),.A. QIUI Iri`I A i.t! !422_053
t�A f,?€1!NTA (:A 911253
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USE OF PERMIT
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RECEIPT
DATE
BY
1
DATE FINALED
INSPECTOR
_«r
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
Exhaust Fans
O.K. to Wrap
5 7
F.A.U.
Framing
- f 5�
Compressor
Insulation
to Ql g
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
O -e?/_ QQ 57
1-5 L
I
Final /57POOLS
BLOCKWALL APPROVALS
Final
- SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final I
I
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
lz
Appliances
Final
Final _
Utility Notice (Gas)
ELECTRICALAPPROVALS'
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) /-io - Y
COMMENTS:
DEC -08-1999 1127 WESTERN INSULATION 909 686 8786 P.08i10
WESTERN INSULATION, INCe .
4211 Latham 8tmeto Rivessi6ep Cal ruk 92901
(909) 686.8760 '
(909) 686.8786 Fax
INSUL.ATUN 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#: 46
SITE ADDRESS: 78-250 DESERT FALL WAY, LA QUINTA, CA.
EXTERIOR WALLS:
MANUFACTURER: JOHNS -MANVILLE THICKNESS: 3 5/8 R -VALUE: R-13
CEILINGS: ATT BLOW
MANUFACTURER: JOHNS -MANVILLE, THICKNESS: 13" R -VALUE: R-38
CEILINGS., BATTSBLOW -
MANUFACTURER: GREENSTONE THICKNESS: •10.3" R -VALUE: R-38
GENERAL
LICENSE NUMBER:
BY: :liL
TITLE: 5 c4Dar'
DATE:
WORLD DEVELOPMENT
INSULATION N CTROR: WESTERN INSULATION, INC.
LICENSE NU BER: x81278
BY:
TITLE: roductlbA Ma&ger
DATE. DECEMBER 8,1999
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