9908-071 (SFD)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 37of the Business and
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
Daie ;' ,;; - !�+Signature of Contractor -f �
1 ..
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).
() 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
E
tjon 3700 of'the Labor Code, for the performance of the work for which this
mitisissued: My'workers''compensation insurance carrier &policy no. are:
er.'- Policy No.
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,al flf.t ursl,!&1,1„f i atep cy '!,J.J
(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 provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those rovisions>.
Date: Applicant
Warning: Failure to secure Workers' Compensation coverage is unlawful and
Whall 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 representatives of this City to enter' upon
the above-mentioned property for inspection purposes.
Si nature (Owner/Agent) Date 4
PERMIT# -
BUILDING PERMIT
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DATE VALUATION LOT TRACT ?
i2190,1i
JOB SITE
APN
ADDRESS 79460 YVAX
OWNER
CONTRACTOR / DESIGNER / ENGINEER
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S! 956.92
RECEIPT
DATE
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
— — (;Ao%
Return Air
Steel
Combustion Air
Roof Deck
:5 -7
Exhaust Fans
0. K. to Wrap
a _ �P 7
F.A.U.
Framing
57'
Compressor
Insulation
_ $. $ i
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
60 S7
Drywall - Int. Lath
o- l- Qv S
!Z Z
r c�
Final
Final
POOLS -SPAS
BLOCKWALL
APP OVALS
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
Appliances
_
!Z _ ( _
Final
COMMENTS:
Final
Utility Notice (Gas) 7
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) .. f 0 Q
DEC -08-1999 11:26
WESTERN INSULATION
909 686 8786 P.O?/10
MMS TEMT INSULATIONINC.
4211 Latham 8tmot, Riverside, Califbrsia 92601
(909) GBG -8760
(90916w-8785 ?on
INSULATION CE&BEICATE
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#: 45
SITE ADDRESS: 78-260 DESERT FALL WAY, 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: 10.3"
GENERAL CONTRACTOR; WORLD DEVELOPMENT
LICENSE NUMBER:
BY:
TITLE:. Svoa✓-
DATE: A2 4
R -VALUE: R-13
R -VALUE: R-38
R -VALUE: R-38
INSULATION CONTRACTOR: . WESTERN INSULATION, INC.
LICENSE NU ER: 481278
BY:
TITLE:roduS nager
DATE: DECEMBER 8,1999