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9902-053 (SFD)N W CY O � M ' W o Z � AD 0_ t`o _J W W.. H '40" d 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 n Exp. Date , r r +f1 B / . � 11,09 Date.'»'!� -� Signature of Contractor OWNER -BUILDER DECLARATION I 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,., 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 permit is issued. My workers' compensation insurance carrier & policy no. are: Carrier Policy No. (This section need no be completed if the permit valuation Is or $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'Pshoujdtbecome subject to the workers' compensation"provis on s of Section 3700"ofvtKe Labor Code;.l shall forthwith comply with,those`proylslons Date:, rs Applicant r ,� .moi. `f—yam. Warning: Failure to secure Wo ens' Compensation co p . ge is unlawful and shall subject'an employer to`b-rririiinal 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, inteesi 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 rrelating,tto the building construction, and hereby authorize representatives of.th159 City to enter upon the above-mentioned property for inspection purposes rf t Signature (Owner/Agent) Date,2/L_� BUILDING PERMIT PERMIT# VALUATION LOT '�9t13�-453 TRACT DATE r Cot 1 '�f�t;ia1 JOB SITE APN ADDRESS _295 Il' ,SR T 1" Ai:. ut°x ' 7.4 .,413. OWNER CONTRACTOR/DESIGNER/ENGINEER ANI DAN D, LLC.:' WORl;D DEYELt ►PMEA• T, INC. 78-120 CL -LE ;1~S'!'AW. it] 04 PO RON 13287 LA QLTRN 'A CA 92253 PALM DESERT CA !-2255 (760)771-5571 C'6L'# 5028 USE OF PERMIT LO`i`35, PLAN Wk 23FD - PRi' 411'1` 00ES NOT INCLUME BLOCK WAT i, OR POOL. T72AC°! CONS;t'RUC`i'fON 11237,00 SI~ PORMPA.TIO 66.00 SF G.ARAGEtcARPORr 4.56.00 St' •.i ESTI MAT 1'.D C11ST 0 F G°C NSTRUCHON 79,699.50 PERMff FEESUMMARY ARY CONSTRUt"T'IGNFW_ `� 1.01-000--418-000 $549 0 PLAN CIMCK FFX °°. ` 1(f'1-000-439-31.8 4463.69 NF-CHANTCAI.'F.(i, ',��101.-000-42.1-000 S1;.0il T 101-0040-000RCP1E $102,67 P.LU?MING FEE 101-000-419.000 SI33.50 81MONCI MOTION EE - RESID 10.1-•000•241.000 $7.97 6RADiNG rfm. 101-000-123-000 $20.00 1NFRASTRUCT(7RET':RE 125-000443.342 $1,773.49 ITE 1DEPOW.T 101.-000-419-3111 4250.00 SU13-`i'D'1'AL CC.IMMUCTION AND PLAN C,l-WCK. 53,097,112 LESS :PRE-E'AIDFEES 42-50.00 TOTAL PER�MI FEES DUE NOW S2,847.82 DATE BY �,1 DATE FINALED INSPECTOR 1� INSPECTION RECORD 4 ' 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 — Z — Exhaust Fans O.K. to Wrap — F.A.U. Framing 4Q Compressor Insulation — . Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath 7— Final Final POOLS - SPAS . BLOCKWALL APPROVALS 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 Q Q Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower -Pans OX for Finish Plaster Sewer Lateral Pool Cover Sewer Connection Encapsulation Gas Piping Gas Test rr 4 Appliances Final COMMENTS: Final Utility Notice (Gas) ?15-7 ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Lowy Voltage Wiring Fixtures Main Service " Sub Panels .Exterior. Receptacles G. F.I. ..Smoke Detectors Temp. Use of Power . UtiIRy:Notice (Perm) 4 ' 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 — Z — Exhaust Fans O.K. to Wrap — F.A.U. Framing 4Q Compressor Insulation — . Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath 7— Final Final POOLS - SPAS . BLOCKWALL APPROVALS 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 Q Q Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower -Pans OX for Finish Plaster Sewer Lateral Pool Cover Sewer Connection Encapsulation Gas Piping Gas Test rr 4 Appliances Final COMMENTS: Final Utility Notice (Gas) ?15-7 ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Lowy Voltage Wiring Fixtures Main Service " Sub Panels .Exterior. Receptacles G. F.I. ..Smoke Detectors Temp. Use of Power . UtiIRy:Notice APR -30-99 FRI 07:19 WESTERN INSULATION FAX NO. 9096868786 WHES7CERN INSULATION, INC. 4211 Latham street, RSveroldo, Caaorala 92501 (909) 686-8760 (909) 686-5766 Fax INSULATION CERTIFICATE P. 01 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#: =�35D SITE ADDRESS: r78-285 DESERT FALL WAY,,LA QUINTA, CA ----------------------------------------------------------------------- EXTE IOR WALLS: MANUFACTURER: JOHNS -MANVILLE THICKNESS: 3 5/8 " R -VALUE: R-13 �4 �IN�GS : 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 .L;ENERIAL CObITRACTOR: LICENSE NUMBER: ME TITLE: DATE: WORLD DEVELOPMENT, INC. INSULATION CONTRACIOORR: WESTERN INSULATION, INC. LICENSE NUMBER: 481278 BY: TITLE: Production Mana er DATE: APRIL. 30, 1999 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 78-285 DESERT FALL WAY Occupancy Group: R-3 Type of Construction: VN Owner of Building: JIM DAN D,LLC Building Official Bldg. Permit No.: 9902-053 Land Use Zone: RL Address: 78-120 CALLE ESTADO #104 City: LA QUINTA, CA 92253 By: STEVE TRAXEL Date: 9-17-99 POST IN A CONSPICUOUS PLACE