9902-054 (SFD)U)
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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 '"rSignature of Contractor
OWNER -BUILDER
I hereby affirm under penalty of perjury that'I 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; a's 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:
Cartier Policy No.
(This section need"notNbe completed if the permit valuation is 15093143,49
(This 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' compensatio5,provisions of=Sn,3� off he Labor
Code, I shall forthwith comply with those provisionsyy� .
Date: ! '% Applicant %�''.✓"'- ="" •�'.
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civ I -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 ty to enter upon
the above-mentioned property forinspectio purp ,�
Si nature (Owner/A ent) ✓� `= Date — "+2
BUILDING PERMIT PERMIT#
DATE G VALUATION LOT "024M TRACT
36 28019
JOB SITE
APN
ADDRESS
75-295 DESERT FALL, WAY
769-791-CP35
OWNER
CONTRACTOR/DESIGNER/ENGINEER
71:&1 DAN D. LLC
W01:LD DEVELOP.MEI\n, INIC
78420 CALIX ESTADO, 0104
PO BOX 13287
LA QUINTA CA 92253
PAL &I DESERT CA 92255
(760)771-55'71 CEL# 5028
USE OF PERMIT
LOT 36, PLAN 213 S -FD - € F64iT DOES -N0T i'NCVUDL BLOCK 'WALL OR
TRACT CONSTRUCTION '1,403.00 sl~
POR.CHIPAT.10 :11~1.111) 8F
GrARACTFICARPORT 493.00 SF
i', TIP>r!CA"! ED COSTOF CONSTRUCTION
PERMIT FEE SUMMARY
CONSTRUCTION FES 101.-000418.000 $590.00
PLAN Ci FXK FBE 101-000439-318 54913.47
MFCHANIC:AL FI% 10.1-000-421-000 $33.50
4ELECfR WAL FE 101-000-420-000 $1.13.47
PLU&IRI1S G FE1? 101-000-41 Ek -WO $139.50
STRONG MOTION FEE - RJ; ID 101-000-241-000 ".83
CS12AIDINO FfE 101. -MG-423-000 1.20.00
iNF.RASTRUC TURS1ISE .'A45,0 0 -*13-342 $111931.53
FEE DEPOSIT 1014)W-439-318 4250.00
SI.fB-'IUTAL CONSTRUCTION AND PLAN CHECK
$3,355.30
LESS:P.RE-P.t1I01 LE'S
-$2513.00
TOTAI. PERMIT FEES DUE NOW
53,105.30
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DATE
BYDATE
FINALED
INSPECTOR
�s
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
ACV
Underground Ducts
Forms & Footings
ZDucts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wali Insulation
Condensate Lines
Party Wall Firewall
Exterior- Lath
R-(- -7 —
Drywall - Int. Lath
-- 81—
Final
Final
BLOCKWALL Al ROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final -
Waste Lines
- 2 Z
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
-tj—
Encapsulation
Gas Piping
Gas Test
Q
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring .
Low Voltage Wiring
Fbdures;
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility. -Notice (Perm) .
,a:
APR -30-99 FRI 07:19 WESTERN INSULATION FAX NO. 9096868786
WESTERN INSULAI'TION, INC.
4211 Latham Stsett, livaraide, Co2foraia 92301
(904) 686.8760
(909) 686-8786 Fax
INSULATION CERTIFICATE
P. 02
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#: C361
SITE ADDRESS: x&295-0ESERTFAL,L WAY, LA QUINTA, CA
EXTERIOR WALLS:
.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
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GENERAL CONTRACTOR:
LICENSE NUMBER:
BY:
Nil-
TITLE:
DATE:ao-7-1.
WORLD DEVELOPMENT, INC.
INSULATION CONTRACTOR: WESTERN INSULATION, INC.
LICENSE NBER: 481278
BY:
TITLE: Production Man
DATE: APRIL 30, 1999