9902-055 (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 3 of the Business and
,Professionals Code,'and my License is in full force and effect.
''License# Lic. Class Exp. Date
743965 � � 1,99
Date Signature of Contractor r
l.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 -,,,6r 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). -
O 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:
,+ )' 1 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:
Cartier Policy No.
STA 1'E :FUND 1509393-98
(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 pp visions of. Se'66o 3�700`of,the�Labor
Code, I shall forthwith comply with those prov ions.
Date: =Applicant
71.1
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 hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes:,;
Signature (Owner/Agent) ! ''=- '�• Date •,.�-�-
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 9911.1 0� TRACT
37
JOB SITE APN
ADDRESS U-30 DESERT FALL WAY 769-79.1-0.36
OWNER CONTRACTOR/DESIGNER/ENGINEER
,111• -LOAN D, LLC %VOkLD DEVELOPMENT, .INC
79-120 CALLE ESI'ADd, 0104 1O ROX 13287 `
LA QUfN"IA CA 92253 PALM DESERT CA 92255,
(760)771-5571 C:RLL 5038
USE OF PERMIT
LOT 37. PLAN 3AR. SFD - PERMIT DOES NOT INCLUDE FlLOCK WALL
OR Pool..
TRACT C(NS1`Klia' :i ION 1,532.00 SF
PUc20WATIO 35.06 8F
GARAWCARPORT 483.00 4F
171,ST MAXED C::UST CDA+' CONSTRUCT ION
PERMIT ?� E S171bitA3ARY
CONSTWC7.10N FEE
10.1.000-418-000
$b12.50
PLAN CHECK FEE
101-0130-439-318
$514.13
MECHAWICAL FEE
101-000-421 -M
$53.50
a FC RI AL. .FEE
101-000-42.0-000
$117.78
PL U B(NO YM,
10.1-000-419-000
$1.33.5+0
STRONG MOTION FEE - RESfD
101-000-211-000
39.31
GRADTtd01'Ef,
101-000-423.000
$20.00
t.NFRASTRUCT'URE FEE
225-000-443-342
32,(184.72
bPFDEPOSIT
101.0100-439-319
42%.00
SUE -TOTAL CONS"1 UCMN AND PLAN CHECK.
LESS .PRE -PAID FEES
TOTAL PEE Mrr FEES DUE NOW
By ' rvi I DATE FINALED I INSPECTOR
9.3;319.90
$3,545.44
-Sy50.00
5:1,295.44
,.r INSPECTION RECORD
4
• Gas Piping
OPERATION
DATE
INSPECTOR OPERATION
DATE
INSPECTOR'
Plumbing Final
BUILDING APPROVALS MECHANICAL APPROVALS
Equipment Enclosure
Set Backs Underground Ducts
O.K for Finish Plaster
Forms & Footings V Ducts
Pool Cover
Slab Grade - Return Air
Steel Combustion Air
Roof Deck —Y T Exhaust Fans
O.K to Wrapq g F.A.U.
Framing W-7 Compressor
Insulation Vents
Fireplace P.L. Grills
Fireplace T.O. Fans & Controls
Party Wall Insulation Condensate Lines
Party Wall Firewall
Exterior Lath 57T-
Drvwall - Int. Lath 4-1.5- - 49 T
BLOCKWALL APPROVALS
Set Backs
Footings
Bond Beam
Final
Steel
Electric Bond
Main Drain
Approval to Cover
Equipment Location
Underaround Electric
POOLS - SPAS
im
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
ELECTRICAL APPROVALS
Power Pole
iround Conduit T—
Sub Panels
Exterior Receptacles
G.F.I. .
Smoke Detectors
Temp. Use of Power
COMMENTS:
. 1
APR -30-99 FRI 07:20 WESTERN INSULATION FAX N0, 9096868786
WESTERN INSULATION, INC.
4211 Latham Street. Rivardde, Califoraia 92901
(909) 686-8760
(909) 686-87x0 Fox
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: THE SEASONS VILLAS TRACT #:28019
LOT#: 37
SITE ADDRESS: 78-305 DESERT FALL WAY, LA QUINTA, CA
-----------------------------------------------------------------------
EXTERIOR WADS:
MANUFACTURER: JOHNS -MANVILLE THICK SS: 3 5/8 " R -VALUE: R-13
CEILINGS : BATTS (!LOW
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
GENERAL_ CONTRACTOR: WORLD DEVELOPMENT, INC.
LICENSE NUMBER:
BY:
TITLE:
DATE: v
INSULATION CONT ACTOR: WESTERN INSULATION, INC.
LICENSE N SER: 481.278
.BY: &U4DO
TITLE: Production Ma ger
DATE: APRIL 30, 1999