9903-0234 (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
488234 B 12/31/99
Date Signature of Contractor
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
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:
Carver Policy No.
STATE FUND 626355-98
(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 provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions.
Date: ADDlicant
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 PERMIT9"3-234
DATE rr VALUATION S119,253_% LOT 56 TRACT 28458-1
JOB SITE
ADDRESS 43286 ALBA COURT APN 609-070-038
OWNER CONTRACTOR / DESIGNER / ENGINEER
THE EXCHANGE GROUP ROGER SNELLENBERGER & ASSOC.
78-615 NAPLES DR 78615 NAPLES DRIVE
LA QUINTA CA 92253 LA QUINTA CA 92253
(760)772-0222 CBL# 1858
USE OF PERMIT
SINGLE FAMILY DWELLING
LOT 56, PLAN 3BR; SFD - PERMIT DOES NOT INCLUDE BLOCK WALLS
OR POOL. PLAN CHECK FEE REDUCED 75'/o FOR MULTIPLE ISSUANCE OF
SAME PLAN TYPE.
TRACT CONSTRUCTION 2.025.00 SF
PORCH/PATIO
52.00 SF
GARAMCARPORT
439.00 SF
ESTIMATED COST OF CONSTRUCTION
119,253.50
PERMIT FEE SUMMARY
' CONSTRUCTION FEE
101-000-418-000
$709.50
PLAN CHECK FEE
1014000-439-318
5146.98
MECHANICAL FEE
101-000-421-000
$53.50
ELECTRICAL FEE
101-000-420-000
$128.16
PLUMBING FEE
1014000-419-000
5140.75
STRONG MOTION FEE - RESID
101-000-241-000
$11.93
GRADING FEE
1014000-423-000
$20.00
INFRASTRUCTURE FEE
225-000-443-342
$2.667.64
ART IN PUBLIC PLACES - RESIC 701-000-255.000
$48.13
SUB -TOTAL CONSTRUCTION
AND PLAN CHECK
$3,926.59
LESS PRE -PAID
FEES
$0.00
TOTAL PERMIT FEES DUE NOW I 53,926.59
IIIIIIIIVIIIIIIVIIIIIII 60
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RECEIPT DATE BY DATE FINALED JINSPECTOR
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
ProfG4.9i.onali�ode,.and my License is in full force and effect.
License # Lic. Class Exp. Date
i
4£8234 I3 01.41 . ..11Y)
rr { 01 1
k,oate l ! Signature of Contractor-✓ _ f
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 properly, 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
Sec on 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.
STATE, FUND
(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,
Lshall not employ any person in any manner so as to become subject to the
workers' compensation laws of California, and agxee that if I should become
subject to the workers' compensation provisions of Section
X00 el the Labor
Code'I Mall forth 'th comply with4hose provisio s.> f
Date: -Y& Applicant l/� 1- Y
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
I
ddition 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
1 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 proppeertyy for inspection purposes.
Signature (Owner/Agent)(11_e, 7--m �J Date: " rG}
9
PERMIT #
BUILDING PERMIT 9903-N
DATE ` VALUATIONi�,x� LOT S1`lf1T TRACT
JOB SIyE
ADDRESS }3 ZS &Acoulc
APN
OWNER
CONTRACTOR / DESIGNER ENGINEER
Ci7vr'�3 AR7 3^
ae.. i�.+Lft,�PvliE. 3
ASSOCId
*%A� 1111 ENO E 0 .
7S-615 NAPLES DR
79 i3 `1JA¢° E'S 1DRI VE
1.,A QUIN%'A (,A V1253
LA Qi1INTA CA 92253
t:"IfefIl77Z-t1`d2 C110 IFZ58
USE OF PERMIT
SNOLE F.�11��f11 A' .DWEL E..;fNG.
i,uT K T)LiVfq' 3W, $00-1•UMFf D UES NOT iNil,UDE :s'' OCK 41t#U_LG
oxI4001,. PLAN C::I-ftiCK FFilo k FUUC ED FOR .N61:ULTIM, R lSSUA140i O
SAW, C LIVIR'MMA,
"Ii2a�G'T 1Kv 'i 1JC L� J ^U23.00 S1
L�rRi1fAl.0 .52.00 Sr
f: ARA(Tk'JL:.Al2Pi. ART 4.'4+: ,Qu �;.F
t""y.� TIMAT � D L" N € F CON-S`RUC-"� 101\1
1.11,«. �.�'s�n
A �y+ +� ye �yy dpi t�
I''VRIN� A d, ER n7�i} tF�!' AIt l�
C(YNKrRtfCfION 1?ai 1,01-000-418-000 $17000
€r), k3 tC"MCK FIT 1Q! -0M-419-_;!8 $146.99
r.111SCILI CAL PT.M 101.OW-1121-000 $53.50
MCPR ICAL FIM 10,It-WO-420-000 $128.16
IjLWV113INt1FIM 1.01-()pE1-41941t)t3 5141).75
4'C%1C1?�f4; MC1'I'[:1N 1;# F _ s St_17 1011.-4n��0 241.000 511.93
�rlUU)�N' Y17M 1.11!1-00"2:"1-rf00 $20.00
1N1-iIA.slkuC•1°CJr" 1.Ifft 2225-0a443_342 xZ661.64
ART IN PUBLIC I)LAC;E,S - RESPC 701••OW,25�-000 $/48.13
&OVIDTA;, C11NS"1'1tUC17M AND PLAN' C''IiECK
LFSS M, E—PAID FEES
$0,00
1*0TAL Pf',XIVl IX PUN DUK'NOW
s.:1,926.s')
IIIIIII
VIII III VIII IIII 61
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RECEI T �
a
t
DATE L "i ""
!�
BY
DA F AL
INSPECTOR'
�
t1
1
if17
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set�Backs
Forms & Footings
Underground Ducts
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
/
Exhaust Fans
O.K.to
F.A.U.
ming
Compressor
Ins
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath f
Drywall - Int. Lath
77
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
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
7
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G. F.1.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
WESTERN INSUL TION1 INC.
4211 Latham Street, Rivwside, California 92501
Tel. (909) 686-8760 Fax (909) 686-8786
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: BELLA VISTA — TRACT 0284,58-1
LOT # : 56
SITE ADDRESS: 43586 ALBA COURT, LA QUINTA, CA
EXTERIOR WALLS:
MANUFACTURER Johns-,'v1aq,,IJ1JTHICKNESS: 3 5W R -VALUE: R-13
CEILINGS: BATTS BLOW
MANUFACTURER:
L,�a5ifle THICKNESS: I], R -VALUE: R-30
-
GENERAL CQINTRACTOR: FRACITIONAL BUILDING CO.
LICENSE NUMBER:
BY:
TITLE:
DATE:
INSULATION CONTRACTOR: WESTERN INSULATION, INC.
LICENSE NUMBER: 4812:8
BY:-U��
TITLE: PROD C'PIONAWCER
DATE: SEPTEMBER 22, 1999