9903-0232 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter 9 (r9mmencing 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
44'"-234 B
—
DM644 lr' ! �� Signature of Contractor
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.
M 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.
.:TATS; BAND $:16355-9S
(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
Co" e,.l shall forthwith comply with.those provisions. // �� )) �
bate: `,•�(f '""/ Applicant .» "`r,; 6 ')/ / 1 �tn�
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, ove-mentioned property -for inspection purposes../,'
,Signature (Owner/Agent) �' r ti�i � �� .� '� � Date`3620 9
PERMIT #
BUILDING PERMIT
99
J /,03 .iL
DATE 3 („J /^ [� VALUATION ,I'9•l�� Mi LOT -%K TRACT
ADDRESS -SS-/646 ALIL. 00,11141
APN "9-070-038
OWNER
CONTRACTOR/DESIGNER/ENGINEER
Tl It- I- I I'l,'I- :^!:p
P.! I:'s R S"x1:1,1,1:*1una.if'1:.�'
in-ui5 NAPLIS bit
18651; NAPLES DRIVE
LA. QUINI'A CA W2,53
1-A t,►UIMI.A CA 422 +3
f7W1772-072^ ('ill MR
USE OF PERMIT
SiNc.ti,h PA.�,M11,1 I.1 J,LIN+..
LV f 58, PLAN *A.:4-0 - PLf All f WES ?404 fNl:l,14)13 BL,X_ K WA1.i,.ti
(,A( 14, k)f.
(if )RQfi11A.Tf10 i4l,00 SF
4JARAk1FJ .'A1LNC.►KT 439 Of; SM'
C+.sTmisam Ct3K')r' or („uNwi RITCTION
111.21i3.So
PERAUT FRE 81IMMAM'
LX)NVK(JC."TIUNFER 101-500-419-tW S709-sU
P+1 At4f1q r K rT"F IW SIM790
A'WX1IA1dIC AI. rM 1151 000-171-000 353 i0
E f.W1 WLAL Flt: 101-0004204M 312 u (6
f'LUNIBFNO NO 101-(iU()-4l(%-000 5140,70
STR()t t7 Mc►TION' U14- _ RF51f? 101 -MO -1414M il-(1(1f) $11 9z
GRAi)I;3G FM- 1011500--521.000 520.00
INI�RASITRUC'I' RE ITH 21254-0 443-342 S2,oV.64
AR I' IN PUBLIC PLACES - REsI13 701.0U0 -255-f)00 $18, 13
4111-'1�f�Tti;.CON!."1Ri.}� "I10N AND PI -AN (�'N1?C K
S4.10 %I
I.C.S.C. PRE 1' UD I'as
S0 00
TOTAL PERMIT FERS DUE 14OW
N4,367.51
11111111178
n:4)✓
IE
RECEIPT
DATEr
BY ti 1,
DAT F ALE
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Sat Backs
Underground Ducts
Forms &Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck //
ExhaVst Fans
0. K. to Wrap
F.A.U.
Framing
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
Final
Final — <f-
BLOCKWALL APPROVALS
POOLS - SPAS
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
Final
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.I.
Smoke Detectors
Temp. Use of Power
Final (5,rt-
Utility Notice (Perm)
COMMENTS:
1
'1'11E GAS COMPANY
CcntrW.izcd Sct Dcsk'
ltcdl:,nds Cull Ccntcr
I'lionc (800)225-7377
1=j,: (800)577-3999
Fax (909)307-7050 (51
GAS HOUSELINE APPROVALS ULLEASLI.) TO
THE GAS COMPANY
•Clearances faxed ul or uJier 5:00 pm will be pruce44ed IMS ljexl work duy •
*wile"" wse a new sheet each time when juxisi rele"A4.b •'
:CITY OF LA OUINTA
building and Safray 13cparunuu
PI►a�:
: Bldg. Counter Tvor .
=. 6 0777-7011 1
Datc: 9 2.q 9 9
N of Pujjcs:
PLEASE NO'T'E IF RELEASE IS FOR
ADDRESS DiFFERkNT FROM PERMIT
ADDRESS (I.E.. REAR UNIT)
j r v
WESTERN INSTULATION, INC.
4211 Latham street, River£ide, California 92501
Tel. (QO9) 686-8760 F&X (9011) 686-8766
INSULATION I:E]2TIFICATE
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 #28458.1
LOT # 58
SITE ADDRESS: 43646 ALBA COURT, Lk QUINTA, CA
EXTERIOR WALLS:
MANUFACTURER: Johns -Manville THICKNESS: 3 5/8" R -VALUE: R-13
NGS: �
BATT$ BLOW
MANUFACTURER: /ohns, anv!Ile THICKNESS: 11" R -VALUE: R-30
-
GENERAL CONTRACTOR: TRADITIONAL BUILDING CO.
LICENSE NUMBER:
BY:
TITLE:
DATE:
11 5U"TION CONTRACTOR: WESTERN INSULATION, INC,
LICENSE NUMBER: 481278
BY:17
TITLE: P DUC IR
DATE. SEPTEMBER 22- 1999
k
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:
Carrier 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: Applicant
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#9"3-232
DATE VALUATION 5119,253.50 LOT 58 TRACT 28458-1
JOB SITE
ADDRESS '• 43-"6 ALBA COURT
APN
60¢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 58, PLAN 3A; SFD - PERMIT DOES NOT INCLUDE BLOCK WALLS
QR POOL.
TRACT CONSTRUCTION 2,025.00 SF
PORCH/PATIO 52.00 SF
GARAGEICARPORT 439.00 SF
ESTIMATED COST OF CONSTRUCTION
119,253.50
PERMIT FEE SUMMARY
CONSTRUCTION FEE 101-000-418-000 $709.50
PLAN CHECK FEE 101-000-439-318 5587.90
MECHANICAL FEE 101-000-421-000 $53.50
ELECTRICAL FEE 101-000420-M $128.16
PLUMBING FEE 101-000-419-000' $140.75
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 - RESIT; 701-000-255-000 $48.13
SUB -TOTAL CONSTRUCTION AND PLAN CHECK
$4,367.51
LESS PRE -PAID FEES
$0.00
TOTAL PERMIT FEES DUE NOW
54,367.51
IIIIIII
I I I II III I IIII 79
IE
RECEIPT
DATE
By
DATE FINALED
INSPECTOR