SFD (9905-051)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
rofessionals Code, and my License is in full force and effect.
license # Lic. Class Exp. Date
759465 H 021"'0201
Date _'� l r�!I ¢ Signature of Contractor, -y
OWNER -BUILDER DECLARATION
Thereby 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.
k/.) 1 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 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 shouldRbecome
subject to the workers' compensation provisions of Section 3700 of: he Labor
Code, I shall forthwith comply with those provisions.
Date: 1T : Applicant 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 insp
ectt purposes. r
j:
Signature (Owner/Agent �. Dat t-�
BUILDING PERMIT PERMIT#
'N1054151
DATE VALUATION S>M3fl,tS4.fif) LOT32
TRACTJOB
SITE
ADDRESS d3-5110 tiit1i. Vq COM
APN1
609-070-038
OWNER
CONTRACTOR / DESIGNER / ENGINEER
I° DVANUD 1)Et'I;1.OPIMI'Xr MIT
I RAi)MONAL BUILDING CO INC
78-613 NAPLES DRIVE
78615 NAPLES UR
I.A. QUIM-A CA 92153
LA (; UINTf1. CA 92253
(760pri-1222 Celt.# 5750
USE OF PERMIT
SINGUIR I'AMILY DWRLUNG
SFD • LOT 32 PLXN 4AR-1'L:"11T #?UES NOT iNCLUM: ALOCK MkL1,
ViG fK]UL.
IRA T CONSTt;U K ION :,100.01 SF
l�1iCi i�PA`l`10 ! Itl.if0 3F
(!ARA0€JC,NtPu1Vr 471.00 SF
f'S' I'iMXrrt,.9 COST .OF CONI STitI1C'"1 ON
130,154.60
I'11s'.UMIT FRE SUMMA%3Y
CONSTRVC-1'100 FFAE 101-000.4111;" $748.t►f)
PLAN (1.1T?(1K FFr f 01-W-4:49-31 R V.1 R 74
,NU71ANICAL l'Lf 101-000-4:1-000 50.00
WIMICAL .FEE IGl-00.420-W S1.143Z
PLUNIBI +fC1 P 1311 101-000-419-1H)() 3140.75
13 A-2
fvfC1S'Q ION ATF% - RVIST) 101-(t1(ji)-7q A*, -y�/�(�
lS�,+'fit�"1?1�t,'(� e$i
CRIU)1t�l G, 1'.i��. 101 -ODD -421.3-000 $120.00
1Aitrl A.VF; UCI'VKG FITI 225.{,0{i413-3,42 $2093%
AWT IN P013JAC PLACES - RES11; 70I iil!(1255-OrJO $75.3
r
S1 t 'Irg I CONIMY. )PION AND PIAN CTIECK.
x4,706 ?S
PALESS Mr -PAID PEES
$000
MAY 171999 -TOTAL (" CRINi T VERS ME N0W
$4,706-18
.CITY OF LA. QIJ111"I ,
RECEIPT
DATE "
BY
DATE FINALED
INSPECTOR
«
INSPECTION RECORD
'a..OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
zi
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
,L
Exhaust Fans
O.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
—z
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
I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
S
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
j
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.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
APR -18-2000 09:47
i
WESTERN INSULATION`•
909 686 8786,, P.06i13
WESTERN INSULATION, INC.
1211 Latham Street, Riverside, California 92501
Tel. (909) 686-8760 Fax (909) 686-8786
INSULA'T'ION 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 # 28458-1
LOT# 32 '
SITE ADDRESS: 43580 MILAN COURT
----------------------------------------------------------
EXTERIOR WALLS
MANUFACTURER: Johns -Manville THICKNESS: 3 5/8" R -VALUE: R-13
CEILINGS: CAT�TS BLOW
MANUFACTURER: Johns -Manville THICKNESS: 13" R -VALUE: R-38
CEILINGS: BATTS BLOW
MANUFACTURER: Greenstone THICKNESS: 10.3" R -VALUE: R-38
,
-----------------------------------------------------------------
GENERAL CONTRACTOR: TRADITIONAL BUILDING
LICENSE NUMBER:
BY:
TITLE:
DATE:
INSULATION CONTRACTOR: WESTERN INSULATION:INC.
LICENSE NUMBER: 481278
BY:
TITLE: PRODU ON MANAGER
DATE April 17, 2000
F]