SFD (9905-055)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.
Licensgit Lic. Class Exp. Date
759465 'f32!28120(
)
J
laet � 11<t 1�� , Signature
of Cont�actorr! {' ' t f 1
r
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.
(t) 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.
TiM P1;y D tNiX355-`:3
(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 SeCtioan!"300 of the Labor
Code, II shall fgrthwith comply with those provisions
Date: /���/"� Applicant Zk w 0 6 / k
Warning: Failure to secure W k rs' 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 JI
99fir'+-+715.5
DATE VALUATION 5,08,611,3.4 LOT 29' TRACT 29458.1
JOB SITE _
ADDRESS 43-665 MILAN COURT
APN
60.070-034
OWNER
CONTRACTOR / DESIGNER / ENGINEER
ADVANCED D}:'SIls1.Ok'MENT CORP
TR11,1?CCK)P'AT. BOULDING CCI' INC
78-613 RtWLES DRIVE
78613 NAPLES Ata,
LAQIJR1 TA C.A. 92253
LA QUINTA CA 92253
(70)77'-0222 0111.4 5740
USE OF PERMIT
fi11`lir1�.E A�i� Y 1 WEH, .ANO
SrD - LOT 28 FLAN 2A - PERMIT JDOES NOT INCLIME OUXX X t7L'ALL 0R.
t: -WL. 475",p ELAN{."NF1 Y► FBI: REL) K_ -.r.( )N F0X MUt T11)J ? V913U r' W11i O
SAME, PLAN T"YPI3.
IRA(r oNsni 1iC'.iiON I's. tSc? IT.
110RCHIPATItQ 76.00 SF
0A1tA.GFJCA1WOWf 409.00 yF
US T I M ATC,, )) CCi.'C'Y7 0 F MNSTRUC.fION
l tt8,613.40
fIERMIT FEE SUMMA RV
CONS'11RUC'PTON Fi3Is' M -000-4184W 5671.00
PLAN (IIF;C"K VI -E, 101AM-439-318 Silo -U6
MEC"TLMOC:AL F M 101-000-42t-000 Sd 7 JX)
ELEsCT'RWAL FUE 101-000-420- )O 812.0.1 ,
PLUMBING F'Els' i0i-OC)041Y-+DUO 5134.75
5'T )NO Mt3'ritaN n- iii - R.Fs.311) 1014W,-24.1 -CHH} Si(,W)
GRADING FEE 101-000423.000 $20 (0
iNFRA,TPREit"£17 E F;c.�F.'s '125-W)-443-342 5':»421.111,
A129' IN PUBLIC: PLA('ES - REST 701-000-2-55-000
a
SLfti'itTi A.f, COC i.T Mf TCTON AND K -AN fT!FCk
$3,58S91
LESS' PRE -PAID ?EES
SU w
TOTAL PERM ff FEE'S i)UE NOW
$3,-.45.93
MAY 171999
BY DATE FINALED INSPECTOR
V,
INSPECTION RECORD
`OPERATION
DATE
INSPECTOR
OPERATION
DATE
I INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Stab Grade
Return Air
Steel
Combustion Air
Roof Deck Z — — G
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
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 S25
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral r7
Pool Cover
Sewer Connection
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 =_0_0
Utility Notice (Perm)
APR -18-2000 09:4e WESTERN INSULATION' ora,q r' 909 686 8786 P.10/13
y ,
.y
WESTERN INSULATION, INC.
4211 Latham Street, Riverside, 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 # 28458-1
LOT# 28
SITE ADDRESS: 43665 MILAN COURT
------------------------------------------------------------------
EXTE_RLOR WALLS
MANUFACTURER: Johns -Manville THICKNESS: 3 5/8" R -VALUE: R-13
CEILINGS: BATTS Y BLOW
MANUFACTURER: Johns -Manville THICKNESS: 13"' R -VALUE: R-38
CEILINGS: BATTS BLO W
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: PRpU TION MANAG
DATE Aoril 7.2000
Apr 28 00 09:<39aTraditional Design Cen't.er 760-674-166EI p.4
FELLA. USTIL
RELEASE OF RESPONSIBILITY
LANDSCAPING
I,•, —, , purchaser of LotL_3_ Pliase 5(fat Bella Vista Homes,
hare" cknowled e t ,6t purchasing the furnls e—d L•-ndscaping in the front yard within
ttie price of my hohml will receive at Close of Escrow IS /Lcredit.
I understand that the City of La Qulnta requires front yard. landscape with all new construction.....
therefore I agree to install my front yard 15 calendar days of file Close of Escrow. I will receive the
a':,ove credit from. Traditional :Building Company DesiLra Cun.ter as soon as the yard is installed.
I :?.iso acknowledge this action voids any landscape warrantee.
Date: p Buyer.
Dater _ Design Center: