SFD (9910-049)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Cha . pter 9 (commencing with Section 7000) of Division 3 of the Business and
Professionals Code, and.my License is in full force and effect.
Lijense #
Lic. Class Exp. Date - -
7.59465021170201
,Date I Signature of Contractor
0
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that l'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).
( ) 1, as owner of . the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
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 i 'declarations:
I have and Will maintain a certificate of consent to self -insure for workers'
compensation, a§ -provided for by Section 3700 of the Labor.Cocle, for.the
performance of the work for which this permit -is issued.
. ( ) I have and will maintain workers' compensation '. insurance, as reqbired 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 I -T NID
(This section need not be completed 'if the permit valuation is,for. $100.00 or less).
O 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 a4ree that if 1. should become
subject to the workers' corripens6tion provisions of 'Section 3700 of the Labor
Code,s6V �P.14hyqi h comply . with those provisions.
\,Pa - te: Aopl . icantI-i".220",
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal 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. i
IMPORTANT Applicati6n is hereby made to the Director of Building and Safety
for 'a' permit subject to. t he"conditions and, -restrictions set forth o n his,
application.
Each person upon Whose.behali this application is made & each person at
whose request and for whose benefit work is'performed und.er.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 commented 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..1 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.
gnature (Owner/Agent)ate
S.
BUILDING PERMIT PERMIT#f
.991040
DATE 1(V(),71..1"VALUATION fi -i3o'Ir LOT T TRA
?A C
ADDRESS SIT' 785MLAN 30T
APN
OWNER
7861 `7 14APLES DRI VE,
LA QMtVCA, CA 92,753
USE OF PERMIT
SINGLE P.AMUY D-WELUNG
CONTRACTOR / DESIGNER / ENGINEER
Tllfid.-010N At. PH JILEUNG COIN -C
7861 _°F NAPLE, S DR
LA QUINTA O� W'2$3
1 57 _V
,760)772-0222
SFC)- LOT 24, PLAN- 4AR INCLUDE WAiJ.
OR POOL -
I
TRAC7r,0T4STKUC`]7KYM Z-Aco.00 SF
Ctti€<Raifklf,'114CFy% E3'4'. 471.00 IV
'0
NSFIRAY7110N,ANID PLAN .1,CK
"I.ESS PRE -RAW FIFES
TU17AL M RMIT FEES 01) V, NOW
V
RECEIPT I DATE I BY jj I DATE FINALED I INSPECTOR
130�154.60 -
U,717.82
PFRA41T FE�;: SITMAIARV
PV_ I." CHEK%11. TITS
1014M -4V--318
'�MCHANIWAL VVI3
10 1 XDQ0-42 1, J) MH
VLEC7171CAL Frr"
16
5134.92
:G1;.AMNO 1171M
.101-000-423-000
1XVVELOPEW RAMCT FEE
010111,00
m 70i4ft-255-000
Awr IN tr0HLfci,)ts - AZ,,FREs
19
'0
NSFIRAY7110N,ANID PLAN .1,CK
"I.ESS PRE -RAW FIFES
TU17AL M RMIT FEES 01) V, NOW
V
RECEIPT I DATE I BY jj I DATE FINALED I INSPECTOR
130�154.60 -
U,717.82
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS_
Set BacksUnderground
Forms & Footings
Ducts
i
Ducts
C
Slab Grade 6'
Return Air
I
Steel
Combustion Air
Roof Deck
Exhaust Fans
I
O.K. to Wrap (yp 195V-
Framing
Insulation
F.A.U.
Compressor
Vents
d i,Jy
1 (�
} -
Fireplace P.L.
Grills
I
Fireplace T.O.
Fans & Controls-
I
Party Wall Insulation
Condensate Lines
p .
Party Wall Firewall
l
Exterior Lath
Drywall - Int. Lath
}
1
Final �_ �
Final
}
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
i
Set Backs
Electric Bond
t
Footings
Main Drain
}
Bond Beam
Approval to Cover
i
Equipment Location
}
Underground Electric
I
Underground Plbg. Test
}
Final .
Gas Piping
PLUMBING APPROVALS
Gas Test
i
Electric Final
f
Waste Lines a . 27_ C%
Heater Final
Water. Piping
Plumbing Final
f
Plumbing Top Out
Equipment Enclosure
I
Shower Pans
O.K. for Finish Plaster
I
Sewer Lateral /_
Sewer Connection G
Pool Cover
Encapsulation
d
Gas Piping
I
Gas Test = —dam
}
Appliances
Final
I
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Widng
Fixtures ..s
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final pl9D
Utility Notice (Perm)
9AY-16-2000 11:56 WESTEPN INSULATION
909 666 3766 P. 13/13
tC
W- M TE INSULATION, iNIC% o
423.1 Latham Strout, Rtverside, Cablarb 92501 '
TeL (909) 686.8760 ]-ax 1919) 686-8.786
INSULATION CEM-TIFICATE
THIS IS TO CERTIFY THAT INSULATION HAS SEEN INSTALLED IN CONFORMANCE WITH
THE CURRENT SNEERGY REGULATION, CALIFORNIA ADMINISTRATIVE CODE, , ITLE 24,
STATI: OF CALIFORNIA, IN THE BUILDING LOCATED AT:
TRACT / PHASE: BELLA VISTA --TRACT # 28458-1,
LOT# 24
SITE ADDRESS: 43785 MILAN COURT LA QUINTA, CA.
-- - - - - - - - - - ----- - --
EXYEI�I�LLS e
MANUFACTURER: Johns -Manville THICKNESS: 3 5/8" R -VALUE: R-13
LII+IGS: BATTSI---I z90
MANUFACTURER: Greens ton ICKN ESE1f: 10.3" R -VALUE: R-38 L
CE9LIIVGS: BATTS BLOW t
MANUFACTURER:,' Johns. -Manville TH,CKNESS: 13" R -VALUE: A.738
GEMEM-L Q 1IN T RACTOR: TRADITIONAL BUILDERS
LICENSE NUMBEFI:
BY:
TITLE::
DATE::
C
INSULATION- CONTRACTOR: WESTERN INSULATION,` INC.
LICE14SE NUMBEFI: 481278
BY:� '
TITLE: PRODU TI N MANAGERV
DATE May 18, 00
F
TOTAL P.'3
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