SFD (9910-058)LICENSED CONTRACTOR DECLARATION .
I hereby.affirm under penalty of perjury that I am licensed under provisions of
-'ChapteF 9 (commencing with Section 7000) of Division 3 of the Business and
Professi6nals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
`159465 13
Date Signature of Contractor 0 ; WAJ'&
OWNER -BUILDER DECLARATION
I hereby 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).
( ) 1, 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:
Canier Policy No.
STATE17UND
(This section need not be completed if the permit valuation is for $1 00.00.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,41sha ply with ose prvisions. -
fo
Date: C
W 'g.
arnii . Fa"il e Workers' Compensation coverage,is unlawful and
shall subject anemployer 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 /017
PERMIT#
BUILDING PERMIT
DATE i twow i, 9,.9VA LU AT I ON LOT TRACT
JOB SITE
ADDRESS
OWNER
CONTRACTOR DESIGNER ENGINEER
ADVANUCTED DEATILOPM,"Iff CO'��P
IRAIDDRONAL
1
18615NAPLES DRIVE
7861.3 NIVLES DR
LA OUINTA tA 9225-4
LA Q�XMUA CA 91,25,)
USE OF PERMIT
.SNOLK
SWD - 1,6T 21, PLAN QK- NOT INCLUDE, MOCK WAU OR
KXA,750,�q I(EaAK.110N 0N PLAN
OF 3A?VtE.,1)(.At4 TYPF
TR kCT CONSTR U C*T 10 NK ZNO 00 SF
POKCII&M 10 110.411 3,V
L'Isr. MAXE111) MST or MINIS
PCRMVT FEE SUAINGUAY
(Y)N&YRUCCIVIN FKS 101 -MG -418 -OW
P11 � &VIN MFCKVW� 'i 4., 69
NX.C.1 LANUCAL FIX 101-000-421-000 $0.0)
Elk(AA MOM. FIX
101-0004114-000 .5 140.75
T
DE"t QPER INIPAA!r Pfli
ART IN PAjbLX'VLA(7V13 � IU�ZIV701 -4)V0-255-M)-
8110. IYYr A I (7UNNSTR I -)V110N AM) PLAN V V X
S-3,2 S 177
LrS$ ME -PAID FENS
1XVIVAL VEIRMIMI, FEKS WiC NOW
RECEIPT
DATE
BY
DATE FINAL ED
SPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
6UILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings I -6LAj
Underground Ducts
Ducts
Slab Grade 1 X-1—
Return Air
Steel f
Combustion Air 4
Roof Deck I I 7—/.s —4-D 4�F
Exhaust Fans
O.K. to Wrap I
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls O!e;�
Party Wall Insulation
Condensate Linvo,00-
Party Wall Firewall I
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS -SPAS
BLOCKWALL APPROVALS
Steel
Set Backs
E-1—ectric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PILUMBING APPROVALS
Gas Test
Electric Final
Waste Lines I —lo --27— 4!!!241
Heater Final
Water Piping I
Plumbing Final
Plumbing Top Out I
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Sewer Connection I
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final f
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole I
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures V
Main Service "0,00"r
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors I
Temp. Use of Power 7
Final 51--- Wp--,3;Uj
Utility Notice (Perm)
WESTERN INSULATICIN .909 L786 P. 10/13
IVA
WESTERN INSTFLALTIONt MCI,
4211 Lathain SUr-et, R11'ers'd(4 CALUfilz%lia 92501
TeL (9091686-9760 Fa;c (�O% 686-8786
INSULATION C'ERTIFICATE
THIS IS TO CERTIFY THAT MULATICIN HAS BEEN INSTALLED IN CONFORMANCE WITH
THE -CURRENT ENERGY REGULATION, CALIFORNIA ADMINISTRATIVE CODE., TITLE 24,
STA7E OF CALIFORNIA, IN THE BUILDING LOCA"ED AT:
TRACT t' PHASE: BELLA VISTA - TRACT # 28458-1
L.0T9f 21
SITE ADDRESS: 43875 MILAN COLRTLA QUINTA, CA.
----------------------------------- ----------- ...............
EXTERIOR WALL i:
MANUFACTURER: Johns-Manv#te THICK VESS: 3518"�,R-VALUE:R-13
CEILI_NGS, BATTS
MANUFACTURER: Greenstone THICKNESS: 10.3- RA�ALUE:R-38
CEILIXOS.'
L(B A T T�S BLO . W
MANUFACTURER: Johns -Manville T�mICKISIESS- 13�' R -VALUE: R-38
------------------------ ..................... --_-----------
GENERAL C )LYTRACTOR_-. TRAMIMONAL BUILDER,",
LICENSE NUMBER:
BY:
TITLE --
DATE:
HOULATIO I CONTRACTOR: WESTERN INSULAT-ION; INC.
LICENSE NUMBER: 481278
t3 Y
TITLE: —APFOD IFION MANA&P
DATE May 18, 2000