9912-078 (SFD)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
Profoasionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
DatA C Signature of Contractor i
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).
( ) 4, 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
p ormance of the work for which this permit is issued.
SeI have and will maintain workers' compensation insurance, as required by
ct, n 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 should become
subject to the workers' compensation provisionWofSe ion 3700 of the Labor
Code, I sla1�lllfufol�rtthccw��ith comply with those provisi
Date:r" 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 inspeclion purposes.
Signature (Owner/Agent) _J4_ rCJ f Date at I 4M
BUILDING PERMIT PERMIT #
9y2.%-4F7K
DATE VALUATIONa1),3i4.,60 LOT 20 TRACT 28458 1
1 s
ADDRESS 78-5l� 1 NAJ1�9 E.S ll'.�iU'VE
APN - 609-470-039
OWNER
CONTRACTOR/DESIGNER/ENGINEER
;y�j�.',�:a;f'�
ITUX:01110NAL BUILDYNG CO INC,
"te-ti1.= s"kS,P .3 T31 LS 1~
79615NNPLES DR
LA QUINTA Ute 92253
LA QUffiTA CA. 92253
(7()01772-{122'21 C 8111: 5750
USE OF PERMIT
q
;SINi�I,�: NAA`11�..�`.UV1f�L,L,1laT1;j
"
A,i ii l l"a:uti DOES NOT INCLUDE BLOCK WALLS O
�3wd�
irrl,3C.)I-111,AN GrfL�l�.i 12 L+UC tAJ f�,' 73�f� �'!Jtt �tUlr4�'f-t�� l: 13.8-UA.NCU OV,
SAM, PLAN TY -P :,
/
TRaVCT C.ilNSTiU1e:—MON 2,200.00 S
L'tJT.GI•FfPAl1O 110.00 u,F'
0A1t.AUWC:ARVXAt1' 4710) SF
41.�ffl 6lYn�'�!L'.��J.S IJ3��' 4.`�A�v t.`FL 1�1.T�\✓1. Yi
AdN�l4WLft�'
PERMIT r, E, E MMMAWf
CONSTRUC1'1C91+ FEXT 1411-000-4111.000 $748.00
IN, AN0;W77(,' alit;. 101-00()-439-31: S35469
JJLJ71 `1IAMT CAL..11703 ILII.0013-4a 1-M ;&60.00
13l:tst. TRICAL FEE 101-000-420-000 S l3•-4.92
Pf.(YVIbJNU FEF itis -000- i:194M 3140.75
T1?ONO 11�tOT;nN 'rVC _ R c `rt ? j -000-241 -MO $13.41
GR Af),ING n` X 101-0'?4: 1 �3 !li?(l Stifi.�3t
'
G8"4VQ',0P'J12R AWAICT HE-
ART 1?J,E'U'BLIC VLAC.K5-!d-.:,3 � 701-lifkl-M-000 $75:39
ART
`4 S•1 -')°(`MAT, t",ONS'FRIXIVION AND PI. -AN t`TIEC K
$3,153,77
LESS 1'RE-PAID FEE'S
$0.00
'.5'MAL J?'Iif;4dMU 1N'I',LTN .DVUI NOW
5.3,25177
RECEIPT``
DATE
BV y f
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings
Underground Ducts
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
F.A.U.
FramingCompressor
Insulation
s —per
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
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 I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste lines
Water Piping
Heater Final
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
Utility Notice (Perm) $'
COMMENTS:
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 # 28458-3
LOT# 20
SITE ADDRESS: 78515 NAPLES DRIVE.
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EXTERIOR WALLS:
MANUFACTURER: Johns -Manville THICKNESS: 3 5/8" R -VALUE: R-13
CEILINGS: f BATTS BLOW
MANUFACTURER: Johns- THICKNE=7"": R-38
CEILINGS: BATTS
MANUFACTURER: Greenstone THICKNESS: 10.3"VALUE: R-38
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GENERAL CONTRACTOR: TRADITIONAL BUILDING
LICENSE N MBER: 481278
BY:
TITLE: PRODUC I N MAP
DATE JUNE 23, 00
iTERN INSULATION, INC.