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9912-061 (SFD)LICENSED CONTRACTOR DECLARATION I herehy affirm under penalty of perjury that I am licensed under provisions of Chapt6r 9 (commencing with Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. License # Lic. Class Exp. Date 759465 13 t)2tai2t7f Date ;'; Signature of Contractor 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 i 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. (1�2, 1 have and will maintain workers' compensation insurance, as required by Se tl 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. ::TATE t FIND 0.526155.93 (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 Sectio 3700 of the Labor Code, I shaIJ forthwith comply with thoseprovisi • n . Date: 7 Applicant Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application Is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his application. 1. Each person upon whose behalf this application Is made & each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Ouinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for inspection purposes. Signature (Owner/Agent) �� a Date' L� t PERMIT # BUILDING PERMIT "12-061 DATEh� ( VALUATION �d: LOT TRACT 2945R -3i �F1Io1. 1013 SITE , 7$-514N"LESDRIVU APN ADDRESS OWNER CONTRAQCTgOR // DESIGNER / ENGINEER ATJ V.1 Olt 4LL! rJk, %,4,L --t i1iIAL4 J, l..V .EO T641i.1iJk i.tV K(6. 1.3T TIT ti.v i4�C 78-61 5 hIAI'I.ES DRIVE166.15 NAPLES DR LA, Q1141vTA. CA. 92253 LA QUINTA CA 92253 (760)7-r..,-0?22 CRT,# 5750 USE OF PERMIT 11NOL.E FAMILY Y )>iWELLF90 k 817D -114M 3131.' C?T#3.F:E ZWT11 DOES NOT IMM'ti113f~•: BLOCK WALLS OR / 1.[Ct9C 1 LLl.K,", A Illi.• d _0N 2 Vb.),m ®r �' PORCI IPATI© / $2.00 S.1: t,tA AAGWCAftK:31Vf 4? .1f0 SE .f�pT 71 ��j+ SUMMARY q 11CRINUT FRE 1Y�JSvx�4)[-'�.RY CONSTRUC".CION r'E, 101.000-418-000 iar,AW C:`ffgCK. f, -VP, 101-000-439.31F $597.94) N2112 C..0 IANtL`AL 0.72 101-000.321-000 $53.50 I iX.Cf`11 CAL IEEE 101-000-420-000 S128.ib PL1J f 110 FHE 101-000-419-000 $140.75 4'r;znnrrArfO'r'1(w1'•T:a -r-,81T) 10)-000-241 -000 $1!.93 GRADING M11 10)-000-423-000 $20.011, JNFJ1.AS`1 RUC CURE FFE 225-000-443-342 $1.907.0 Atrf lief Pt}'l3uc PLACr d ' - l2FSIf.: 701 -01W -255 -ft) $45.13 l f1;-'6Y'1frA1:, l ONSIi3U(:;4.ON -AND 1'I.AN CHECK $3,6M 87 L IF SS PR E 4 'A 1D + E $0.00 TOT.M, PERMIT Fl✓1!»St AYlX NOW' REFF,IP`r DATE BY 1 DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Forms & Footings — e�t Underground Ducts Ducts Slab Grade �-- 9�p� 6' ` Return Air Steel Combustion Air Roof Deck Exhaust Fans CK to Wrap .— C5 -p F.A.U. Framing Insulation Compressor Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall "--" Exterior Lath Drywall - Int. Lath _ Final i D—Ott Final •- - oo 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 Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines f Heater Final Water Piping / 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 02 0 Final O — 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. 71-'00— Smoke Detectors Temp. Use of Power Loe Final pq Utility Notice (Perm) COMMENTS: JUN -23-2000 11:30 WESTERN INSULATION 905 SSF 9?9 P.04i25 mmsirERN INSULATION, INC, 4211 Lutthm. Street, Juvemide. CWiforinin 92501 TeL (909) 686.870) Fa:c (904J iN-8786 INsULATi®,ff CEIR MICATE THUS 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 1.0CATED AT: TRACT / PHASE: BELLA VISTA. -FRACT # 28458.3 LOT '# 3 SITE -ADDRESS; 78524 NA,PLI?fi DRIVE. ..�..........------..------------------------------------ F�T�IQ MANUFACTURER; Joh ns -M eTHICKNES.S: 3 518" FINALUE: R-13 S(i�,t�i9 BATT BLOW MANUFACTURER: Johns -Manville THICKNESS: 1 LUE; R-38 CEILINGS: BATTS BLOW MANUFACTUREEI: Gtoonstone THICKNESS: 10.3"VALUE: R-38 GENERAL CONTRACTOR: TW►D TiON;AL BUILDING LICENSE NUMBER: BY: TITLE: DATE: ^® N16SULAF-T1- N C0IVTRAQT0R: WESTERN INSULATION, INC. LICENSE NUMBER: 481278 BY: 1 TITLE: PROD TION MANAdEFY .2000 DATE: JUNE 23,