9912-07 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chanter 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
739465 A (( U2f2zJiii
Date Signature of Contractor ` l
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).
O 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
Se tion. 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:
Cartier 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 provisions of Section 3700 of the Labor
Code, I shall forthwith comply,with those provisions.
Date: Applicant—
Warning
pplicant e
Warning: secure Workers' Compensation coverag 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 authorise -representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) { 0 R t'„ I Date �� t
Il,
PERMIT #
BUILDING PERMIT
9.917,077
DATE VALUATION
14i .40 LOT 19 TRACT 2&459-3
JOB SITE
ADDRESS'18-52514APL ES DRWE
APN
OWNER
CONTRACTOR / DESIGNER / ENGINEER
ADVANCED DEVELO INIENTCOl'P
TRAD1110NAi 13TUILDING7.CO WC
78-615 NA,+PUI'S DMI
18615 NA.PLESDA
I A Cli3.€NTA.. CA 92251
LA QtJINTA CA 92253
(760)772-112.22 C BL# 5756
USE OF PERMIT
SINGLE FAMILY MUL.I G,
SFD-PLAN 5Ai2,L0 #19..1±• WIT DUES 1-40T 'C-+LLLDE BLOCK WALLS OR
PtJfat,,--AIN CHECK MEC IW- QIUC FD 13V '75Yo FOR N01.1:.PLE tS` UA:NCF OF'
SAIwR PLAN VPE.
., .,•. Y,.r..,f,..,...� r
A. RAC l Ci i`> L til C ION Z400.00 31
'c7i2C,'1� ),1 -T7J, 160.0 SF
0A.R A(UWCARPILMI T 449.00 S1:
e
I5Tall WESDcoS' 0r+ CC.IL s•IZ U.11,�:Ol`
141,'24&4'0,
PERMIT
CONSjRILR 1`IU'N r -HE .101-000-418-M) $786 0
pt; AN 01FC`i, FF . 101..OM-439-3I R 96).98
ItMLIT-LAN1 'AL 1111113 gU.1-Q J 1GIpC41i� sif�.ilf1
aEI i•RICAL RW $10.48
I?1 ON41t•304G :£ ER 10J-110)-419-000 $140.75
4'> tz<?f f�f lvri711c�N F , _ xh f0 M-004-241-000 `614.12
`.iRr1,:DING ffT!,lU!-0(;U�4'�.3
UPi- V.Ei.:OPER ii iPAC i' i-:ta-
A ."I' IN PUSL:I[C PLACES - RESIt: 701-000-255-000 $1()3.12
R I?t-'.YGY.At.. C_'0NS'5WC°►_'7(DN AND PLAN CHTFI 1:K
LESS PRP -PAID FEES
$0,00
r
RECEIPT
pry '=';��
DATE
BY y "
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
_
Underground Ducts
Forms & Footings/
'2�
Ducts
Slab Grade
�z•—��
Return Air
Steel
Combustion Air
Roof Deck
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
_ ®p (.,4—
Final Z (yl>
(f
Final
POOL - S AS
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
��
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
- ev
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
100,
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
. 00 1 S
0
of
N�9
WESTERN INSULATION, INC.
4211 Latham Street, Riverside, California 92501
Tel. (909) 686-8760 Pax (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# 19
SITE ADDRESS: 78525 NAPLES DRIVE.
------------------------------------------------------------------
EXTERIOR WALLS:
MANUFACTURER: Johns -Manville THICKNESS: 3 5/8" R -VALUE: R-13
CEILINGS: LATSBLOW
MANUFACTURER:a THICKNESS: 13"VALUE: R-38
CEILINGS: BATTS (K D
MANUFACTURER: Greenstone THICKNESS: 10.3"VALUE: R-38
GENERAL CONTRACTOR: TRADITIONAL BUILDING
LICENSE NUMBER:
BY:
TITLE:
DATE:
INSULATION CONTRACTOR: WESTERN INSULATION, INC.
LICENSE NUMBER: 481278
BY:
TITLE: PRODUC I N MANAGER
DATE JUNE 23,2000
(P