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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