9912-076 (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
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
79465 B u' /28l20i
Date 7 Signature of Contractor
A04 d
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 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 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.
rov Il Fl UND 061., 0 55-95
(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 shall fo hwith comply with those provisipn's.
Date: �� Applicant—
Warning:
pplicant 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 ins ection purposes.
a
Signature (Owner/Agent) b Date _)l jl
I
BUILDING PERMIT PERMIT#
DATE VALUATION SI LOT TRACT I�b,2S3.:�C9 113 284.i8-
JOB SITL
ADDRESS t 78-535 Iii WLES DRIVE
OWNER
CONTRACTOR/DESIGNER/ENGINEER
CORP
'.t`1'NAI)1 f10NAL t31.f1LDING CO INC
8,615 i' ULL'S 1=. RIE
78615 NAN ES Dit
LA QLAN'1•A C;A. 92253
LA C)UINIITA Ott. 97.254
{ 76.(1)772-0222 MN. 5750
USE OF PERMIT
SINGLE FAMILY DWE1,i,DNIG
SFD--PLitN 313, LO T#1S.Pff"Ii' DO r-, N 0 T INi", ODF BL0<- WALLS OR
f'air?tX,,1'LM 04 IX),. ]FEF. 1t I UCIAD MY 75".o FOR Mi)I.•f.'IPLE 13SUAtNC;E 01-
SAME: PL A14 TYPE.
1►QAC` CONu'I'12LICTIP14 _'.,0:125.00 3F
tPOR(1•1 K117i0 52.00 SF
0ARA00CAlti3C?RT 439.00 S#r
Er.S:S'IMA11 ED MST; OF CONS;12'€ C ION
PI 1'tWY 1N.91.0 SUMMARY
C0NST.RUG.F1QN FEE- 01 -WO -418-000 $7C►y.St)
PT, 4NcffFS;14 W -F 101-000-119-W $146,913
V CI:TANXM M 301-000-421-000 x+33.50
E is ITRICAL FQ, I01-000-120-000 sm.16
PLUMBING Fids 101-000-419•-000 $140.75
S FRONG 1%407TION lea, - RESIT) 1.111-0ffl 41-1)00
GRIADINCI +i= • 101 S100 -473.O 0 520.04
1NT3:ttitiTRUC."1`URR FRB 225-0011-443-342 s i.90 .Cif?
ART IN PUBLIC PLACES - Y. ,'Slt 701-000-2554)00 548.13
S3.iR aTO.' A1, C;Ohi;.'" LIC110N AND PLAN r_HFGIZ'
05
I TESS PA -1 AID FEES
FEES
$0 C0
TOTAL t7 L 2:E.RMI•i. f1' EES .fiUa. NOW
$3,1 65.95
RECEIPTS {;
r
DATE
By ' ,+'' 1
DATE FINALED
INSPECTOR
J
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
_
/
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
_1'
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
Final
E-- C
Final
POOLS - SPAS
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 LinesJ
/ /
lT Q
Heater Final
Water Piping
/— f
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
kLz–az
Appliances
Final
COMMENTS:
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)
►
WESTERN INSULA'T°IO1N, 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# 18
SITE ADDRESS: 78535 NAPLES DRIVE.
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EXTERIOR WALLS:
MANUFACTURER: Johns -Manville THICKNESS: 3 5/8" R -VALUE: R-13
CEILINGS: BATTS BLOW
MANUFACTURER: Johns -Manville THICKNESS: 13"VALUE: R-38
CEILINGS: BATTS BLOW
MANUFACTURER: Greenstone THICKNESS: ALOE: R-38
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GENERAL CONTRACTOR: TRADITIONAL BUILDING
LICENSE NUMBER: c
BY: Z �`
TITLE:
DATE: 5 D C-)
INSULATION CONTRACTOR: WESTERN INSULATION, INC.
LICENSE N BER: 481278
BY: )?�'
TITLE: PRODUC N MANAGER
DATE JUNE 23,2000