9912-064 (SFD)LICENSED CONTRACTOR DECLARATION
I heroy 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
759465 .8 02/nfloi
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 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.
W I have and will maintain workers' compensation insurance, as required by
Sec%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.
S1'J1a1~ 1VNLS ( dG355 7�u
(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 Se tion 3700 of the Labor
Code, I shall forthwith comply with those provisib `s
Date: > �� °t Applicant r ,
Warning: Failure to secure Workers' Compensation cov rage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) — v , Date IL1I
BUILDING PERMIT PERMIT#
DATE 6
VALUATION ;t!13(p,t:#� LOT TRACT p;
j
)II #tGrt
JOB SITE ADDRESS , £!-560 NA�'l. S DRIVE
APN "94764338
OWNER
CONTRACTOR / DESIGNER / ENGINEER
ADVANCEIa DHVEI OP111.411UT ' CORP
T3 IMi` 1101,1111 ,, BU11LDR111, r Cts D11
79-613 NAPL8S DRIVE
78615 NAPLES DR
LAQUINTA CA 92253
LA.QPSI+MA) CA 92253
(760,072-07,72 CNf•,O 5750
USE OF PERMIT
aVKCaU PAWL -V DWELLING
S MILA144A1R L0T/,{6T'UMMIs: I'Oa NOT MCLUDE BLOCK WALLS OR
.PQUL.1LAN (,HECK, F'ltiti REI:itic;ED tW' 749/6 F0R 1VtU$..Y1VLE IaSIlANC JF OF
SJYIv F PLAN T Y PEP.
CON ARUMON SF
F� izeafd=r',.3' o 310.00 W
OA.kAfrWCARPOWY 471 -(At) SF
LSTIE.`I. ATED COST 01F i.^..MSTI R'Ul�". FRON'
130,sTI-i.a60
P.ERiIWI F.E X, i30-tM1R Sr
f 0V.'7T'Rt7C"t'tr N FEE 101-000-418-000 $748AQ
4161.)
P1AN t;qKK x.T-,F 101 -WO -439-319 W4161.)
14fl C3IAN11C1V, rMiT 101 -OW -4111.000 $60.01
01JI ;'41RI AL FEE 101 -OW -420-000 S. X1.12
4I.,tilNWI1 Q M 4.01-01X9-44t-(}iDti Sl4fi.7S
z�;01-000-2 !-OtyO S17.f>
CMDING 11cr: 101-000-423-000 S20.tT0
DLitTLOP►ii'k .%VACT )TTL 3I, 7.tifi
A16' fair IJBLIC; PLAC.`S. S - RESIC 701 -OW -255-000 $75.39
8i..1A-'T'DT"AL CoNS'i'1tC TC;nON AND PLAN CHECK
$3,253,77
LESS, PRE -PAID FEES
X0.0;1
TCD AI, PERMIT FE ES DUN: 4R1O%V
x+3,2$3.77
RECEIPT
DATE _
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
76Ducts
Slab Grade
—02 (ya
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
_&W
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.Q.
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
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
/ J '
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
FinalI
r'BaUtility Notice (Gas) E�!,o
ELECTRICAL APPROVALS
Temp. Power Pole ,
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors —pr)
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
-
:FUN -23-2000 11'32 WESTERN INSULATICIN 909 686 87E6 P.07/25
iJi L 3, "AW IN;51EYL STI®N, INC.
4211 Latham Street, RMnide. California 92501
Tel (909) 686-8760 IhK (9439) 686-8786 '
INSULATION C 4EIRIt 'IFICAT
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 *rwkc-r # 28458-3
LOT# a
SITE ADDRESS: 78560 NAPLE-) DRIVE.
EXTERIOR ---------
-----------------------------------------------
MANUFACTURER: Johns-ManvilleThICKNESS: 35/8' R-VALUE:,R-13
CEILINGS: Al TS BLOW
MANUFACTURER:Jahns- vi
THICKNESS: %13"VALUE: R-38
CEILINGS: BATTS BLpy�
MANUFACTURER: Greenstona THICKNESS: 10.3"VALUE: R-38
OVE-RAL CONTRACTOR: TFLADITIONAL BUILDING
LICENSE NUMBER:
BY:
TITLE:
DATE:
U.SULATIQN O IT CT R: WESTERN INSULATION, INC.
LICENSE NUMBER: 481278
BY:
TITLE: @PRODU LONLMANWAGELV---
DATE! JUNE 23,2000