9912-073 (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
759.465 Is" O2i2UN
Date Signature of Contractor hl�_I_'
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
Secti 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.
TA74 F LRM f)(26,'.55 -`s' .
(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 S cti • n 3700 of the Labor
Code, I shall forthwith comply with those provi io
Date: � 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 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'ape-tion purposes.
Signature (Owner/Agent) Date L
I '
BUILDING PERMIT PERMIT#
!3'!_12-49i:s
DATE ` VALUATION)
S14 -.24940 'LOT aS TRACT 2R45i3-3
[[
ADDRESS . 78-565 NES DRIVE JOB SITE
"L
APN
"9 -070-03S
OWNER
CONTRACTOR / DESIGNER / ENGINEER
( y*('�
c�.D'Y' /� 1./; CEM AAE. i ELOPils ':.. T COMP
TRADITIONAL 81JILDiNG' O TWC
79-16i5 :NA.PLES D'I VE
76613 NAPLES DR
LA. QU IWA. Cts . 9253
LA. Q1LI19rA, CA 922_13
(?C%6)772-0222 CAL# 5750
USE OF PERMIT
SP-4GLE PA.%21.LY DWEL1.NG
Fi",-iI; AN. SjAi.O A 15110iWI DOES 140T 114CLUDE BLOCK WALLS OR
V(X.)L.PI,A1V BY 7' °0FU12 ?V11JILTIPLY, fSSUMCE O
AN►P. PLAN ',t.AFPE.
TRACT C;014N'F_E UC:T'sGi3 2.,400.00 Sr,
110R.C-DPA710 1.60.00 9F
GA)tA.Ci11/(7f114k't:lWr 449.(* S1'
ES'.1M TED COST
241,2K3.40
AAUMId FER 31iI\ V
C0NS'1 R.UC V1(_1N FEE 101,WO-418-Qt)i) $786.50
PxXN C:i•1'F:f: K Z*FT-, }01 -MO -439-319 $tris 93
XMCUANl.CriL, M3 101-000-421-000 5C:0.t 0
£; :frCIRICAL FM 10i-000-420-000 S141.48
YLLIA18INUe 1" ki1;' 1.014)13{}-419-UOO $140.75
MONIO M(MOtq FrF - RySin Mi -OW -24140) 0414.12
C RAD.1NG 1 101 -WO -423-000 $20.M
DEMOPFIR 1Nft1ktur lrLfi 51,91370
ART 1N 1'l1BUC;1sL7lt:%S - REM, 701 -WO -255-0190 3 103. 12 '
S;11B'1'�'1'A },, C�Cfi�l S t �i.fiC` j��Aj .ANT1 Fri, r�7�j t "i �} C k,
LESS PRE -I IUD FEES
5,0.00
1703 `A1.,1r�'FRMIT FECS MAP, NOW
$3,354.9$
RECEIPT
DATE
BY `
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
"-�T�
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Z.. 2 _p p
Return Air
Steel
Combustion Air
Roof Deck
p� _ =y
Exhaust Fans
O.K to Wrap
—_ —pv
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
—C
Drywall - Int. Lathe
Final
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 Lines
_ J _
—�/ `
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral�/�
Pool Cover
Sewer Connection
�T
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
pp
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)
. QO47
RF�O
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# 15
SITE ADDRESS: 78565 NAPLES DRIVE.
------------------------------------------------------------------
EXTERIOR WALLS:
MANUFACTURER: Johns -Manville THICKNESS: 3 5/8" R -VALUE: R-13
CEILINGS: BATTS BLOW
MANUFACTURER: Johns- anville THICKNES UE: R-38
CEILINGS: BATTS BLOW
MANUFACTURER: Greenstone THICKNESS: 10.3"VALUE: R-38
GENERAL CONTRACTOR: TRADITIONAL BUILDING
LICENSE NUMBER: cc Q
BY:
TITLE:
DATE:
INSULATION CONTRACTOR: WESTERN INSULATION, INC.
LICENSE NUMBER: 481278
BY:
TITLE: PRODU PION MANAGER
DATE JUNE 23,2000