9912-072 (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
7.9465 i3 02128x'204
Date '' 1, Signature of Contractor k t
1
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
p rformance of the work for which this permit is issued.
I have and will maintain workers' compensation insurance, as required by
Section 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.
:i7'r�'i"FUND 0626M.9011
(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, Ishall comply with those provisions.
Date: L � 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, indemnity
& 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.
- �i _
Signature (Owner/Agent) D Date it`
PERMIT #
BUILDING PERMIT
"1"72
DATE VALUATION !S122,$99 10 LOT 14 TRACT 28458-3
JOB SITE
ADDRESS 7"75 NES DRIVE
APN 60.9,070-038
OWNER
CONTRACTOR/DESIGNER/ENGINEER
TRA11-141", 40NAI,111;UMINO `0I IC
78-W5 NAPLES DRIVE
78615 NAPLES DR
LA QU1N7A ('A 92253
LA. QUIN'IA Cis 9225:3
(76017',m-, 4272 C". SIX 57V
USE OF PERMIT
SiNGIX PA1Y IIA UWJ 1UI O
SigT;i-PLAN_+t�-3,1.v�'iFti1'isic ti'.ii�iE+NOT lWIGO-titiltr'6i,WALI,SUK,
.^Ti. K, ♦pri 7 7ntA o , .,0�.1.ti0 .�
tIORC'!f/EIA110 5'.600 Sig'
t.}1Vtrbikl4,`t1K1'CrK'1' b7.S.ui! Sr
E.St:'1;:'���� �.'E:�•s >��?'C'�;SI�'�'i�:l�'i'�Ca11`
i22,�9�3.s1
CONti', Xtif-710N t'FE S729.04)
fn 4Nf"`HT'!,' ti }r IfII_1)ntt..4IR $5=16 21
�„t-CIIAtli("� ,If 101 CW4} 1"2i 00C S "t.ttt
::iLlsi x WCAL ' EE HH -000 -420 -OW s f +t.88
PLUMBINUF•'.#Sk' 101 -OW -42441()t) 310u 7,5
�i'1"►'jO1nIC111Qi T(ON VINT- . RtF RIT? 1014 0-241-001) �I^ '<►
G RAD1NC n,.T' 101-000.42-1-000 5400)
INr-I ASfkUCTURb FEE 225-000-443-342 S1,30'(0)
Ali `I' !N Pi i1tLll TyLAc'€�:S » tt1 S!:!. /01-(YJ0-2:55-C)0'J 1;57.25
AIRA'( MA1, ( i-INIM 121 !t""PON AND PT -ANT {'.1 -Ii CK.
S1,6 O on
1.I:w;; .PR ;SAM, FEES'
$0,VA)
TOTAL PERMIT k'Y98 DUE NOW
$3,639.00
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RECEIPT
DATE r
BY,.. %"�
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings
__
"'
Underground Ducts
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck—/%
�iZ�
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
S �� .,
Compressor
Insulation
�j .- Ub
Vents
Fireplace P.L.
Grills
Fireplace T.O.
,y
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath/—�
Drywall - Int. Lath
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
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
�9-
Appliances
Final
COMMENTS:
Final,- &-
3F
Utility Notice (Gas) I
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) -
:rU14--23-2000 11:36 WESTERN I NSULAT I CIN 909 696 8786 P.15/25
e
INI�•�/�JrM13N9 1110.
4211 LathatA Su=t, .Riv*rs ide, California 92501
TeL (909) 686-87150 Pax (949) 686-8786 .
Il SULATI®N A21EFTIFICATIEw
THIS IS TO CERTIFY THAT INSULATION HAS S;_EN 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 7FW1C'T # 28458-3
LO f# 14.
SITE ADDRESS: 78575 NAPLE:3 DRIVE.
---- -----------------------------------------------
EXl- W
MANUFACTURER: Johns -Manville THICKNESS: 3 5i8" R -VALUE: R-13
CEIILIPdGS: BATTS ~� SLOW
MANUFACTURER. Johns -Manville THICKNESS: LUE: R-38
CEILINGS: BATTS C --BLOW
MANUFACTURER: Greenstane THICKNESS: 10.30VALUE: R-38
OiRA T : TRADITIONAL BUILL)ING
- - - 1— - - -1 - - . - - - -
LICENSE NUMBER:
BY:
TITLE:
DATE:
IN$LATI®I CObITRACTOR: W:Wf;TE:RN INSULATION, INC.
LICENSE NUMBER: 481278
BY:
TITLE: PRODUC. 1 N MANAGER
DATE iJUNE 22,2000
,a;
BELLA VISTA
RELEASE OF RESPONSIBILITY
FLOORING
I, William Schissler, purchaser of Lot 14, Phase 7 at Bella Vista Homes,
hereby acknowledge that by not purchasing my flooring through the Roger
Snellenberger Development Design Center:
1. The flooring allowance I will be credited in escrow is $1,573.00
2. Traditional Building Co., Inc. is only sanding the standard tile areas
(kitchen, entry, laundry). Any other floor prep is the responsibility of
the buyer or their subcontractor.
3. Traditional Building Co., Inc. has no responsibility to buyer as to any
cracked floor tiles, any leaks from toilets removed for flooring
installation, or any other damage caused by flooring installation.
4. Traditional Building Co., Inc. has no responsibility to buyer as to any
paint, baseboard or wall damage not noted at orientation.
5. This is considered a "Bare Floor" closing and the flooring will not be
installed until after title has transferred and the escrow is closed.
Date: �`- �l '-0 Buyer:
Date: 61 — �� 0 CD Design Center: