9912-066 (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
11"'Orofessionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date t
J) d FCJ i1�f"<f'YiIA)i
Y
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.
VI 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 y y r Policy No.
r_1 0. A �l E I' UNNT eil �1 15a �i•,J��
(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 sh °II fo' hwith comply with those prj, ns
Date: N 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 rs 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.
Signature (Owner/Agent) Date
PERMIT #
BUILDING PERMIT
[�1a;tir4
DATE VALUATION LOT TRACTJOB
SITE
ADDRESS 1514 4 NAPIX11; DRIVE,
APN 4-070-OZ33
OWNEyRT
CONTRACTOR /({DESIGNER / ENGINEER
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RECEIPT
DATE
By '
DATE FINALED
INSPECTOR
--I
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs (
_ _
/
Underground Ducts
Forms & Footings f
`
Ducts
Slab Grade
Return Air
Steel {
Combustion Air
Roof Deck I
Exhaust Fans
O.K to Wrap (
F.A.U.
Framing ;
�—�a —e> -a 6�
Compressor
Vents
Grills
Insulation
Fireplace P.L.
Fireplace T.O. f
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall .
Exterior Lath I
Drywall - Int. Lath I
E
Final
Final
e
POOLS - SPAS
BLOCKWALL
APPROVALS
steel
Set Backs t
Electric Bond
Footings f
Main Drain
Bond Beam
Approval to Cover
Equipment Location
f
Underground Electric
f
Underground Plbg. Test
Final I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines f
AA
/
Heater Final
Water Piping I
Plumbing Final
Plumbing Top Out ;
Equipment Enclosure
Shower Pans f
O.K for Finish Plaster
Sewer Lateral I
Pool Cover
Encapsulation
Sewer Connection — p
Gas Piping
Gas Test
Appliances I
1
Final
}
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole'
Underground Conduit
Rough Wiring f
Low Voltage Wiring r
Fixtures
Main Service i
Sub Panels f
Exterior Receptacles
G.F.I. S
Smoke Detectors '
Temp. Use of Power
r
Final: —fZ . p•�
Utility Notice (Perm)
JUN -23-2000 11:32 WESTERN INSULATICH 909 696 879E P.08/25
wy
wE%-7'rERN INSUL ATION� INC.
4211 Leth= Street Rfwnddc, CalifomiiL92501
. TeL (9C9) 886.87110 :ieY (979) 696.8786
INSULATION C�:F;TIFICATE
THIS IS TO CERTIFY THAT INSULATION HAS BEEN INSTALLED IN CONFORMANCE- WITH
THE CURRENT ENERGY REGULATION, CALIFOFNIA ADMINISTRATIVE CODE, TITLE 24,
STATE OF CALIFORNIA, IN THE BUILDING LOCATED AT:
TRACT / PHASE:: SELLA VISTA TR)kc-r # 2845841
LO'T # 7
SITE ADDRESS: 78572 NAPLES DRIVE.
EJ(TLRIORYVALI----.....---- --- --------.--- -----------------
MANUFACTURER: Johns- THIC(NEE S: 3 5/8" R•VALUE: R-13
CEILINGS: BATT �> BLOW .
MANUFACTURER: Johns -Manville THICKNESS; '3" VALUE: R-38
,E,IJNGS: BAITS C;
BLO:
KANUFACTUREk Greenstone TAICKNE;iS: 10 -3 --VALUE: R-38
...-------------------•---------
G AL CONTRACTOR: TRADITIONAL BUILDING
LICENSE NUMBER:
BY:
TITLE:
DATE:
PYSULATI N CONTRACTOR: W.::iTERN INSULATION, INC.
LICENSE NUMBER: 481278
BY: a-- 41 -
TITLE: PROM O MANAG
DATE JUNE 2,-:-,2 000