9912-067 (SFD)LICENSED CONTRACTOR DECLARATION
I he1/.by 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
M465 A 02/20011
Date �, Li 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 fol lowing ;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'df the work for which this permit is issued.
Sp�^l I have and will maintain workers' compensation insurance, as required by
in 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.
"mrr% ,Aeftz',Cc no
al!�at V%JVtU .Aofdtf-oJJ .fo
(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 o Section 3700 of the Labor
Code, I shall forthwith comply with those pro i io
Date: 1-_'JWAQCk Applicant
V, TVT
Warning: Failure to secure Workers' Compensatio coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for insp ctionurposes.
Signature, (Owner/Agent) Date
Ir
BUILDING PERMIT PERMIT#
9912 -067
DATE (F VALUATION S119.253.% LOT TRACT 28458 -JOB
SIT21
ADDRESS$ 78-59 NAPLES RIVE
APN 609-070-033
OWNER
CONTRACTOR/DESIGNER/ENGINEER
ADVANCED D1=! ELOP.11 E rr CORP
i`fd.t-*.)t1'IONAL BUIFLODIN10 CO INC
78615 NAPLES DRIVE
78015 NAMRS DR
1..& QUtN l'A. CA. 92153
LA QUINI,A. C'A. 92253
(700)772-02`2 CIAIN 5780
USE OF PERMIT
SINULA, .1/A141l L Y� :L)W. l.Ji,lNU
0:WILAN;t1IRIOT49.1 URAE T DOES MC UM BLOM VIALLS OR
PUO) .PLAN Ci-tt`s[ KYJPXkP— WC;E0 8Y 75%.FOR MU1A'.1PtX t SUANCE (.)F
SAA1% PLAN 1TP&
It RZACT +„0 43 a UC ioN 2,065.00 of;
P0RCt TI.PXf,.0 52.00 3F
t. �A3t.E1G13/i:Aftk0k0' 439.00 SY
ij CTal1 A 11°0$1 SlYN4"r nil
.Y..,.1.i.,DJi►tf .l JWc# 41llL'9.� 60II' %_1kA ,kV A&%1U%. Y&%., -I
d[C�
AA.? IC,J.1..
C(�, STRUi; fit N FEF 101-000418-M 570:+.50
P1, A'N KF (79 is (TT 1101-M-439-318 %14699
ivtly-ZILNNICAL t sX $5:1.50
fsl EC',M tCA% CE~ 3 101-000-420-000 V28.16
1�1.�11V1HiNC11 E 101-000-419-000 $140,75
C11ADINC 0130 101-000-12-1-000 V0.00
1NrrtA,8TRJU rl"-u7fi FU- 225-000413-34:2 $1,907.00
AWr tN PUALLC PLACES - .IZES11" 701 -M-V;5-(K1,0 sm. 13
,11T3-pO1ALr.n_ �.° r?UIrry AND PTANrH1.C1
$3,1.6505
LESS PRIE-1111€) PEES
$0.00
TOTAL PERMIT FEMME E a OW
$3,165.95
RECEIPT
DATE
BY r /
DATE FINALED
INSPECTOR
* �_
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
_�j,�
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Flo--p-b
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
Insulation
pU
Compressor
Vents
Fireplace P.L.
_
Grills
Fireplace T.O.
Fans & Controls
_
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
_
Final
Final
BLOCKWALL APPROVALS
Steel
POOLS - SPAS
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��
Sewer Connection
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbctures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final y
Utility Notice (Perm)
COMMENTS:
%
'fUN-23-2000 11:33 WESTERN I NGULAT' I CIN 909 b86 8790 P.10,25
viEwrERN INNS LA�iONINCo
4211 Letham Street, R7v vide, Calitomia92501
TeL (809) 686-87150 AX (919) 68f,8786.
INSULATION C"ERTIFICATE
THIIS IS TO CERTIFY THAT INSULATION HAS BEEN INSTALLED IN CONFORMANCE WITH
THE CURRENT I_NERGY REGULATION, CAUPOF:NI.1k ADMINISTRATIVE COC4=, TITLE 24,
STATE OF CALIFORNIA, IN THE BUILDING LOCATED AT:
TRACT / PHASE:- BELLA VISTA TN%CT # 28458-3
LOT# 9
SITE ADDRESS: 78558 N/kPLE.5 DRIVE.
MInERIOR WALLS -
MANUFACTURER: Johns-MdnvilleTH`I�C(14 ESS: 3 518' R -VALUE: R-13
SLOW
MANUFACTURER: Johns -Manville �THICKNEiS: 1�ALLIF: R-38
CEILINGS; BATTS /� BLOW
MANUFACTURER: Gre&nSlone. T-IICKNESS: .VVALUE: R-38
GENERAL C®NTRACTt�R: TR4DITIONAi. BUILDING - - - - - - - - - . - .
- -
LICENSE NUMBER:
BY:
TITLE:
DATE:
Mir TI®NL=NTRACT0R: W=;;TERN INSULATION, INC.
LICENSE NUMBER: 481278
BY: Awup
TITLE: PROD CTIONVA-NAGEqV
DATE JUNE: :,2000