9912-068 (SFD)F -
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LICENSED CONTRACTOR DECLARATION.
I hereby.affirm under penalty of perjury that I am licensed under provisions of
Chapt4Y 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
Date 1 1 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:
O 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.
NY I have and will - maintain workers' compensation insurance, as required by
S&OW 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.
STNI Cl�VI'U• iS�1f�1� 1.7W
(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 forthwith comply with those provisions. y
Date: ! pq4A Applicant
Warning: Failure to secure Workers' Compensation coverag 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 statefthat 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 , #a
PERMIT #
BUILDING PERMIT,��{
DATE VALUATION 7�I�FPx�3Q� LOT TRACT308
SITE
ADDRESSIF z 1ia��syiS I�g 4 ' —
APN Ft�l�'T-9I
OWNER
CONTRACTOR / DESIGNER I ENGINEER
ICED DEVi:l.O}'n,iCNT CORP
': RADIT!CiNAL B1J1.'LDtlet0 C0 .-DIC
78-6I5 NAPLES DRIVE ,
78615NIU-LES DR. ;
LA. QLFfN'I'A CA 92253
LA. WIV T.A. CA 92253
f7(itJ�772�02 2 C L## 5750
USE OF PERMIT
SINGLE F.AM:t.EY DWEL3JCi G
SED -PLAN 6Aci.I.0Witd.PIItaNUT DOES NOT INC -LURE 13LOCK WALLS OR
.t3('0L.
TE�.AC r CONST RUC; i IO'rd 7„ 7o..00 SP
PORCllr't XfJo 90.00 SF
r
OAltAeaWCAIAWOR T 598.00 SF
}.Y .01tNA f•A J'4 V�v,A W�.���il/A-V�AiA AIS.. Y.Y4✓t ti
�lM7.d:,JTF9•�V
CON TR-U(7fION 0:E,• io1-tom �I:a�s-qua s�R6fl.ct0
P'€,nN
R:tMIA19CA1.I� E 592.00
�
Ei EMt'RICAL FUZ 101 -WO -42040
PLUMi iwaFHE_ 101-000-419••M $1615,01i
STRC?Nf \.ttae'f, t !?►-f7ESID 104-M-24'1-�3i?rl
GRADING I7M3 101-M?t)fl-423 000
DC-VELO-P-0t RAP ACT ITE
PRLA',ISE'PLA25 li}!-ppl)_E i1-.395 $125.00
ART INPiffai,t(' PLA.C?:S - I��SIC 701-fNiOt►-25g-0110 �1.5;_z7
SUB-•din•AL l„",C)i+15'MIK—'J' ON AND .4'1e11�t°y�,�CHECK
<$4,RQ':.,(9,57
'7y y 7 r,��
AXSS 9: pllr'�.�`1.V �f�L�ES
$0.00
T!:9.9'A.l., .€°fr.ltN,1 T 1+'EEN .DUE NOW
54,3:19.52
,
RECEIPT
DATE `
BY' ter'
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION,
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs I
Underground Ducts
Forms & Footings i
Ducts
Slab Grade !
Return Air
Steel i
Combustion Air
Roof Deck ?
s&0
Exhaust Fans
O.K. to Wrap 1Z.7
—49
F.A.U.
Framing {
Compressor
Insulation i
Vents
Fireplace P.L. i
Grills
Fireplace T.Q. t
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath {
Drywall - Int. Lath 1
t
I
IFinal
Final t "
BLOCKWALL PPROVALS
POO - PAS
steel
Set Backs {
Electric Bond
Footings !
Main Drain
Bond Beam i
Approval to Cover
[
Equipment Location
i
Underground Electric
i
Underground Plbg. Test
Final {
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines i
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
.–vo
Gas Test I
Appliances {
1
Final
{
I
r
Final !
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring I
Low Voltage Wiring
Fixtures {
Main Service d
Sub Panels I
Exterior Receptacles
G.F.I.
Smoke Detectors 1
Temp. Use of Power
I
Final i
Utility Notice (Perm) 137
COMMENTS:
�01
WESTERN INSULATION, INC.
4211 Latham Street, Riverside, California 92501
Tel. (909) 686-8760 Fax (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# 10
SITE ADDRESS: 78608 NAPLES DRIVE.
-----=-------------------------------------=----------------------
EXTERIOR WALLS:
MANUFACTURER: Johns -Manville THICKNESS: 3 5/8" R -VALUE: R-13
CEILINGS: BATTS BLOW
MANUFACTURER: Johns -Manville THICKNESS: 13"VALUE: R-38
CEILINGS: BATTS BLOW
MANUFACTURER: Greenstone THICKN "VALUE: R-38
GENERAL CONTRACTOR: TRADITIONAL BUILDING
LICENSE NUMBER:
BY:
TITLE:
DATE:
INSULATION CONTRACTOR: WESTERN INSULATION, INC.
LICENSE NUMBER: 481278
BY: )
TITLE:' PROD TION MANAG R
DATE JUNE 23,2000
BELLA VISTA
RELEASE OF RESPONSIBILITY
FLOORING
I, Kevin McCarthy, purchaser of Lot 10, 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 $1756.00
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:
Date: ep
ri
Buyer�;�- 92: 47 -
Design Center: