9905-172 (SFD)LICENSED CONTRACTOR DECLARATION
fiereby affirm under penalty of perjury that I am licensed under provisions of
1-- - Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
NUJ Professionals Code, and my License is in full force and effect.
C) License
T# LLic. Class Exp. Date A/ p fy
r� it � \ _
Z Y Date ��� s� Signature of Contractor -
(Do no tractor
(D
O�
J U C:) OWNER -BUILDER DECLARATION
LU LU I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
Z ( ) 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
ul
N Date Signature of Owner
ON
rn
Q WORKER'S COMPENSATION DECLARATION
C) Z I hereby affirm under penalty of perjury one of the following declarations:
U-) P O () 1 have and will maintain a certificate of consent to self -insure for workers'
X W �: compensation, as provided for by Section 3700 of the Labor Code, for the
O � Q performance of the work for which this permit is issued.
m Q C) I have and will maintain workers' compensation insurance, as required by
QUSection 3700 of the Labor Code, for the performance of the work for which this
rn H permit is issued. My workers' compensation insurance carrier & policy no. are:
v Z Carrier Policy No.
O :; TAT73 111141) 0620355-93
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 �h 11 fo hwith comply with those provisions.
Pate. 1 2L, 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, 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 inspection purposes.
t %
Signature (Owner/Agent) Date ' f�
PERMIT #
BUILDING PERMIT
, � I_
DATE VALUATION .141,248.40 LOT 1 TRACT 294%1-1
x+'
' 'i
JOB SITE
+[ +' st *�
ADDRESS %.1�x3:i l�iali°3i.i'S 01-iAl.1'e
APN
M9..41141103
OWNER
CONTRACTOR / DESIGNER / ENGINEER
A1)VANr'CED DENT L0Phi 011'COR P.
IRAI M01%IAL BUILINN10 CO INIC
78-615 NAVUS OR
7&u15 NAPLES DR
LA QUI19TA CA 922_'53
LA QUINTA CA 9275;
(760)'7;2-0222 f H lff sll (o
USE OF PERMIT
1AKLUNI'l
I.O f 3. PLAN 5b - E'li hfff DOES, NOT INCLUU6 BLOCK WALT. OR
TR. -%CT CO24 IRUMON1 ,. 400 Oto SF
PORtIV17ATIV IrA) 00 bW
(JARAQJi1 jW10K*f 449 (9) SI:
104T1'MAUM COM' OF CONSTRIX-110N
141,243.40
C"DNSTRU( 1'I0N FEE 101-000419-000
P1, AW CIIF04 F1+'i% 101 -0m -AW -31 R V47 91
N11- 1IANICAL tTX 101.WO-421-000 SCS 00
ELE(:1 RICAI, trU. 101 -000420 -OW $1,41.48
11I,MIBINO 1"FE 101-000-419-000 $140.75
STRt N(l MC)TION F'F'F. - R1;S1n MI -OW -2414M $td 17
ORAVINO FEE 101 000-423-000 $210 04)
INFRASTRUCTURE IEE 225-W-143-342 53.130.21
ART IN MJi31.IrW" PLACI,S - RPS1I: 701 -01I#) -25-5-M) $103.12
Rf IB.`3'CI'I'A1, f tiN;,"1'lt[ I(MON AND PI.AN ci,i CK
1;5 fi.i:l 09
LESS PRC -PAID FEES�C
ao
TOTAL PI RMIT Me,.i MiftNf)W
55.044."
RECEIPT L j
DATE ( 1 f"
BY �` \o,
DATE FINALED
EFINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
A BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings 4ige
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
'�
Exhaust Fans
O.K. to Wrap
(�
F.A.U.
Framing
2
Compressor
Insulation
�_ ,�
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
17Z V-9, q
Drywall - Int. LathX13
—rz' 0—
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
PLUMBING APPROVALS
I JI
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
Appliances
Final
Final
Utility Notice (Gas)
ELECTRIJ#AL 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)
COMMENTS:
FROM ROGER SNELLENBERGER DEVELOPMEN FAX NO. 760 360 8019 Feb. 08 2000 01:57PM P2
FEB-01�-2000 : l • UU wpb I erm : IvyuLH i i U14 • -- -- -
,'" T;rRN INSULATION, INC.
4211 6
Lath= SWM, RMn86-8760 F t'l 486-8782502
INSt"TION CERTIFIC&TE
THIS IS TO CERTIFY THAT INSULATION HAS BEEN INSTALLED IN CONFORMANCE WITH
THE CURRENT EN::RGY REGULATION, CALIFORNIA ADMINISTRATIVE CODE, TITLE 24,
STATE OF CALIFORNIA, IN THE BUILDING LOCATED AT;
TRACT / PHASE: BELLA VISTA - TRACT #28567.1
LOT gyp: 3
SITE ADDRESS: 78.565 NAPLES DRIVE, LA QUINTA, CA
MANUFACTURER: !ohns-Mar
#ik THICKNESS' 3 5/8- R -VALUE: R-13
CEILINGS- BATT BLOW
MANUFACTURER: Joins -.Manville THICKNESS 13` R•VALUE: Rr38
CRILISGSs BATTS BLOW
MANUFACTURER: G
roonstone THICKNE55 . " R -VALUE: R-38
9;ENF_ =►NT &CTO- TRADITIONAL BUILDINC COMPANY, INC.
LICENSE NUMBER:
BY:
TITLE;.
DATE:
INSLIW10 I CONT OR: WESTERN INSULATION, INC.
LICENSE NUMBER: 481278
BY.
TITLE: -PRODUCTION MANA
DATE: FEBRUARY 8, 2000
TOTAL P.03