9905-173 (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
WoW/20f
rbate 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:
( ) 1, 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
a
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.
(y) 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:
Cartier Policy NO.
STATE i�NI)
(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
slect to the workers' compensation provisions of Section 3700 of the Labor
Code, I s all f rthwith comply with those proujsions.
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 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 abo e -mentioned property for inspection purposes.
t
/Signature Date
BUILDING PERMIT PERMIT#
1 99i�=x'73
TRACT
DATE VALUATION $1311,154.60 LOT ; 4 `_
2$457-1
JOB SITS —
ADDRESS "— 6S5 NIU111 Cy'�S DRIVE
i'�-
APN
G01-�11-.004
OWNER
CONTRACTOR / DESIGNER / ENGINEER
ADV.ANC.E'D Did'%T?.LO.PME-14F." CORP
TIUDMOINAL B[.iL'�DING IC
78-615 NAPLES DR
78.6.15 NAPLES .DR.
1.cA QUIN1A CA 92253
LA QUIN'1.A CA, 9.2253
4760)7112-0222 CBL# 5750
USE OF PERMIT
kNG is FAN11L`i' DWSLa, l+ O
Ski} .-1.('Yf 4, PLAN 4AR - ill -EMT DOES NOT 1A1sv:LUTaiu BLOCK WALL
Ti \C'.i CONSTPLUCTIGN 21204.00 SI
PORCINIATIO 110,00 311,
0ARAt &CA11K)KY 471.00 8F
MST I.1f..�.T!,"V WSTOF CVN•C'%X6lIJ;V..III.ON
AiVa f.�T•6�
PERMIT FEE SUMMARY
C0HdS1'RVC7I0N F'1% 101-000-4113-WJ 57480)
K.hN +.'Sla',h'. flM 101.000-8139-318 $618.74
Nu C€MIC,r'u. FM 101-000-121.mo x60.00
t.t,T1MIC".A1..FEL 101.000-420-000 $134.92
PLUXIBING MO 101-0W419-000 3140.75
gi1RONC'_t4_0T10N'FF't3 > R ,,8TD 101-0ffl=241.-000 S13.02
GRADINGr M, 101-000-423.0()0 • S200)
l`T.Ii.t37;RWT11R1:4766 2.25-404-443-342 $2.895.%
ARI' IN PUBLIC PL AC:FS - T,W'TiC 701 -000 -255 -WO $+75.35+
SU13-TQC TAL. V,0NS 1'P:V; t 10t1J AND PLAN C HIEC,K
$4,70638
.LESS :P1'.:E-PAIL) FES
WOO
i"(3CAL t'EEfWIT 1:F:.VS DUE -NOW
$4,706.38
RECEIPT y
DATE �. (
BY" v `v
DATE FINALED
INSPECTOR
INSPECTION RECORD
9PERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Bacl:.
Underground Ducts
Forms 8 Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
O.K. to Wrap
Exhaust Fans
F.A.U.
Framing
Compressor
Insulation
�— _ 6���
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
2 -tv-9 2®uL
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
zo
Appliances
Final
COMMENTS:
'
Final
Utility Notice (Gas)
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)
JAN -31-2000 13:27 WESTERN INSULATION 909 686 8786 P.03iO4
WESTERN INSUL .kTION9 INC.
4211 Latham $tt"t, Riverside, CO forIIli 92601
(909) 686-8760
(909) 686.8786 Faz
$NSU _ TION CERT FICATE
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 Vl'STA — PHASE 6 TRACT #:28458-1
LCT#: 4
SITE ADDRESS: 78655 MAPLES DRIVE, LA QUINTA, CA
EXTERIOR _WALLS:
MANUFACTURER: JOHNS -MANVILLE THICKNESS: 3 5/8"
C611IN 0, SATTS BLOW
MANUFACTURER: JOHNS -MANVILLE THICKNESS: 13"
C jjUNGS : . BATTS
MANUFACTURER: GREENSrONE
GENERAL CQIYTRACTt)R:
LICENSE NUMBER:
BY:
TITLE:
DATE:
INSULATION CONTRACT®
LICENSE NER: 4 78
BY: 7 _-.7
TITLE:rod n Ma ger
DATE: JANU 31, 2 )0
BLOW
THICKNESS: 10.3"
R -VALUE: R-13
R -VALUE: R-38
R -VALUE: R-38
ROGER SNELLENBERGER
WESTERN INSULATION, INC.
,ki