9905-174 (SFD)LICENSED CONTRACTOR DECLARATION
U) I hereby affirm under penalty of perjury that I am licensed under provisions of
F— Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
C14 W Professionals Code, and my License is in full force and effect.
O =) M License # Lic. Class Exp. Date
I LU
oZ ti /ateSignature of ContractorCS 0
U OWNER -BUILDER DECLARATION
HLU I hereby affirm under penalty of perjury that I am exempt from the Contractor's
U) 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
LO
N Date Signature of Owner
ON
D)
a- Q WORKER'S COMPENSATION DECLARATION
o Z I hereby affirm under penalty of perjury one of the following declarations:
Lo H 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 J Q performance of the work for which this permit is issued.
m Q U (k) I have and will maintain workers' compensation insurance, as required by
O U Q Section 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:
It Z Carrier Policy No.
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
3 Code, Ifshall fo hwith comply with those provisions)
yDate: 1 `f 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 above-mentioned property for inspection purposes.
,sSignature (Owner/Agent) Date�'�'
PERMIT #
BUILDING PERMIT
DATE` f`, VALUATION -%I 19, 4;1) LOT , TRACT `8,5 , '
.. !,
JOB SITE
APN
ADDRESS i, N)5 iV- PLLS Dilly C
609-511-605
OWNER
CONTRACTOR/DESIGNER/ENGINEER
.,11"A" (1-D D1,101" 'C
101 11,114 O."P
'lit-M)I1I!?NAL lit'ff IDl":G CO INC
F8-05 NAPLES I k
Tri -u1 i NAPLES DR
i.A t,ttJW17A ('A 92253
LA (.1WKI'A CA 922S1
(760)771,0722 rBL0 57,10
USE OF PERMIT
bINtiLL I-AM1I,ti IM0.I,1NO
SH) - Lv t i. PLAN 3A - I'i; RNUT LX) --3 Nv'I INkA tli./E flLt .K WALL
TRA(1' C.6143 07VION ;t?zm SF
KIRC'Tltl'Ai"10 52.00 SIF
ONAHA(AYCAWAORT ai').tit) 81-
LSTIMATE1`J COST 014T CONSTRUCTION
114),253 --so
PFIRMI1' Fir,i; SUNIMAK1'
C< 1N:s tltIAI T ION }'Els 101-000-418-000 5701) S0
PI AN C111YX FMi' Q0
,'4fI:(:IIAN ICAL FEE 101.000 421 000 $; 31.50
LUA.'FWCAL F13F 101-000-4244" SIN.Io
PLUMBINO F I:B 101_000A19_0W S I40.7i
,TTRONG M(Y1ION FFTF - Rrq►T'p }(11-(){y(1-241-(10(1 Sl T 93
GlItU 14G rL-E 101.000 423.000 $:0.00
1NF ItASTRUi i 11kii i t: ii 225-000.443-342 $2 +w7 64
ART tN PUBLIC PLAC i S - RESII; 701-000-25g-000 3,1813
S1 iT3•tryi'A1. CnN�"IR.tIC"11f�N AND PI.AN ('11F('K
I
LESS PRE -PAID F,:
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts'
Forms 6A Footings
Ducts
Slab GradeReturn
17
Air
Steel
Combustion Air
Roof Deck
/,
�`'
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
77 2 YEOv 6 yL
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
//-Z " 6'
Drywall - Int. Lath
Z.- / 9
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
Gas Test
Electric Final
Waste Lines
p
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)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fb(tures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
JAN -31-2000 13:2e WESTERN INSULATION 909 680 8786 P.04!04
WESTEMN INSULJ!LT'ION9 INC*
4311 Lath= Street, Riveroldel California 92501
(909) 686-6760
(9091686-9706 Fax
INSULATION CERrIFI
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 BUILDIiNG LOCATED AT:
TRACT/ PHASE: BELLA VISTA — PHASE 6 TRA(T #:28458-1
LOT#: 5
SITE ADDRESS: 78665 NAPLES DRIVE, LA QUINTA, CA
MANUFACTURER: JOHNS -MANVILLE THICKNESS: 3 5/8" R -VALUE: R-13
CEILINGS ; BATTS �) BLOW
MANUFACTURER: JOHNS -MANVILLE THICKNESS: 13" R -VALUE: R-38
CEILINGS: BATTS BLOW
MANUFACTURER: GREENSrONE THICKNESS: 10.3" R -VALUE: R-38
G9IVERAL CONTRACTI)R: ROGER SNELLENBERGER
LICENSE NUMBER:
BY:
TITLE:
DATE:
INSULATION CONTRACTOR: WESTERN INSULATION, INC.
LICENSE BERh3l,
BY:
TITLE: Pro uger
DATE: JANU)0
TOTAL P.04
r�t
Dzl::p <�_ ;
�1
A RE -INSPECTION
WILL BE CHARGED IF
PLANS A M JOB CAI
THE SITE FOR i
NO
VACATION POOLS & SPAS
9522 Donaldson Road
'— Lucerne Valley, CA 92356
(760) 248-6045
(760) 248-2919 FAX
Lic. #C-53-351673
Sales Locations
Bermuda Dunes, Irvine,
California City, Rialto,
Lucerne Valley
1 800 999-1811
F $30
PROVED
NOT ON
C EDULED
CI OF LA QUINTA
BUIL11ING & SAFETY DEPT.
PPROVED
FO CONSTRUCTION
DAT
i E
oa
�Mlgal
33=
CONTRACTOR cannot assume responsibility for DATE
damage to cubs, sidewalks, driveways, cement
slabs, sewers, lawns, trees, fences, retaining walls,
sprinklers telephone lines or shrubs
DEPTH 3'/a' — 5-' I
PUMP CAPACITY
GPM
MOTOR HP
HP
MOTOR HP
HP
FILTER
SQ FT
FILTER RATE
GPM
HEATER SIZE
BTU
TURNOVER
HRS
SUCTION LINES
RETURN LINES
SKIMMER MODEL
CHECK VALVE
GASLINE BY V -P FT.
411
POOL LIGHT 3oo CLOCK YCS
ELECTRICAL BY V P FT.
AUTO CLEANER
DECK BY SQ.
DECK TYPE C%A) — 5"+
STEP FT.
SPA SPECS.
SIZE -71 RAISED /8
LITE GS WATTS jap
DUAL L VEL SEATS 2_21' -a,
SPILLWAY SIZE !7"X jQ1 WIDE
SPILLWAY S c/k 4u4v,+.
When access is made through a neighbor's property Name. rYci -SO N
it is understood that you, the owner, have thatAddreS 78 6 �0 Nq✓'' V
neighbor's permission and assume full responsibility.
city L_ q
DATE TRACT &1(4�i OT# .
SIGNATURE I -