9905-348 (SFD)LICENSED CONTRACTOR DECLARATION
i,fiereby 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
759465 13 ;1`2/12(N
'j y
pat! , -,`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:
( ) 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.
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:
Carrier Policy No.
S'C.XI'8 I<'L NID 0026345-93
(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 3700f of the Labor
Code shall forthwith comply with:those,provisions. ) �f
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 itrspection purposes.
Signature (Owner/Agent):;' r f 3 f j -'�'- Date r4
rt ff
PERMIT #
BUILDING PERMIT
990348
DATE w4w.71iOALUATION $1,62,949.70 LOT 17 TRACT 284513-f22
JOB SITE
ADDRESS 78-592 PO&IRE11 COURY _TPN
609-070-0. 8
OWNER
CONTRACTOR/DESIGNER/ENGINEER
ADVANCED DE :VELOMIN7 Ct3R'P.
'I'IL�I'TIONAL BUILDING CO INC
&615 74APLFS 13R
78-615 NAPLES DR
LA QUINTA CA 92253
LA. QUINTA C.k 922.53
(760)772-02.22- CBL'Y 5754
USE OF PERMIT
SINGLE FAf\41LY DWELLING
SPD ,- LOT 17, PLAN 6BR. - PeG ff utal�S .NOT I.NCILME BLOCK t,
OR POOL PLAN CHEM PORTION Or ME R'EDVCtE � 75% FOR ILLTIIrnLE
ISSUANCE OF SAIb1E Ptt1N TNTE
R
`CRACI,* CONSTRUCTION 21763.00 SP
PORI (PATIO 90.00 SF
crA1tA a/GARPOR'r 598.00 SF
ESTIMATED COST Olt' CONSTRUCTION
162,948.70
PI~'RIWIT FEIN: S'i31'1f11L\': Y
C0NS39t.IX'11 0Nf!'1 lot -000-418-000 S36fi.oQ
Py -A1 CfIFXK:fJX 101.000-439-318 179.67
14P.CHANT.OAI VEF, 1.01.000-421.-000 592:00
E1 C9:K1C,'A1vFF.F M-000-420-000 xiS7..tF
PLUMBING FEE 101-OW419-000 5166.00
STRONG -MOTION FF1s - ItESU> 101-000-241-000 81£.2St
CRADiNG 1EF. 101-000-423-000 620.r1t►
i` FRASI".ftt",!(;'rt:1£tE FFE 225-W-443-342 $3,639.41
PR -CISE PLAT. f 10.1-000-44 1 145 $25.110
MT'IN.PUBLIC PLACES - IZF.;SIE 701-000-'«55-0110 $157.37
8Lf13-TCY1'.AL CONSTRUC110NAND PL.t1N C1.1ECK.
55,312.91
LESS PRE-PAI1) HES
MOO
TOTAL F'EAMIT FEE S 1011E NOW
S5,312.9.1
EC\QT,,�� ,
DATE
BY (f/
DATE FINALED
INSPECTOR
^
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
r BUILDING
APPROVALS
MECHANICAL APPROVALS
SO Backs Ot
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
/Z
F.A.U.
Framing
_ 6-v
Compressor
Insulation
— cz� 4
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
12 — 6 _F
Drywall - Int. Lath4±.m (
_ / --gyp
_:
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
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
4LPool
Cover
Sewer Connection
v
Encapsulation
Gas Piping
Gas Test
Appliances
Final
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)
COMMENTS:
MAR -02-2000 12:09 WESTERN INSULATION 909 686 8786 P.18i18
W T R INSULATION, INC.
4211 Latham Street, Rivcmide, California 92501
Td. (909) 688-8760 Pax,(Wl) 686-8986
INSULATION CERTIFICATE'
THIS IS TO CERTIFY THAT INSULATION HAS BEEN INSTALLED IN CONFORMANCE WITH
THE CURRENT EI4ERGY REGULATION, CALIFORNIA ADMINISTRATIVE CODE, TITLE 24,
STATE OF CALIFORNIA, IN THE BUILDING LOCATED AT;
TRACT / PHASE: BELLA VISTA- TRACT #28458-2
BLDG # i 7
SITE ADDRESS: 78592 POMPEII, COURT.
EXTERIOR WALLS
MANUFACTURER: Johns -Manville THICKNESS: 3 518" R -VALUE; R-13
CEILINGS: 8A BLOW
MANUFACTURER: Johns -Manville THICKNESSX 13" R -VALUE: R-38
CEILINGS! BATTS BLO
MANUFACTURER; GREENSTONE THICKNESS; 10.3" R -VALUE: R-38
GENERAL CONTRACTOR: TRAD17101NAL BUILDING
LICENSE NUMBER; .
BY:
TITLE:
DATE:
INSULATIO111 CONTRACTOR: WI:$TEIRN INSULATION, INC.
LICENSE NUMBER: 481278
BY:
TITLE:
DATA MARCH 2, 2000
LC