9905-364 (SFD)LICENSED CONTRACTOR DECLARATION r
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 'ode, and my License is in full force and effect.
License # Lic. Class Exp. Date
5yuc�w, r� i3
n ie J'' ,�9 signature of Contracto X- �` F%' f _ 17,
+
7 f
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.
(,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:
Carrier Policy No.
(This section need` not becompleted if the permit valuation is fo $100.0$0 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 shall forthwith comply with those provisions.
I
bate: A � z 1 / " 4' -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.
/gnature
��./ ..,., (Owner/Agent) '• Date
BUILDING PERMIT PERMIT Ii
54
DATE VALUATION LOT , TRACT
05/27/199 $162,048.70 !" ' l.w. '`� 28458.2
JOB SITE -"'
ADDRESS
APN
MFE11 COURT
609-07"38
OWNER
CONTRACTOR/DESIGNER/ENGINEER
ADVANCED DE'V UOPMENT CORP.
TRADITIONAL BUILDING CO INC
79-615 NAPLES DR
79-615 NAPLES DR
LA. QUINTA Cry 92253
LA QUINT,A. C_I` 922.53
(760)'772-0222 rB 5750
USE OF PERMIT
SND - LOT L PLAN 6B - PM- 41 T DORS NOT INCL IDE 13LOCK WALL OR
POOL, PLA14 CHECK P0RT10r$`Ctr FFXs REIDUC;FD 7.5% F011 111L%T.TPLF,
IS..I1A C°f ? SAA _. AN TYPE
TftAC `i' CC+s fS'J'I 1701 lON — 2,763AX SF'
PORCH7PHTTO 90.00 Sr
GARAf, WCARPOR`1' 598.00 Sr
ESTIMATED COST OP CSJNSTRIITC-7ICIIN
162,948.70
PERMIT F ESE SLM1VtEi,RY
CO1t43TRUC" I1ON' FE8 1.01-000-41&000 $8,0.00
PLAN (BECK rEE . 101.400-439=a13 X179.67
MECHMNICAL FEE 141-000-421-000 $92,00
ELE( tR1CA:C..FE;E 101-000-120-0(10 $157.17
P1,U ]BINC11"EE 101-000-419-000 $.166,00
STRONG N,tOT,10V F03.• •- RESID 101-000-241-000 $16.29
QR:UANG .FEE 101-000-463-000 $26.00
1NFR"17RU'M'U#2EFR 225-000-443-342 $3,639,411
.PRECISE PLAN 101-000—V1I=2V15 S25.00
ART IN PUBLIC 1'LACES - RESIC 70,1-000-255-000 $157.37
SUB-TC7FAL CONSTRUCTION AND FLAN CHECK
Lk SS PRE -PAID 1 fir!,S
X0.010
TOTAL PERMIT FE1i S DUE � OW
S.%312.91
l .1 n� \ i
RECtE,IPT `\
DA, E /1
BY 1
DATE FINALED
INSPECTOR
hV
V d'��
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set.Backs
Underground Ducts
Forms 8 Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
_ Crb E-'
F.A.U.
Framing
y/—®p l�
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
�--�
Drywall - Int. Lath
Final
BLOCKWALL APPROVALS
Final
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
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
Final10
.. 77
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 S
Utility Notice (Perm)
COMMENTS:
MAR -02-2000 12:01 WESTERN INSULATION '909 686 876;6 P.02/18
wESTIURN
NSULAXION' INC•
4211 Lotham Street, p4vemide, California 92,501
Tel. (909) 686.8760 Fax (909)686-8786'
INSULATION CSF WIFICATE
THIS IS TO CERTIFY THAT INSULATION HAS BEEN INSTALLED IN CONFORMANCE WITH
THE CURRENT ENERGY REGULATION, CALIFORNIA ADMINISTRATIVE CODE, TITLF 24,
STATE OF CALIFORNIA, IN THE BUILDING LOCATED AT,,
TRACT / PHASE: BELLA VISTA- TRU%CT ,#28458-2
BLDG 1
SITE ADDRESS: - 78561 POMPEII CUURT.
EXTEMOR W LLS
MANUFACTURER: Johns-Manvllle THICKNESS: 3 5/8" R -VALUE: R-13
CEILlN� rBATTS BLOW
MANUFACTURER! Johns -Manville THICKNESS: 13° R -VALUE: R-38
CEILIN BATTS =BLOW
MANUFACTUREIR: GREENSiONE THICKNESS: 10.3" R -VALUE, R-38
GENERAL CONTRACT_ TRADITIONAL BUILDING
LICENSE NUMBER:
BY:
TITLE:
DATE:
INSULATION CONT : WESTIERN INSULATION, INC.
LICENSE NUMBER: 481278
BY: I
TITLE: P O TION MA14AGER
DATE MARCH 2, 2000
t ,
Ma., -14-00 11:56A Whita Sun P. 02
S@r` by: UAKlt"rA DIWGVC�,"
`' ---• ..:,avi°PVA; 02 P.02
00 04:45P Whitt Sun
BELLA VISTA
P,El..F:ASE OF RESPONSIBI LI TY
V4'e. Mary & Stcphea Carroll. purc:har of L.ot 1,1'hasr 6-2 ;tt 11 1h, V��t�►
HtlTllt'S. (tettiby ackntlrYledge tlWl by not (furc,hmvtttl; my tt�xNtng, tltroultl► the
Rneer SrxttcSherW.rr Developmcllt. Inc. Design C�cntcr.
1 Tktic l%xn ist� alk�watiie, l will tst credited in Cycrc+w ►, 61.7 fib. (N).
Roger Snellentwrger YXI eloPfric"t is u;:ty a:tttJing the stattdacd ttic arc:ss
( LOOM entry way. laundry). Any other flcxlr prep i, the mspmRihility (it'
tilt huycr of lhvAr suhcontl actor.
;, itngtr 5: ltcnher er Mveto9awfit has no rccp snsihiiit� t�) buyer as to
any ctsacked floc) hies. ;tny other d:urtage cat►sed by Mooring fwstall"11 In
4, Roger 5Tw11e1%bct8e1 f)evelopmrnt has no re+po�tl�ilyt)to htryer as, lu
any paint, baseboard cm wail ctwnagr ntu rloit'tt at �rnr�tits�t,on
S This is considered is "have ttcfor" dosing and the lkxuiag will ntrt bc:
mstallcd until after tick hats transferred.
)u(c.-..— - (. - --
m -sig) C'entar.