9905-349 (SFD)ti, s LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I-amlicensed 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 P. Date',
ate/ j ignature of Contractor,>c'.
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).
O I am exempt under Section B&P.C. for this reason
Date Signature of Owner
WORKER'S COMPENSATION DECLARATION
I hereby affirmunder 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.
`(,4)1 1 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'rA•1� � trNta f)fis355-98
(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 37..00 of the Labor
Code, I shall forthwith comply with those.pfcrvisions�? r f% f
Date: �" 1 r' f ;Applicant • �!" � � / r ^� .� _.-
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 inspection purpo es.
gnature (Owner/Agent)../ 1 Date's)=
BUILDING PERMIT PERMITN
99057349
DATE t5127/194ALUATION $122,899,10 LOT - .t6 -- TRACT 28-j.58-2
M
JOB SITE
ADDRESS 7$,;132P0f_1
APN
609-0713-038
PEiI1"0-fJfPT
OWNER
CONTRACTOR / DESIGNER / ENGINEER
ADVANCED DEVELOPMENT CORP.
°I'1?A1iC1''ION.AL 13UIL.DING CO tNC
78-61 5 NAPLES DR.
78-613 NAPLES DR
LAQUINTA LA 92253
LAQUINTA C -r1. 92253
(760)772-01222 CBL## . 57513
USE OF PERMIT
S1NOLF :h.AWLY 1WELtrI..NG
SIF -D - LOT 16, PLAN 3AR.-3 - PEWIT DOES. NOT MC`..LUDE BLOCK
•WALL OR:POOL. PLAN CHECK. PORTION OF.F'EE I111DUCED 79/u FOR
MULTIPLE ISSUANCE OF SANTE PLAN TYPE
TRACT CON!4R JC 11ON 2625.00 SF
PORC"A'i" 0 52.00 S.i:
GARAGE/CARPORT 625.(i) ,W
•
ii8'I1NIXriTD COIST OF C:ON 7•:RUL" pit€ N
12.2,899.10
PE MUT FEE Stil rs-1-kRY
CONSTRUCTION FELT 1$720.00
:PLAID QIECI rT_1E, 101-000-439-.318 $149,0$
MECHANICAL FF14 i(li Q00-d?1-0011 S53.50
1Li CiR1.Cs4L ` 1* 101 0-420 000 $131.88
I?l;[JAifEiING FF13 101-000-=119-000 5140.75
S'MO v0?,ICYfIOi ON, RES ID 101-0002241`000 t,i229
GRADINGPEC 1.01010fl-423.000
l il'2A i`?.!t"tJ(`.i"llf2.ir h BE 225-M-441.342 $2,749.07
AR 1" N PUBLIC, :PLt\CES 701 -ON -255-000 $57.:5
SUB -TOTAL L COIdS'!"RUC"I:ION AND PLI\1 CHECK
84,03=1.42
LESS PKE-Pt1,113 FEES
$0.00
TOTAL .PERMIT FE&S DUE NOW
S4,034AZ
\41 N
HE �
DATE
BY � r �/
DATE FINALED
INSPECTOR
1�1 , VX ix I
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deckp
--
Exhaust Fans
O.K. to Wrap
9' �-
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulatior
Condensate Lines
Party Wall Firewall
Exterior Lath
Z—lo-9 Ar—
Drywall - Int. Lath
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
l
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
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 08 WESTEPN INSULATION 909 686 8786 P.17i18
Wm oim gr'moRN INSULATION, Mt
4211 Latham Stmet, Riverside, C)aMrrda 92501
TeL (909) 686.8760 Fax (90a) 686-8786
INSULATION CERTIFICATE
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 VISTA.- TRACT #28458-2
SLOG #16
SITE ADDRESS: 78552 POMPEII COURT.
EXTERIOR WA 0,
MANUFACTURER:. Johns-M.anvilleTHICKNES:S:' 3 5/8" R -VALUE: R-13
CEILINGS: CfA_TIS: BLOW
MANUFACTURER: Johns -Manville THICKNESS: 13" R -VALUE: R-38
CEILINGS: BATTS LOW
MANUFACTURER: OREENSTOIVE THICKNESS: 10.3" R -VALUE: R-38
- - - - - - - - - -
GENERAL_ CONTRACTOR: TRADITIONAL BUILDING
LICENSE NUMBER:
BY:
TITLE:
DATE:
I ISHULATION! CONTRACTOR WESTERN INSULATION, INC.
LICENSE N BEFI: 481278
BY:
TITLE: PR DUC,TI N MANAGER
DAT E --MARCH ;, 2000
.i