9905-363 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chanter 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
7594
j p te- 2 �� M Signature of Contractor._
Y .-%
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
( ) I am exempt under Section B&P.C. for this reason
Date 1 1, 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.
(This section a d' ot'be completed if the permit valuation s o $100900 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 pr6visions of Section,3700 of the Labor
Zing:
"Lsall.foy'thw'th'comply with those provisions..:1` / /Applicant 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
t7gnature
hove-mentioned property for inspection'purposes,. r
(Owner/Ag'
)1=- j^ �---• Date 7 J
BUILDING PERMIT PERMITk
DATE VALUATION - LOT J F�1.aif��'TRACT
0SM/1" $119;253.50 218458-2
JOB SITE �-
APN
ADDRESS--�+r--- - �. _
7 1 POMP II CO-_ifR C
09-070-0341
OWNER CONTRACTOR / DESIGNER / ENGINEER
r
ADVANCED DEVELOPMENT CORP, TRADMONAL BUILDING CO INC
78-615 NAPLES DR 78-61.5 NAPLES DR
LA. QUiNT.A Cts 92243 LA QUIWA CA 92253
(',60)772-'0621 CBLA 5750
USE OF PERMIT
0
A Y1.:
CY;'rG 12 I Y 'E'L
11 la -.C�fA 6. 1' ¢f .I.t 1./!✓I3
D -1.0T 2, PLAN 3B - laf+;32,t�'iT :DOES NOT MUM BLOCKWALL OR
'Si- POOL. PT. AN CHFCK POFUFFO:N OF FEF.. ttk'IyUCED 75%FOR ..j JIMP.LE
T' T A Turf n 17 0, A h 4V 0 A XTi %A.
TRACT CONSTRUCTION 2,025.00 SE
PORCHfPA7 IfJ 52 00 SF
GARAGMARPORT 139.00 SF
C, S T.tMATE D MIT OF 4✓''4aNS`t'.1iUC ION
1.19125:3.548
P;ERAUT FEE S'UMM1_ Tti'
CONSTRUCf'IMTFEE 101-000-415-000 $709.50
PLAN CDECK FEE 101-000-4:3931$ $146.98
MECHANICAL FFA 101-00042.1-0W $53.50
8LECTIUCAL Fa 1131-000-420.000
15L1 f�IBn�Tct 1 H 101-000-419-000 5140. 775
SMONO MOT100FEE- PX- SID t07-000-241-000 $11.93
QKADINOF S 101-000-423s000 $20.00
1Nh'RA,S;rXA1FIR .K.! F:t� ;225-GW-44MQ 1.2.667.64
ART T:4PUBT.1C.PLACES-R.ES1T.701-000-255-000
SU1 -TUrAL CONSTRUCTION AND PLAN.CHEC.K-
$3,926.59
LESS PRE. -PAID tl'Xi S
$0.00
TCOTM.• PERMFF r, EES D'i
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Roof Deck
' . /9_ '
Combustion Air
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
—$—�
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL
APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final I
I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
YZ
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
— p->
Appliances
Final
COMMENTS:
Final Oa
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 dt�
Utility Notice (Perm)
Z'
Traditional Design Center
5 White Sun Way
Rancho Mirage, CA 92270
(760) 674-1188. Fax (760) 674-1668
George and Lenore Orr
729*18 Bursera Way.
Palm Desert, CA 02260
(760) 340-2083
Purchase Contract
DATE INVOICE NO.
7/15/99 1 1495
.. ......... .......
C.O.E.
02/15/00
QTY I UNIT
" `_,_, , 'y �
110"I
TERMS
Due on receipt
RATE AMOUNT
1
ea 385.00
LOT/PHASE i PLAN
i
I ea 385.00
2/6 BV .3
AREA
ITEM DESCRIPTION
439.00
ea
ea -224.00
Kitchen
107
Corian Penninsula Extension V
Kitchen
!07
'i Corian B ackspla.sh_,@Cooktop V
Kitchen
::02
Upgraded Dishwasher Model #GSD
Credit
Std Dishwasher
Various
Carpet-Bayview/Canyon Sand
Various
.14
Upgraded Pad -1/2" 6 lb
Various
14
Tile-B/Plateau
14
Hearth Face
Grout- Classic Bone
Credit
Std Cat -pet
Tiled
43
Seal Grout
Throughout
Sid Verilcals
Purchase Contract
DATE INVOICE NO.
7/15/99 1 1495
.. ......... .......
C.O.E.
02/15/00
QTY I UNIT
" `_,_, , 'y �
110"I
TERMS
Due on receipt
RATE AMOUNT
1
ea 385.00
385.00
i
I ea 385.00
385.00
ea 439.00
i
439.00
ea
ea -224.00
-224.00
788.00
2,215.00
135.00
-1,028.00
178.00
I have read, understood and. signed the attached Condition of Sale Agreement.
Signature:
Date: Total $3,273.00
NC
ea
788.00
ea
2,215.00
ea
135.00
ea
1,028.00
I ea
178.00
NC
788.00
2,215.00
135.00
-1,028.00
178.00
I have read, understood and. signed the attached Condition of Sale Agreement.
Signature:
Date: Total $3,273.00
MAR -02-2000 A2:01 WESTERN INSULATION 909 686 8786 P.03i18
WESTERN I11T ULkTIONg INC. ��
4211 Latham Street; Riverside, C%Vornia 92.501
Tel. (909) 686.8760 Itax (4091646-8786
IIOTSUL TION CERTIFICATE
THIS IS TO CERTIFY THAT INSULATION HAS BEI --EN INSTALLED IN CONFORMANCEWITH
THE CURRENT E14ERGY REGULATION, CALIFORNIA ADMINISTRATIVE CODE, TITLE 24,
STATE OF CALIFORNIA, IN THE BUILDING LOCATED AT:
TRACT / PHASE: BELLA VISTA- TRACT #28458-2
BLDG # 2
SITE ADDRESS: 78581 POMPEII COURT.
EXT1E OR 1A A S
MANUFACTURER: Johns -Manville THICKNESS: 3 518" R -VALUE: R-13
gELL. NGS: BATTS BLOW
MANUFACTURER: Jahns-ManvllleTH ICKNESiS. 13" R -VALUE: R=38
MOMS. •BATTSLOW
'MANUFACTURER: GRFENSTONE THICKNESS: '10.3d R -VALUE: R-38
ERA`, ONTRACT TRADITIONAL BUILDING
LICENSE NUMBFR:
BY:
TITLE:
DATE:
INSULATIQIV CONTRACTOR: WESTERN INSULATION, INC.
LICENSE NUMBFR: 481278
BY:
TITLE: PROD TION MA GER
DATE MARCH 2, 2000
i