9905-350 (SFD)LICENSED CONTRACTOR DECLARATION
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 Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
s
75y4
�- ti B ,,.� � � �
D t�� iI r Signature of Contractor ' ?0
f
VVV OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) 1, 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).
( ) 1, 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.
( ala 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:
Gamer Policy No.
(This section
TA �oATcompleted if the permit valuation iMoNQI00.00 or less).
( ) [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
Coded shall forthwith comply with those provisions fr j
Da4a3 / jl., f , Applicant-
Warning:
pplicant 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 Siate taws relating to the building
Construction, and hereby authorize representatives of/this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) If /l f� Date -
V Ut- _.
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 99"5.350' TRACT
(KI . / 99 .1413111,154.61 `.2
JOB SITE
APN
ADDRESS
7lit %72'P0hgPF. iw COTIR T
f(t9-0711�i3
OWNER CONTRACTOR/DESIGNER/ENGINEER
ADVANCED DEVELOPIV11 Ni CO.RR TRADI717ONAL BUILDING CO INC
78-6115 NAPLES DR 78.61.5 NAPLES OR
LA QUINTA CA 97-253 LA QUiNTA CA 92253
(760)772-0222 CPL* - 5750
USE OF PERMIT
SFU - LOT 15, PI.,AN 413 - PFdMT DOES NOT INCLUDE BLOCK WALL
OR POO.1;. PLAN CHF.,CK PO1'RTION OOFFP.,E'REDUCED 7504 FOR.MIXTI(PJE
7 ri m c . M AW
TRACT CONSTRUCTION 2.200,06 SF
PORCHIPATIO a 1,10.00 SF
GARACfE/CARPORT 471.00 mil''
"TIMA'lTED COST OF CONSTRUC110N
f3a)ju.-1:11)
PERMIT FEE SUMMARY
C:ONSTRUC I[ON.FFE, $748.00
P:LXN CHECK; EE; 101-000.439-318 Wq, A9
MECHANICAL FU, 101-1300-421-000 $61).(30
ELECTRICAL FEE 1014)00-421-000 $13M ,
PLUM NO FEE 101-000419-000 $140,75
ST13ONQ MOTION FEE-:RESID 101-000-241-000 $1102
GRADING FFM 101-000423-000 $20.00
1.14 RASTRU NAW Wik 225-000-443-342 $211895.56
ALIT IN PUBLIC PLACES -'RESIC 70.1-000-255.000 $7+.39
SUB—TOTAL CONSIMUCTiON AND FLAN CHECK
54,242.33
LESS PRE -PAID ILLS
�(,f-Gi
TdT_i1(,PERMIT FEES ®OE NOW
$4,242.33
JR CEIPT f�
ti `�
DATE
BY r]� r
DATE FINALED
INSPECTOR
V
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
^ BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms 8 Footings
Slab Grade
Ducts
Return Air
Steel
Combustion Air
Roof Deck — 3- Z71
Exhaust Fans
0.K to Wrap /0 3 grC.
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 Z—
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 I I
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 _ d�
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:
BELLA VISTA
RELEASE OF RESPONSIBILITY
FLOORING
I, Mary Hunt, purchaser of Lot 15, Phase .6-2 at Bella Vista Homes, hereby
acknowledge that by not purchasing my flooring through the Roger
Snellenberger Development Design Center:
1. The flooring allowance I will be credited in escrow is $2,486.00
2. Traditional Building Co., Inc. is only sanding the standard tile areas
(kitchen, entry, laundry). Any other floor prep is the responsibility of
the buyer or their subcontractor.
3. Traditional Building Co., Inc. has no responsibility to buyer as to any
cracked floor tiles, any leaks from toilets removed for flooring
installation, or any other damage caused by flooring installation.
4. Traditional Building Co., Inc. has no responsibility to buyer as to any
paint, baseboard or wall damage not noted at orientation.
5: This is considered a "Bare Floor" closing and the flooring will not be
installed until after title has transferred and the escrow is closed.
Date: c).- (D7o
Date:
Buyer:
l�
Design n er.
in
MAR -02-2000 12:09 WESTERN INSUL,�TION 909 686 6-196 P.16/18
WESTERN, INSULATION, INC.
42 11 Latham Street, Riverside, (:alitbrnia 92501
Tel. (909) 686-8760 Fax (909) 686-8786
{
INSULATION CERTIFICATE
THIS IS TO CERTIFY THAT INSULATION HAS BEEN INSTALLED IN CONFORMANCE WITH
THE CURRENT ENERGY REGULATION, CALIFORNIA ADMINISTRATIVE CODE, TITLE 24,
STATE OF CALIFORNIA, IN THE BUILDING LOCATED AT:
TRACT / PHASE: BELLA VISTA- TRACT #28458-2
BLDG # 15
SITE ADDRESS: 78572 POMPEII COURT.
............................................. .--------------------
i
EXTERIOR WALLS `
MANUFACTURER. Johns-Mailville TH ICKNESS: 3 518" R -VALUE: R-13
CEILINGS: BATT BLOW
MANUFACTURER: Johns -Manville THICKNESS: 13" R v'ALUE: R-38
CEILING$: BATTS SLOW ,
MANUFACTURER: GREENSTVAlE THICK;NESI3t 10.3" R -VALUE: S-38\
GENERAL CONTRACT®R: TRADITIONAL BUILDING
LICENSE NUMBER:
BY: ,
TITLE; 1
DATE: .
INSULATION CONTRACTOR: WESTE!1N INSULATION, INC.
LICENSE NUMBER; 481278
BY:
rt
TITLE: PRO UCT ON MANAG
DATE MARCH- , 2000
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