9905-361 (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
7
594 �,,� B d 8/2i
�Date�� 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 w0i•k, 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:
Cartier Policy No.
31fA"119 ,' IS,'IM 0626355-98
(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 if11 should become
subject to the workers' compensation provisions of Section 3700 -of t l Labor
Code, I s alllfo hwith.cQmply witFi thgse provisions,*' �/
�ate� .r! L'%6j7pplicant ��L.�°
Warning: Failure to secure WVrkers'l 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 inspectionipurposes.
nature (Owner/Agen`�� (rT �l Date •/
BUILDING PERMIT PERMIT#
DATE i% VALUATION LOT 'L4.'.D.�.-3�� TRACT
�•
tD:S/27�'199 $�22,$99.]IID `1 281513-2
JOB SITE
APN
ADDRESS ="- "-
78-561 PONT VEH.COURT
"9470-038
OWNER " ":
CONTRACTOR / DESIGNER / ENGINEER
AD'AlVCEDwDEVELOPMENT C,.OIRP.
TRUDI3IONAE.Ri✓"Ai..M1LrOCOINC
78-615 NAPLES DR
7&615 MAPLES DR
LA QUINTrA. CA 92253
i.A QUINTA CA 92253
U60.}7';2-0222 MY .5750
USE Of PERMIT
s'9A r' 9 V Ml ' T C.
M. f - LOT 4, PLAN 3A-3 - PERMIT DOES NOT 1INCLUDE BLOCK WALL
'OR POOL, :PLAN CHECK PORI -ION OF :FFE- REDUCED 754fn FOR h![1t.TIPLE
iS sU dCR OF SAibfE PLAN TYPE
TPUNCT CONSTRUCT ION 2,()25.00 SF
PORCHiPATIO 52.013 SI±.
t: ARA.GFJCARPO'RT 625.00 -1W
I US� 1XIATEW COST Of CONSTRUCTION
122,899..141
VERAW FIE T >y1LI1171'tdltl,RY
CONSTRUCTION FEE 101000-8118.000 $7.20.00
PLAN CfX -CR FM 101-000-439-318 $149,0$
WMANICAi F GE 101.000-421-000 $il s I
P3,EM CAL FE.E. 101-000420.000 $1.31.88
PLUMBING F UX 101-000419-000 $1.11035
S` RONO MaDON FEE - RES1D 101-0 241-000 S1Z. _9
Gtr(. I`INGFSE 10.1 -000 -423 -OW
iNMAS'. RUC`.fiURE FrM 225-0?10-443-342 52,749,67
/ART IN.PUBLIC PLACES - RESIE 701000-255-000 $57,2:5
f
S1:MrOT L CON-STRUCTION AND PLAN CHECK
LESS PRE -PAID FEES
$000
TOTAL PERMIT FEES DUE NOW
$4,034.42
i
RE I T��
DATE f `\ \
BY
DATE PINALED
INSPECTOR
e�\�
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 Deck
Exhaust Fans
O.K. to WrapZ–B—�'l
– r e
F.A.U.
Framing
—1 _ �� 67 d!:bL_
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
—cs�
Drywall - Int. Lath
_Zr
Final
Final
3_ -4io
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
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
COMMENTS:
Final — 10
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)
.P--% ': - -
BELLA VISTA
RELEASE OF RESPONSIBILITY
FLOORING
I, Susan Sakala, purchaser of Lot 4, 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 $2202.00
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: � -,2-0ji:
Date:-
f
BuyerS,\
C '
Design Center:\
MAR -02-2000 12:02 WESTERhI INSULATION 9019 686 8796 P.05i18
w
,ti
WESTERN INSUL.ATION,' I TC.
4211 Latham Street, Rimalde, alelifbiTAa 92501
Tel_ (909j 686-8760 Fax (909) 666-8786
INSULATION CERTIFICATE
THIS IS TO CERTIFY THAT INSULATION HAS SEEN 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 # 4
SITE ADDRESS: 78561 POMPEII COURT,
EXIERIO8 VAf
MANUFACTURED: Johns-Manvfl/0 THICKNESS: 3 5/8" R-VALUE:"R-13
CEILINGS: CA5 BLOW
MANUFACTURED: Johns-Manvll/e THICKNESS: 13" R -VALUE: R-38
CEILINGS: BATTS LOW
MANUFACTURER: OREENSTONE THICKNESS: 10.3" 8 -VALUE: R-38
GENERA LONTRACTOR: TRADITIONAL BUILDING
LICENSE NUMBER:
BY:
TITLE:
DATE:
INSULATIOI Q0NTRACT0R; W1ESTERN INSULATION, INC.
LICENSE NUMBER: 481278
BY:
TITLE: PROD ' ION MAN ER
DATE MARCH 2, 2000