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9905-352 (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 •;PiG,fc- sionals Code, and my License is in full force and effect. L. Ge n s a k,'-" Lic. Class Exp. Date Al `• v / !l A . 8/201 p� f /� Signature of Contractors y - V t` 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. , I have and will maintain workers' compensation insurance, as required by Stiction 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 sectio ` eed not�eOcompleted if the permit valuation i06261"49 10or 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. / Date: r_I 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,00mply 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 inspectiori�pur`pofses. f Signature (Owner/Agent)4 Date% �'°`f i � -..+ �- BUILDING PERMIT PERMIT# DATE VALUATION LOT - . Q�i15>` z-. 'TRACT 05/27/499 S 162,948.7ti 13 f 28158-? JOB SITE APN ADDRESS - PON, 'F-1-1 CO�JFdT � 6�[i 47"38 OWNER CONTRACTOR / DESIGNER / ENGINEER ADVANCED DEVELO M1rNr Coo. TRIAMM{ NIAL BUILDING- CO INC 78-615 NAPLES DR 78-615 NAP i',ES DR LA QUR4TA CA. 92253 LA QUINTA. CA 92253 .('760')-/72-0222. CBL# 5750 USE OF PERMIT eI%J , Q A � Ai 1- 'V' 0i%rJ;g t SM - LOT 13. PLAN KAR -.PORMI^t DCTIS NOT MCLUDE B1.0cK WALL OR POOL. PLAN CHECK PORTION OF FEE REI)UCTAID 75% FOR iG•11:f MPLE 1.14111pi c ,. r. t ter. TR.t'I,C'T (';033 .RUCf[ON % 2,763.00 SF PORCIWA.7°f.0 90.00 SF GARAMCARPORT 598.00 SF M INIATED COST OF CON STRtl C`,"f,Q014 162,9411.713 ff'IETm1.i'i' EEE SUMMARY CONSTRUCTION FEE 101.000.41"00 $860.00 PLAN CHY.CK FEE 10.1-000-439-313 $179.67 MECHANICAL FFA 101-000421-000 $92.00 a,ECTRICAL FEE 101-0011-•='120-©00 $157.17 PLUNIk31NG FEF 1:0.1.•000-=1190M $166,00 STRONG A 0T iO1< FEE - RESID 101-000-241-000 $16.29 G9AD114G FEE 101-000 423-000 $20.00 WR ,STR0CT(1t2.L PEE '225000-443=342 $3;639.41 I'RCCI•SE PLAN 1.01-000-4:11-345 $1.5,00 ART ilk PUBLICr RESM 701-000-255-000 $157.37 .PLACES .. SUi3=1'WAL C0N$1 R lJC n N .AND PLAN CHECK $5,31191 LESS PRE -PAM .EES lo,,00 TOTAL PERMIT:FEI-S DUI;NOW 55,312.99 RE; C��_ DATE BY •. �V DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Bp'cks Underground Ducts Forms 8 Footings Ducts Slab Grade Return Air Steel Combustion Air Roof Deck —97 Exhaust Fans O.K to Wrap 12-2—$79 6'C<- F.A.U. Framing — '- e -o E, Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans 8 Controls Party Wall Insulatior Condensate Lines Party Wall Firewall Exterior Lath�r- 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 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.1. Smoke Detectors Temp. Use of Power Final Arjot Utility Notice (Perm) COMMENTS: BELLA VISTA RELEASE OF RESPONSIBILITY FLOORING I, David or Barbara Germain, purchaser of Lot 13, 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 $2,927.00 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., Inca 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: Mcxx , �; ] Date: 3—Z -CEJ Buyer: Desig 4 MAP=02-20001 12:07 WESTERN INIULATION 909 686 87% P.14i18 WESTERR IN' SU ATION9 INCO 11 4211 Letham Street, Rlvm side, California 92501 Tel, (909) 686.8760 Fax (909) 686-8786 ' IN JULATION C ETIFICATE THIS IS TO CER"rIFY THAT INSULATION HAS BEEN INSTALLED IN CONFORMANCE WITH THE C CURRENT ENERGY REGULATION, CALIFORIVIA ADMINISTRATIVE CODE, TITLE 24, STATE OF CALIFORNIA, IN THE BUILDING, LOCATED AT: TRACT I PHASE, BELLA VISTA- TRACT 1128458-2 BLDG # 13 SITE ADDRESS: 78552 POMPEII COURT. ------------------------------------------------------------------- •EXTERIOR WAU.S MANUFACTURER: Johns-Maiivil/e THICKNESS: 3 5/8" R-VALUE: R-13 C_EILINOS:BLO W BATT MANUFACTURER:: Johns-Manville THICKNESS: 13" FI-VALUE: R-38 CEILINGS: SATTS BLOW MANUFACTURER: GREENSTONE THICKNESS: 10.3" R-VALUE: R-38 - - GENERAL CONTRACTOR: TRADITIONAL BUILDING LICENSE NUMBER: . /TITLE: z. DATE: i INSULATION CONT"CTOR: WIGSTERN INSULATION, INC. LICENSE. NUMBER: 481278 BY: TITLE: PRO U IOIT N MANAGJA DATE MARCH 2, 2000 1