9905-356 (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
759465
Dated f�fl% Signature of Contractor
/,.J / ./`. `.
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 maijtain 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
SeJJion 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 sectiortThAe% i oifWcompleted if the permit valuation is'fo0$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 37dof the Labor
Code„I-shall,forthwith comply with those provisions. r'f,Cc
Da eOl f t, „ ¢ Applicant L,r:�, ..r..' y.
)a r r ,f
I/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 for inspection purposes.
/Snature (Owner/Agent) $ #`•_ Date—k-1 �
BUILDING PERMIT PERMIT# tai
DATE VALUATION LOT 9�Q.r�.�6 TRACT
0�5/Ti/149 SI19.2S3.50 9• 284.584,
JOB SITE
PN
ADDRESS
POMP 'n Colik"T
609-070-038
OWNER 06_: _ CONTRACTOR / DESIGNER / ENGINEER
.ADVANCED DEVELOPMENT CORP. TRAD1110NAL BUTLD1NaCO INC
78-615 NAPLES DR 78-615'NAPLES DR
LA QUtNTA CA 92253 1A QULNT.A CA. 92253
(760)772-0222 CBL# 5750
USE OF PERMIT
SPD -LOT 9, PLAN 3A - PERMIT DQES NOT INCLUDE BLOCK WALL OR
POOL, PLAN CHECK. PORTION OF FEEREDLIC.ED 7.54ffOR 1411ANIPLE
Q* Q'If r '4T . or S A *LjR PL T:
TRACT CT CONST RIA7..17ON . 2,025.00 SF
PORCCWPXnO` 52.41) Sly
GAt2kGrYCARPORT 439.00 SF
'ES1TIMATU) COST OF CONSTRUCTION
1.19,85:1.511
PERAUT FEE SUMMARY
CON917RUCTCCiN FEF t.01.000418-0013 ^$709.50
PLAN CHECK FEE 1011-000-439-318 5146.93
TV ECHANICAL FEE 101.-000-421'-000 $5350
EIL'FC7' UCAL FEE 1.01-000-420-000 3128J6
F'LL%1B)NG FEE 101-000-419000 $140.75
STRONG NIOTION FEE - RE, SID 101.000.211-000 $1193
GRADJNG FEE 101-000-42-1-000 $24.00
TNFRAS 11tf1C URE FEE 225-000-443-342 $2,667,64
ART IN PUBLIC PLACES -'ItIM1L' 701.-000 X55-000 $48.13
SUB-TO'1i L.CONSrRUCI,"ION i�ND PLAN CHECK
$3,9'*6J9
LESS ;PRE -PAID C7 EE S
X04:00
T'OTiM PERMIT FEES Dfi C NOW
53,926.559
/X�
RECEIPT \\
DA �\�
BY' {�
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel 7
Combustion Air
Roof Deck —2.7 4944
Exhaust Fans
O.K to Wrap G OL�
F.A.U.
Framing — _ �, 6'(�
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
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 o
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 .Z
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
Firgal .r spm
Wily Notice (Perm)
COMMENTS:
MAR -02-2000 12:05 WESTERN INSULATION 909 686 8786 P.10i18
WESTERN INSULATION. INS.
4211 Latham Street, Riverside, (.Norma 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, CALIFOR141A ADMINISTRATIVE CODE, TITLE 24,
STATE OF CALIFORNIA, IN THE BUILDING LOCATED AT:
TRACT / PHASE: SELLA VISTA- TR' ACT #28458-2
BLDG # 8
SITE ADDRESS: 785.11 POMPEII COURT.
EXTERIOR WALLS
MANUFACTURER: Johns-ManvilleTHICKNESS: 3 518" R -VALUE: R-13
CEILINGS BATTS SLOW
MANUFACTURER: Jahns-Manville THICKNESS: 13" R -VALUE: R-38
CEILINGS; BATTS BLOW
MANUFACTURER: GREEN5TONE THICKNESS: 10.3" R -VALUE: R-38
GENERAL CONTRACTOR: TRADITIONAL BUILDING
LICENSE NUMBER:
BY:
TITLE:
DATE:
INSULATION CONTRACTOR: WESTEAN INSULATION, INC,
LICENSE NUMBER: 481278
TITLE: MO"TION MANA R
DATE MARCH 2, 2000
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