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9905-340 (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 i%ryy ,//DateDate + ,,!Signature of ContractoI )'A 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 mai6tain 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. (ti),/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. S 1 XfE+ M-4) 06,26355-93 (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 if I>rshould become subject to the workers' compensation provisions of Section,3700 of the Labor Code, I shall forthwith comply with'those provisions. 1 Date:d� / L` )i 't Applicant Yf; r 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 perntt,.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. ldagree to comply with all City, and State laws relating to the building construc4on, and hereby authorize representatives of this City to enter upon the above-mentioned property for inspection purposes. Signature (Owner/Agent)-' !_ A•-- �-+V Date/� / BUILDING PERMIT PERMIT# DATE VALUATION LOT "05.340 TRACT 05/27/1" $108,613.40 125 284159.2 JOB SITE APN ADDRESS 7&513 SAN MARINO C'iti.ilt� 609-070-038 OWNER CONTRACTOR /DESIGNER /ENGINEER ADVANCED DEVELOPMENT CORP. 'IRADITIONA.L BUILDING rQ .!.NC 78-615 NAPLES Did. 78-615 NAPLES DR LA QLUI1TA. CA. 92253 LA QUIIV3 N CA 92253 (760)772-02222 CB # 5750 USE OF PERMIT 7f , 'A k411 Y INIum Ii►.i SF"D - LOT ��5, PLAN 2A - PFJ MiT DOES W)T CNCUME BLOCS WALL OR POOL. PLAN CEi1?GTr PORTION OF FEE RFDUCED 75% FOR NILTLI[PLE fSSUA,NC"E OF SAIVE PLAN TYPE lRACC CONSTRUC1`ION 1,834.00 SP PORCIi/M.10 :6.00 SF GARAWCARPORT 409.00 SF EXITMATE.0 COST Ori CONST RIiC.'�` ON 108,613.44) P7ER119-9't'FEE: SUMMARY CONSTRUMON FEE 101-001-418-000 $671.00 'PLAN OMCK. FES: 1:01-000.439-318 5138.86 NiFC11.A.NICAL FE101.-000-421-000 $47.00 ELECTRICAL Fn 101.000-4211a W $120.t;'7 PIARVIBINt1 FFE 1.0'1 -WO -419-000 $131.75 STROM MOTION FEE - REESID 101-040-241.000 $1.0.86 GRADING FE1i 101-000-423.000 $20.00 MF1iASTRUC1`` RE FK- 225-M-443.342 $2,421.06 XRT IN PUBLIC PLAMS S-RESIU'701-0011-255-1100 $21.53 SUB -TC,'" CAL CONS' I RU("'! ON AND PLAN Cl-1;FCK $3,58$5.93 LESS PRE -.P r) FEES $0.00 TOTAL PERMTT VE&S DUE Ni OW $3,585.93 4 P�_ -R CR ATE BW 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 — — (',� Exhaust Fans O.K. to Wrap 9-13 g C& F.A.U. Framing �_ l Compressor Insulation / Z —95; 49 4z— 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 —2 POOLS - SPAS BLOCKWALL APPROVALS 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 COMMENTS: Final Z 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 Final2— Utility Notice (Perm) DEC -20-1999 15:5? WESTERN INSLI-ATION 909 586 8786 P.11i18 UT STERN INSULATION, INC. 4211 Latham Street, RiVeraide. C oMinin 92soi (9091696-876c). (909) 686.8766 Pax INSULATION CERT FICATE THIS IS TO CERTIFY THAT INSULATION HAS BEEN INSTALLED IN CONFORMANCE WITH THE CURRENT ENERGY REGULATION, CALIFORNIA ADMIN:!STRATIVE CODE, TITLE 24, STATE OF CALIFORNIA, IN THE BUILDING LOCATED AT: TRACT/ PHASE: BELLA VISTA - PHASE 1 TRACT #:28457-1 LOT#: 25 SITE ADDRESS: 78523 SAN MARINO, LA QUINTA, CA. EXTERIOR WALLS: MANUFACTURER. JOHNS -i ANVILLE THICKNESS: 3 5;8 R -VALUE: R-13 CEILINGS ;: �AS BLOW MANUFACTURER: JOHNS -MANVILLE THICKNESS: 13" R -VALUE: R-38 -CEILINGS: BATTS �O MANUFACTURER: GREENSTONE THICKNESS: 103" R -VALUE: R-38 GENERAL CONTRACTOIt: LICENSE NUMBER: BY: TITLE: DATE: IN ULATION CONTRACTOR: LICENSE NUMER: 48127$ BY: TITLE: DATE: il ER 20,1 r ROCER SNELLENBERGER WESTERN INSULATION, INC.