Loading...
9905-338 (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 D eA t Signature of Contractor. or 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). O 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. t(4)3 1 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. (This Sectionneed not be completed if the permit valuation0626,455-08i f 1.00 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 stiou(d`become subject to the workers' compensation.provisions Of 'ectio 3700 f 'he Labor Code,,I-shall,forthwith comply With Those provisions. Dated!. Applicant �arning: 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, indemnity & 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,ihis City to enter upon the above-mentioned property,4dr nspection2puposes! C Sgnature (Owner/Agent)•/ -!-- Date / BUILDING PERMIT PERMITN DATE ' VALUATION LOT 9805-338 TRACT ©3!'27/154 $108,613.40 27 28458,.2. JOB SITE APN ADDRESS 7#"24 SAN Mr3 RINO COURT 60-070-038 OWNER CONTRACTOR / DESIGNER / ENGINEER ADVANCED .DEVELOMIENT CORP. Ti'aADTTTONAL BUTLDIN. iCO TNC 78.615 NAPLES .DR 8-615 NAPLES UR LA QUINT!1. Cil 92253 LA QMNTA CA 92253 (760)772-0222 C.BL# 5750 USE OF PERMIT T 7Ir T►TP+ {,t1`I L,. 4a Y- A. J. R4 %D -LOT V, PLAN',I R 41ERflOT DMS NOT INCL ' VILO "K WALL OR POOL TRACT CONa'MUC 1 oN 1,ni,00 SE PORC IVIPA.T1.0 76.00 SF OttRACa&VAR,PORT 409.00 S!: E3'1'11L'1Xf:1ia13 COST Or, C`1JNY1'RUC'1"1ON 1081613.44 PERMIT FEE SUMMARY CON S'E RCTMON FFd3 i0 t -000-f11'il-(100 $647:1.06 PLAN CHECK FTE 101-000439-318 S555.42 'Nfl i�%MCAL FFA_ 101-000-421-000 $47.03 FLECIRICAL FEE 101-000.420-000 $120.87 PLTJN(B ING M 101-000-419-000 $134.73 STRONG MOTION FE1 - RESU) 101-000-24.1-000 $10.86 GRADING VEY. .101-000-423-000 $20.00 114FRASST RI7C"WRE FEE 22540-443-342 $2,421.06 ART IN PUBT C PLAtifiS - RESIr 701,-(00-255--000 121,53 StM=iWAL CONSTRUC ION AND PLAN C;HEC ;. &4,1102.19 LESS PRI-PA.113 Mot) 'T'OTAL P1 Ri01f iT FEES DUE NOW $4,002.49 � A\ {' kAEA� T ' DATE BY j DATE FINALED INSPECTOR �� V INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR 11 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 Wrap Framing /O—Z47- F.A.U. Compressor _ 10_ Insulation 2.25- Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewal Exterior Lath Drywall - int. Lath 23� Final Final F LOCKWALL APPROVALS Steel POOLS - SPAS 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 OX for Finish Plaster Sewer Lateral — l' Pool Cover Sewer Connectior. Encapsulation Gas Piping Gas Test 2—/ — Appliances Final Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wirir!g Fixtures Main Service Sub Panels Exterior Receptacies G.F.I. Smoke Detectors Temp. Use of Power Final Z Utility Notice (Perms) COMMENTS: DEC -20-1999 15:56 WESTERN INSULATION 909 686 9?86 P.09i18 i v ESIVERN INSIJLATION, INC. 4111 Latham Street, Ri"nido, California 92901 19091686-876(1 {909) 686.8788 Fax 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 - PHASE 1 TW,CT 4:28457-1 LOT#: 27 SITE ADDRESS: 78524 SAN MARINO, LA QUINTA, CA. EXTERIOR WALLS: MANUFACTURER: JOHNS-iVIANVILLE THICKNESS: 3 5/8 R -VALUE; R-13 CEILINGS: �TTS� BLOW . MANUFACTURER: JOHNS-10ANVILLE THICKNESS: 13" R -VALUE: R-38 CEILINGS : BATTSLOW . < MANUFACTURER: GREENSTONE THICKNESS: 10.3" R -VALUE: R-38 GENERAL CONTRA_ CT®It: LICENSE NUMBER: BY; TITLE: DATE: LICENSE N BY: TITLE: DATE: ER: 48 "DECEMBER 2.0,199-9. ROGER SNEILLENIBERGER WESTERN INSULATION, INC.