9905-341 (SFD)C
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
'158165'-- --;' 022 i'20i
Dai n' ; Signature of Contractor `•
OWNER-BUILDER'DEC SLARATION
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
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 section need not be completed if the permit valuation is6forr3$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 Sectio 3700 of 'he Labor
Code, I shall forthwith comply with those provistons/
Plate -'-f !r i'{'1 Applicant �✓ .�� 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,�s 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 purpos S.
/ t (Owner/A ent) j I h Date�o
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 9"5-141 TRACT
05/27/.199 $1151,253.50 14 2&158-2
JOB SITE
APN
ADDRESS
78-533 SAINT Aa:ltWi3COURT
"9-070-038
OWNER
CONTRACTOR/DESIGNER/ENGINEER
ADVANCED DEVELOPMENT COW).
TRA.D3'I ONAL BUELDING CO INC
78-61.5 NAPLES DR
78-615 NAPLES OR
LA QUtN'£A CA 92253
LA QUINTA CA 9'2253
(760)776!-0222 CSLi# 5750
USE OF PERMIT
A .y.. 2 . A . "' f`%/VfhfOz
SFD - f,0 i 24PLAN 3Eit. - PFRkiff DO.zS NOT .i'AfCLWE fl -LOCK WALL
OR .POOi, PL AN CHI- PORTA N OF FEE REDUCED 75% FOR MIXT (PLE ,
ISSUANCT OF SAME PLAN nTJ
TRA'71' CONSTRUCTION 2,025.00 3F
PORCYPPATIO 52.00 SF
0ARACIrYCMIPORT 439.00 SF
ESiTtNIN ED COST OF CONSTRU(MON
119,253.54)
CONSTRfJCTIONFEL 101.-00041$-000 S7f19.50
PLAN CHECK FEE 101-000-439-318 3.146.98
MECNANlCAL IFEE 10t -000-421-M, 353.E
F1EC1VCAI..FEE 101-000-420-1300
'PLLiML41.N( FES 101-000-419-0019 $140.75
STRONG MOTION TE -REST) 101400-241-000 811.93
GR 1DWO l FE 101-000-423-000 $20.00
INFRA,STRLJ('"1'tiRl fEE 225-000.413-341 $4Z,667,64
ART'IN PUBLIC PL i,.CES : RES11 701-G00-2 55-000 $48.13
,SUB-T(YF_AL. CONSTRUCTION AND PLAN CHECK
$3,926,59
.L.EM PRE -PAID t' LiS
to W
TOTAL, PERIMIT FEES DUE NOW
S3,926.&9
1 All
RECEIPT /
DTE
BY Y
DATE FINALED
INSPECTOR
4J'
I
INSPECTION RECORD
I
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings ,�
Ducts
Slab GradeReturnAir
Steel
Combustion Air
Roof Deck
J- .—'F ®d-
Exhaust Fans
O.K to Wrapq
�3 �j !c
F.A.U.
Framing
04
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
611,
Drywall - Int. Lath
Ogg 10,
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
/
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
—
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Z
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G. F.I.
Smoke Detectors
Temp. Use of Power
Final Z ?-957
Utility Notice (Perm)
COMMENTS:
DEC -20-1999 15:58 WESTERN INSULATION 909 b86 878E P.12i18
• WESI°SIM INSULATION, INC.
4311 Latm m §weet, Rive"Wq, CaUbrniA 99601
10001686-8760 -
(909)68s-8786 Fax
INSULATION CERTIFICATE
THIS IS TO CERTIFY THAT INSULATION HAS BEEN INSTALLED IN CONFORMANCE WITH THE
CURRENT ENERGY REGULATION, CALIFORNIA ADr1i IMSTRATIVE CODE, TITLE 24, STATE OF
CALIFORNIA, IN THE BUILDING LOCATED AT:
TRACT/ PHASE: BELLA VISTA - PHASE 1 TVkCT #:28457-1
LOT#: 24
SITE ADDRESS: 78533 SAN MARINO, LA QUINTA, CA.
EXTERIOR WALLS:
MANUFACTURER: JOHNS -MANVILLE THICKNESS: 3 5/8 R -VALUE: R-13
.CEJJ,INGS: B�BLOW
MANUFACTURER: JOHNS-44ANVILLE THICKNESS: 13U R -VALUE: R-38
-CEILING$ : BATTS riFo
W
MANUFACTURER: GREENSTONE THICKNESS: 13.3" R -VALUE: R-38
GENERAL CONTRACTOIL:
LICENSE NUMBER:
BY:
TITLE:
DATE:
ROGER SNELLENiBERGER
INSULAT Cid: WESTERN INSULATION, INC.
LICENSE NER: 481
BY:
TITLE: 7Produ ionana ;er
DATE: DECEMSFRiln.1 QQQ
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