9905-337 (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 -I Exp. Date
i
7-9465
6atd " ` . i' / 6ySignature of Contractor
, /I /
dF
{
OWN ER-BUILDER`DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) 1, 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).
( ` ),- 1, 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-nodRcompleted if the permit valuation is for�$1�00.�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 37,0 of the Labor
Code, I shall forthwith comply tiw` h thoselprovisions.
%Da ;�' Applicant /8
"Warning: Failure to secure Wbr eYt rs' 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',
City to enter upon
the above-mentioned property for inspection purposes. %
(Signature (Owner/Agent) f �^ fr Date�r+�
V
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 9"5,337 TRACT
0S/27/1" 5122.899.10 i8 28454R-2
JOB SITE
APN
ADDRESS
i!1 -53a SAN NlAfUNU CCYMT
609-07"38
OWNER CONTRACTOR / DESIGNER / ENGINEER
ADVANCED DEVELOPIVIENT CORP. TRADITIONAL BUILDING CO D41C
78-6.15 NAPLES DR 79-6t5,'NAPLES DR
LA, QU1NT.A CA. 92253 LA QUIN'TA CA 92253
(70)772.0222. CBL# 5750
USE OF PERMIT
144r �: t v A f 1,4
.S D -LOT 28, PLAN 3rt-3 - PER1biIT DOES NOT INCLUW BLOCK iCK WAi..L
OR POOL
TRACT' CONSTRUCTMN 2 025.00 Sl:
PORC PATIO 52.00 SF
t' 3ARACE{CARPO.RT 6125.00 SF
ESTIMATED COST OF CONSTRUC°l' ON
12.21899.10
PERMIT FEE SUMMARY
CONSTRUCTION FEE 101.000-4111-000 $720.00
PLAN CHECK FEE 101-000-439-318 $596.33
Ni ZCHANICAL!iFE 101-000.421-000 $53.30
fiLEC` R[CAL. FF.F 101.400-420-000 $131.88
PJAMMB1NG FFX 101-000-1194= $140.75
SIW. NG !MOTION FEE -111x ID 1101-000-24.1-000 $12.29
OR.ADING FES 101-000-423-000 520.00
INFRAS`.I'1211CT1."FEE 222-5-000-443-342 52,749.67
ART IN PUBLIC PLACES w:RE,SIC 701-000.255-000 557.25
SU13-10TAL CONS71RUC11 N AND PLAN CHUCK
1;I.1Rt;c�7
LESS PRE -PAID EES
$f:1.G0
TOTAL PERMIT FEES DUE NOW
"
54.681.67C)
X\0�1
7' f Cy
R CEIPT' r� 4 TE
1
BY !
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs '
Underground Ducts -
Forms & Footings�7
gglldgy
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
—7-5F
Exhaust Fans
O.K to Wrap
— — Q G
F.A.U.
Framing
— a ( eCL
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 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
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 Test71-7-077
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fndures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
DEC -29-1999 15!56 WESTERN INSULATION 909 686 878E P.08i18
WESTERN INSULATION, INC.
4711 Latham 8 MSU Rlwraide. Catlfarala 92601
(909) 686.876[►
(909) 686-8786 Y+az
INSULATION CERTIFICATE
THIS IS 7O CERTIFY THAT II1ISULATION 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 TRACT #:28457-1
LOT#: 28
SITE ADDRESS: 78534 SAN MARINO, LA QUINTA, CA.
EXTERIOR WALLS:
MANUFACTURER: JOHNS -MANVILLE THICKNESS: 3 5/8
CEILINGS: , ATTSJ) BLOW
MANUFACTURER:. JOHNS-10ANVILLE THICKNESS: 13"
CEILINGS : BATTS BLOW
MANUFACTURER: GREENS -TONE
t GENERAL CONTRACTOR:
LICENSE NUMBER:
BY:
TITLE:
DATE:
THICKNESS: 10.3"
ROGER SNEIL LENIBERGER
R -VALUE: R-13
R -VALUE: R-38
R -VALUE: R-38
INSULATIONCONIRACTOR: WESTERN INSULATION, INC.
LICENSE N4BEBY:
TITLE: n ana ;er
DATE: DECEMBER 0,1999