9905-342 (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
?50461 13
bate ! ! ` '` Signature of Contractor
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 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.
10 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.
STA.TF Ff.1f, I) 0!,"�. i -nq
(This section need not Abe completed if the permit valuation Is forV O.UO 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 3 00 of the Labor
Code, I shall forthwith comply with those probisioni. Ef
Date: = j /�1' /Applicant
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 ins(pecttiio�n`p rposes.
-/Si nature (OwnedA ent)`-" _c /`— Date's /
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 9"5.3421 TRACT
95V2 7/1 5141,248.40 23 2808
JOB SITE
APN
ADDRESS
78.543 SAN MARINO COURT
609-0711.038
OWNER CONTRACTOR / DESIGNER / ENGINEER
ADVANCED DEVE1,t_)P1v1EN'r CORP. 'IRAI)mONAL BUILDING CO INC
78-615 NAPLES DR 78-615 NAPLFS DR
LA QUINTA CA (2253 LA QUINTA CA 922-53
(760)772-022' CBLt# 5750
USE OF PERMIT
3FD -1.OT' 23, PIAN :+A - PIRANT DOES NOT INCLME BLOCK WALL
OR POOL
TRACT C0N3TRUCTION 2,400.00 3F
Pr3ltc'HtPATIO 16u.10) qF
GARAG&CARP€)RT 449.00 SF
1+:.5"11NIA'1'ED COST OF C ON3'MUCTION
141,248.411
PERMIT FEE $UNIACARY
CON..i TRUCTION ME E 101-000--119-000 5786.50
PLAN CHECK F11% 101-(W-439-318 StA7.91
N, WCH.ANICAL FIX 101-000-421400 �frt►.f>n
I LBC'TRICAL FFF 101-000-420-OWO S1 ii.18
PLUMBING HUE 101 -000419 -CM $1110.75
sl,RoNo MurwN FL -Lt - RPSID 101-000-241-000 $14.12
GRA WNtl MTR 101-000-•12.3-000 520.00
INFRA3`t RUCTUkl? 1:'1 -:Fs 225 -ft) -443-142 33, 130.21
ART IN PUBLIC PLACES - RCsSf1: 701 -(X0 -255-0(X) $10312
SUB -TOTAL CONSTRUCTION AND PLAN CHECK
$5,044.0k)
LESS PRE -PAID i,'EES
$00)
TOTAL PERMIT FEES DUE. NOW
$5,044.09
RECEI
DATE
BY { j
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION j
DATE
INSPECTOR
OPERATION
DATE
It-SPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings ,`
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
O— o 4r., C
Exhaust Fans
0. K. to Wrap
Framing
—!
% —/,jiv zj
F.A.U.
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
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
57— e1., 2_
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
7Z
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G. F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
DEC -20-1999 1558 WESTERN INSULATION 909 686 8786 P.13i18
WEEN -STERN INSULATION, INC.
4911 LaUmm 8trset, Piwn ide, CaMzala 90601
(409) 686-876c,
(909) 686-8786 Fax
INSULATION CERTIFICATE
THIS IS TO CERTIFY THAT INSULATION HAS BEEN INSTALLED IN CONFORMANCE WITH THE
CURRENT ENERGY REGULATION, CALIFORNIA ADMIMSTRATIVE CODE, TITLE 24, STATE OF
CALIFORNIA, IN THE BUILDING LOCATED AT:
TRACT/ PHASE: BELLA VISTA — PHASE 1 TRA►CT #:28457-1
LOT#: 23
SITE ADDRESS: 78543 SAN MARINO, LA QUINTA, CA.
EXTERIOR WALLS•
MANUFACTURER: JOHNS -MANVILLE THICKNESS: 3 5/8
CEILINGS: �8 BLOW
MANUFACTURER: JOHNS -MANVILLE THICKNESS: 13"
C I LI N $: BATTS BLOW
MANUFACTURER: GREENSTONE
GENERAL CONTRACTOI :
LICENSE NUMBER:
BY:
TITLE:
DATE:
THICKNESS: 10,3"
ROGER SNELLENBERGER
R -VALUE: R-13
R -VALUE: R-38
R -VALUE: R-38
INSLJLATION CONTRACTOR: WESTERN INSULATION, INC,
LICENSE NU R: 481278
BY:
TITLE: rodu on ana ger
DATE: ECEMBER 20,199