9905-336 (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 /DateJ_7V Signature of Contractor i2 f ,r J;
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.
(S) 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 sectonneed not'b) completed if the permit valuationfiiss'�fo r$100ff00 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 370 of the Labor
Code„I shall forthwith comply with those provisions.
/ 16-;f Applicant Y'. ., t 1-/(
Warning: Failure to secure W6rkers' 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 inspection purp
oses. �-�i
vSlgnature (Owner/Agent _ -�! Date`1.;'
C
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 990S-336 TRACT
O.'W27/199 S141.248.40 29 M458-2
JOB SITE
APN
ADDRESS
79,U IAK N444 YlNO COURT
609070-039
OWNER CONTRACTOR/DESIGNER/ENGINEER
ADVANCED DEVEWPi1 EXT CORP. TR ADMONAI, BLULDING CO INC
'78-615 NAPLES DR 78-6151`I•.APLES DR
LA QLIIN'1 A CA 92253 LA QLJ NTA CA 92253
f760)7i2-02V2 CBL# 5750
USE OF PERMIT
tt- 'r ra z' . r
+•.t r47 fSSV , �
SH) - LOT 29, PLAN 58R - PUM1T DOES NOT INCLUDE BLOCK: WALL
OR POOT
T%AC'.i COSI ,"I.1�U(NION 2,4(X)A0 SF
PORICH11PATIO I60AO SP
GAPLA UCCAR1 OWF 4919.00 S
Ei.VfIMATED DOST 010 CONST.It,"I.iC'-TIION'
141•,24 8.40
PERMff FEE SUMMARY
CONTfRUCTION ME 1.01-000-418-000 $786,50
PLAN CHEM FM 101-000-439.318 $547.91.
MFICHANICAL FM 101.000-421-000 30,00
FiXi TRICAL FE,E 101.4101-4210-000 $141.48
K:U1IBING, bTC - 1.01-000-419-000 $140.75
STRONG MOTION FEE,- RE&RD 101-000-241-000 $14.12
GRADZIO FEE 101-000-4923.000 V-0:00
iNFRASTM)MOM PEP, 225-000-43'13-342 33,13().21
A I' 1N PTIRI.IC PLACES - X ESTE 701-000-255-000 EI01.12
SUB=IUrAL C ON•S1'TiLK.;” ON AND Pi, -,Vhf C.LIL:C1
LESS PRE -PAID FrwVS
$0,100
TOTAL PE FLMIT b`FXS DUE NOVV
55.044.09
v�
r
_ n
RE IIT'
DATE
By
DATE FINALED
INSPECTOR
INSPECTION RECORD
` OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECT
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
7- G
Exhaust Fans
O.K. to Wrap
Framing
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 G�
BLOCKWAL A P VALS
Final
Steel
POOLS - SPAS
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
C
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
-2 E,97 A: 7
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
Utility Notice (Perm)
COMMENTS:
DEC -20-1999 15 55 WESTERN INSULATION 909 666 87% P.07i18
..f
WESTE-R-T INSULATIONt INC.
4211 I61Cham Sbvzt, RWOft de, CalltorWa 92601
1909) 69"76(1
19091686-6786 Itis
INSULATION CER11FICATE
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 TRACT #:28457-1
LOT#: 29
SrrE ADDRESS: 78544 SAN MARINO, LA QUINTA, CA.
EXTERIOR WALLS:
MANUFACTURER: JOHNS -;MANVILLE THICKNESS: 3 5/8
CEILINGS : BATTS BLOW
MANUFACTURER: JOHNS-0ANVILLE THICKNESS: 13"
-CEILINGS: BATTS
MANUFACTURER: GREENSTONE
GENERAL CONTRACTOR
LICENSE NUMBER:
BY:
TITLE:
DATE:
THICKNESS: 10.3"
ROGER SNELLENBERGER
R -VALUE: R-13
R -VALUE: R-38
R -VALUE: R-38
INSULATION CONTRACTOR: WESTERN INSULATION, INC.
LICENSE NU ER: 48127
BY:
TITLE: troductUn pager
DATE: DECEMBER 20, 1999