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9905-343 (SFD)t: C0 • pN . 0) Q Nr Z r Q.0 X W O.�Q m<3 11 ur) Z ob 5 �d i.. �f • LICENSED CONTRACTOR DECLARATION I','ereby 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 Profe.psionals Code, and my License is in full force and effect. License # Lic. Class Exp. Date 759465 BBQ——'''�, Els" r2Cd ,©ate -�/> � • 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. (f)71 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: Cartier Policy No. (This section need not' 6e completed if the permit valuation its for3$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, arid agree.that if•`I should become subject to the workers' compensation- provisions; of Section'3700 of the Labor Code, I shalltorthwith comply with those provision's. ' Dater,,, 1 i 1`-°''- Applicant t, r• Warning: Failure to secure WorkersCompensation 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 jof this City to enter upon the above-mentioned property for inspection % purposes. J Y" Signature (Owner/Agent) /r Dat BUILDING PERMIT PERMIT# DATE VALUATION LOT 990.9-343 TRACT 051291199 5162.948.70 ?. 28458.2 JOB SITE APN ADDRESS "7l3 aS3 SA*4 '�it�RMO COURT 64W-470-038 OWNER tea__ _._ CONTRACTOR/DESIGNER/ENGINEER ADVANCED DEVELOPMENT CORP. IRADMONAI, Bt111DWO CO INC 78.h15 'N'A_PLES DR 78-615 N[aYILE5 LSF:. LAQUINTA CA 92253 LAQUINTA. CA. 92?43 (760)772-0222 CBL## 5750 USE OF PERMIT S1=D - LOT 2; PLAN 6B - PE�zTI' DOIN NC~I tivCd UDE BLOCK WALL OR, POOL. TRACT CONSTRUC` ON '"063.(A Sk POR CRiPA lIO 90.01) 8F CIARAGRIC ARPORT 598.00 SF CSTIMAT E0 CMIT OF 00149 RC,CTION 162,948.70 PERMIT FEE SUMAIAR CONSTRUCTION FEE 10.1.000418.0110 $860.00 PLAN (SCK FE..f~ 101- At -439-318 V 18,69 MECHANICAL HANICAL FEE 101-000-421-000 1192,00 &ECTR1CAi. f7E , 101.000-420-000 S157,17 LUNWING FEE l01-000419-000 S16$.00 S' R.CJNG MLY!' N FEE, � .R37..51I7 1.01-000,24.1-000 S16.29 GRADING FEE 1.01-000-423-000 .$20.00 INMA,ST.ttill"C[1i E FEE 275-000-443-342 $3,639.41 1 REC'fSE.PLgN 101-000-441-:341 525.00 AWC IN PUBLIC, PLACES - fU-*,9 x'701-000-255-001) 5157.37 SLIB- YYf AL CONSTRUMON AND PLAN CHECK $5,8M.93 LESS PRE -;PAID FEES $0.001 TOTAI, PERMIT EEL4 DUE 1VOW 55,851.93 /�d A r �ECE�1� � , QATE BY ' j � DATE FINALED INSPECTOR ■ INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade Return Air Steel Combustion Air Roof Deck Exhaust Fans _L O.K to Wrap _ Z — F.A.U. Framing— Compressor Insulation //_ 2 Vents Fireplace P.L. Grills Fireplace T.O. Fans 8 Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath 2 �' Drywall - Int. Lath Z z Final —� � BLOCKWALL APPROVALS Final 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 Pool Cover Sewer Connection Encapsulation Gas Piping Gas Test 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 —2 Utility Notice (Perm) . COMMENTS: DEC -20-1999 15:59 WESTERN INSULATION• 909 586 6786 P.14i18 W °I112D1�T INSULATION, INC. 4911 Latham Street, RSvemide, Col *naa 89501 (909) 686-876Ci (909) 686-6796 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: SELLA VISTA — PHASE 1 TRACT #:28457-1 LOT#: 22 ,SITE ADDRESS: 78553 SAN MARINO, LA QUINTA, CA. EXT'E'RIOR WALLS: MANUFACTURER: JOHNS -MANVILLE THICKNESS: 3 5/8 CEILINGS: BATT BLOW MANUFACTURER: JOHNS -MANVILLE THICKNESS: 13" CEILINGS : BATTS BLO MANUFACTURER: GREENSTONE THICKNESS: 1,1.3" 1 GENERAL CONTRACT01t• LICENSE NUMBER: BY: TITLE: DATE: INSULATION CONTRACT: LICENSE NUlvWM 481271, BY- . TITLE: oductitjM nager DATE: DECEMBER 20,1999 ROGER SNELLENBERGER R -VALUE: R-13 R -VALUE: R-38 R -VALUE: R-38 WESTERN INSULATION, INC.