9905-344 (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
;594ci5 0 1201
r �, g
Date��' if 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 mairitain 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.
Q,1I 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 sect ne dFnot �e completed if the permit valuation WOR1�0' 0 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 37001of the Labor
Code, I shall forthwith comply with'those provisions. ;
Date:` h' 1 Lsei Applicant V.
IVWarning: 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 '@ this City to enter upon
the above-mentioned property for inspection purposes.
1�i
Snnature (Owner/Agent) !� .f ''� r Date/n �� Ar
innature
BUILDING PERMIT PERMIT#
L
DATE VALUATION LOT 9905-344 TRACT
05/277199 $122.599.'10 1. .2$1.58-2
JOB SITE
APN
ADDRESS
7&563' ri1V A�'t.(NO �'ta1tRT
�'+ 9_07(W39
OWNER CONTRACTOR / DESIGNER / ENGINEER
ADVANCED DEV LOPMIE'N 7 CORP. TRADMONAL BUI1 DR4G` CO IM." .
'78-6.15 NAPLES DR 77"15 NAPLES DR
LA QUKTA CA 92253 'LA QIUINTA CA 92253
(760)772-0222 COL.# 5750
USE OF PERMIT
c7. acv r :i. rpcv SA • • � .,;L.. a.v
SFD - 'LOT' 21y PLAN 3A-3 - PEit3' UT DOES NOT iNt�LUM3 DT_(7f,ly: WALL
OR POOL. PLAN Cf1F..CK PORTION OF F?~E' :ftE1�UCET3 75fo FOR &MMPTA
rr r a hLC . lM V , SU n . ,p r 'MMV
TRACT (` ONS:CRUC ION 2,025.00 SF
PORCH/PATi4 510 SF
G.ARAGWCARPORT 625.00 SF
ES t IMA:TED COST Off' t ON.%`URIUC1 I`ION
122459).1ti
PERMIT FEE SUMMARY
CONS: 'RLIC ION t� E8 1.01-000-418.000 $92i 100
PIAN CHECK. FEE 101-000-439-318 $149.08
NIECRAN:ICAL .F7 13 .101-)00-421-000 $53.30
F --t. crRicALFFx 101-000-42.0-000 S13IM
PI,>;TW3i3+GM 101-000-419-000 $1= 3.75
STRONG MOTION FEE -RESID 101-M-241400 $12. 9
G.ft�iWNG FEE' 101-000-1123-000 $20.00
1W,"RAS'11R(G1'f; RF.:1:EE 225000-443-342 52,7=19.6;
AR IN PUBLIC PLACES - RESIE 741-1100-255-000
WD -TOTAL CONSTRUCTION AND .PLAN CHECK
X1;;034.42
LESS P11,E-PAIC11'E S
$07.00
1tOTAI, PERMIT FILES DUE, NOW
$4,034.42
�u
'RECF,IPJ�rt
DATE
BY }
DATEFINALED-
INSPECTOR
INSPECTION RECORD
r OPERA—ION
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
O.K. to Wrap-94
F.A.U.
Framing
/—/S=BSC¢.
Compressor
Insulation
—
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall FirewalR
Exterior Lath /,rnj?__q2
Drywall - Int. Lath
Final
Final —
MOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. 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
OX for Finish Plaster
Sewer Lateral
—�_
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
— 6
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 -- 3— 00
Utility Notice (Perri)
COMMENTS:
DEC -20-1999 15:59 WESTERN INSULATION 909 686 8786 P.15/18
WESTERN INSULATION, INC. b
4911 Latham 8lrent, Ytiseu.ide, CaUfoxnla 92901
(909) 68fi-S?6t�
(9091686-87M 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; BELLA VISTA - PHASE 1 TRACT #,28457-1
LOT#: 21
SITE ADDRESS: 78563 SAN MARINO, LA QUINTA, CA.
EXTERIOR WALLS:
MANUFACTURER: JOHNS -MANVILLE THICKNESS: 3 518 R -VALUE: R-13
CEILINGS! 5)1
BLOW
MANUFACTURER: JOHNS -MANVILLE THICKNESS: 13" R -VALUE: R-38
CEILINGS: BATTS BLOW
MANUFACTURER: GREENSTONE THICKNESS: 10.3" R -VALUE: R-38
GENERAL CONTRACTOR:
LICENSE NUMBER:
BY:
TITLE:
DATE:
LICENSE N
BY:
TITLE:
DATE:
�1;
R. 4812
Pkductibh Man ;er
DECEMBER 20, P399
ROGER SNEILLENIBERGER
WESTERN INSULATION, INC.