9905-345 (SFD)LICENSED CONTRACTOR DECLARATION
Thereby 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
Professiom4ls Code, and my License is in full force and effect.
License # Lic. Class Exp. Date �^
759465 02/ j
/201
9ai���` r,Signature of Contractor 1, %
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.
(�) I have and will maintain workers' compensation insurance, as required by
Sec ion 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.
STAT'& FUND 061353-98
(This section need not be completed if the permit valuation is for $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, and agree that if I should become
subject to the workers' compensation provisions of Section 3700fof the Labor
Code, I shall forthwith comply with those provision
Dater' Ll - _Ib' - Applicant s. �
6Vl/arning: 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 authorizer representatives of this City to enter upon
the above-mentioned property founspection purposes.
Signature (Owner/Agent) / a�^ • Date�nr1�i.,
BUILDING PERMIT PERMIT#
9"59 -;gas
DATE . 4)&27/,WLUATION $130'154.60 LOT4 TRACT 2284-2
JOB SITE
ADDRESS --78.,5+ 73 SAN NIA,RYNO COU f
APN
609-070-038
OWNER
CONTRACTOR/DESIGNER/ENGINEER
ADVANCED DEVELOPMENT CORP.
TRADITIONAL 13I.;ILDINir CO INC
78-615 NAPLES DR
78-615 NAPLES DR
LA QU.'NTA CA 52253
LA QUINTA CA 92253
(760)772-0222 CBLY 5750
USE OF PERMIT
SINGLE FAMILY DWELLING
yF`D �- LOT 20 PLAN Q'Il - PERMIT DOES NOT INCILUDE BLG4K MALL
OR POOL
TRACT" CONS'1'RW iON 2.200.00 SF
PORCHiPA7110 110.00 SF
CIARAG CARPORT 4171.00 SF
ESTII INrEID COSY' OF CCINSTRUMON
130,154.60
PERI UT FEE S UMMARY
C'ONSTRUC'TION FEE= 101-1)00-418-(}00 4748.00
PLMN CHECK FEE 101-000-439-318 $618.74
MECHANICAL FEE 101-000-421-000 460.011
ELEC'iR[CAL FEE 101-000420-000 $.1134,93)
PLUMBING FEE 101-000-4.19-000 St40.75
STRONG X40TION FEE - RE 1D 101.-000-241-000 $13.02
GRADING FEF 101-000-423-000 $20.00
INFRASTRUCTURE FIM 225-000-443-342 $2,895.56
AWIAN PUBLIC PLACES - RFS)E `701-Q00-255-000 875,39
SUB -TOTAL CON9MUCTION AND PLAN CHECK
$4,706.38
LESS 'PRI? -PAID FEES
$0.00
TOTAL PERMIT FEES DUE NOW
$4,706.38
R CEIP`T /� `
\. 1
DATE
BY (3
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
,,,Z .—� C
Exhaust Fans
OX to Wrap
F.A.U.
Framing
/ 2Z—q 97
Compressor
Insulation
/ Z _
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
.2 _
Drywall - Int. Lath
zz.- 7.r C
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
/
Neater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans -
O.K. for Finish Plaster
Sewer Lateral
/ i 6
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
Utility Notice (Perm)
COMMENTS:
DEC -20-1999 16:00 WESTERN INSULATION
909 686 9786 , P. 16!18
'DEQ"`EST INSULATION, INC.
4811 Latham Street, Rivwdde. Cai rak 98301
(909)6067 AT%
(909) 666-x36 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#: 20
SITE ADDRESS: 78573 SAN MARINO, LA QUINTA, CA.
EXTERIOR WALLS -
MANUFACTURER: JOHNS -MANVILLE THICKNESS: 3 518 R -VALUE: R-13
CEILINGS: ATT BLOW
MANUFACTURER: JOHNS -MANVILLE THICKNESS: 13" R -VALUE: R-38
CEILINGS: BATTS LO
MANUFACTURER: GREENSTONE THICKNESS: 10.3" R -VALUE: R-38
GENERAL CONTRACTOR:
LICENSE NUMBER:
BY:
TITLE:
DATE;
ROGER SNELLENBERGER
INSULATION CONTRACTOR: WESTERN INSULATION, INC.
LICENSE NUM ER: 4812
BY:
TITLE: Pr duct n anal;
DATE: DECEMBER 0,1999