9905-333 (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
1
Datel ^^� 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).
( ) :• 1, 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.
V 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.
`n'xre muo 11626355-98
(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 sh uld become
subject to the workers' compensation provisions of Section A00 6f the Labor
Code, I shall forthwith comply with those provisions. ` l/
Dater Applicant
LAarning: Failure to secure Workefs' /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 purposes.
,Signature (Owner/Agent)=' / '� De e••.
1/ !`��
r�
BUILDING PERMIT - PERMT#
DATE VALUATION LOT 9#05-333 TRACT
05/27/1,99 $130,154.60 32 28,158.2
JOB SITEAPN
ADDRESS
574 SAN MARINO COURT
609.070-038
OWNER
CONTRACTOR/DESIGNER/ENGINEER
ADVANCED DEVELOPMENT CORP.
TRADMONAL SUILDiNO Cts INC
'78.615 NAPLES D,R.
78-615 NA.PILES DR.
LA QifiN'1'A CA, 92253
LA QUINTA. CA 92253
(76())772-02'?2. CBLY 5750
USE OF PERMIT
lmnf P'raa:° r VVr.r 1
SFD - LOT 31- PIAN 4A PERMT DOES 1407 IN('.. J -DF f3L0CK WMA, OR
POHOL
TRhCf CONSTRUCTION 2,200.00 Sl:
PORT 'RTATIO 110.00 'Sr
CARAGEICARPORT 47:1.00 SF
L: TIMA" ED CO9T OF CO1WFRIjC $10 -IN
130,154,60
PERMIT :1<':EE 8011WARY
Cl7Ns'IRucrioNT`f E 101-0O0-4j,R-M S?49,00
PLAN CMCK: FfX 101000-439.318 $6AS.7 4
1*11 CHANICAL FM 101-000-421-000 $60,00
ELIEC RICAL'FEN I01.-OfJf 420-000 $134.92
PLUNIBIN0 FEE 10 1 -000-419-000 $140.75
ST. RONws A10TION M. - RMID 1.01.-000-211-000 $13.02
GYRADINOFFE 1.01-000-423-000 520.130
1NFR ASTRUC.rQ.1t1_'FFE 225-000-4.13.342 $2,895.56
ART .I.N .PUBL W :K t1:1"T? i - IL13,s11. 703.000-255-000 $75.39
SUIS-!'(3'IAL C0NST WC'1: f0_N AND PLAN CHECK
$4,706.38
LESS PRE-PAUD FEES
su.W1
TOTAL. PERU T FEES S DUE NOW
5+4,706.38
EC E IST` DATE
BY f� [/
f
DATE FINALED
INSPECTOR
�
II
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
I 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 G'
F.A.U.
Framing _
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,2 2y+
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
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
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
COMMENTS:
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)
DEC -20-1999 15:54 WESTERN INSULATION
909 686 8786 P.04i18
WESTERN INSULATION, INC.
4211 Latham 6troet, Riverside, California 92501
(909) 686.8760
(909) 6868786 Fax
INSULATION CERTIFICATE
THIS IS TO CERTIFY THAT INSULATION HAS BEEN RNSTALLED 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#: 32
SITE ADDRESS: 78574 SAN MARINO, LA QUINTA, CA,
EXTERIOR WALLS:
MANUFACTURER: JOHNS-"ANVILLE THICKNESS: 3 5/8 R -VALUE: R-13
CEILINGS: B�� BLOW
MANUFACTURER: JOHNS -MANVILLE THICKNESS: 13" R -VALUE: R-38
CEILINGS: BATTS BLOW
MANUFACTURER: GREENSTONE THICKNESS: 1,0.3" R -VALUE: R-38
GENERAL CONTRACTOR: ROGER SNELLENBERGER
LICENSE NUMBER:
BY:
TITLE:
DATE:
INSULATION CONTRACTOR: WESTERN INSULATION, INC.
LICENSE NUM : 481278
BY:
TITLE: Pr uction M#,)99 ;er
—4.
DATE: DECEMBER
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