9905-346 (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 li Lic. Class Exp. Date
-•V,
ate Signature of Contracto
/p crc /
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.
( ) 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. -
STVrH FIM 4626355-98
(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 shtoluld become
subject to the workers' compensation provisions of Section'.3760' of the Labor
Code, I shall forthwith comply, with those provisionsel
Date•Applicant"-.., - i. J f i
VVd Warning: Failure to Secure Workers' Compensation coverage is unlawful and
subject an employer to criminal penalties and civil fine's 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,thi' City to enter upon
the above mentioned property for inspection pu.poses`.
Sig ature (Owner/Agent) ' +� c4 / �x %f y Date%`I "'� / 7
PERMIT #
BUILDING PERMIT _1990.11W46 I
_.
DATE 0&2711WLUATION $119,253. So LOT y 19 j TRACTJOB
SITE
ADDRESS 78..AN�i�.? RWO COURT
APN 609-070-038
OWNER `—
CONTRACTOR / DESIGNER / ENGINEER
ADVANCED DE-'ELOPMENT CORP.
TRADMONAL BUILDING CO INC
79-61314APIX'S OR.
78-61.ir;APLES'DR.
LA Q W'A CA 9722,-53
LA QU NTA. Cts 92253
(760)772-0222 CBL# 5750
USE OF PERMIT
SINGLE • fA.MILY DWELLING
f
SIM - LOT 19, PLAN 3.3 - PERMIT DOES NOT IN UDE BLOCK WALL,
OR POOL. PL AN C;RECK POJ�TION OF Fff- REDUCED 75°'o r O.R MuTaTIPL`E
ISSUANcr, OF S-Amr. PL AN TYPE
TRACT CONSTRUCTION 2,025,(10 SP
PORCHMAT.IO 5100 Sr
GARAGMARPOR'T 4:39.00 SF
!�>ti3T4;°1 A`!' 3o �2ST w' Ct�iY�'1'Q:1!'C."Q taN
1.1'9,2;150
PERMIT FEE SUMMARY
CONSTRUCTION IEE 101 -OW -4.18-000 5709,511
PL.NN C'HEr_ 1K FEE 101-000.439-318 $146.98
M I WiCAL:I`FE 101-000-121-000 $53.50
t;f:.E=.C'1'R.ICAL FF -C 101-000-420-000 �Io7i.lti
PL.UNIRI'NG FRT"s l01-000-419-000 $140.75
S`T`RO'N'G mol[ON -FE -1tEM 101-000-241-000 511.93
GR-ADINC ME 101-000423-000 $20.00
INF'T2:ASTIR(1CrniKETARE 225-00044-1-342 $2,019.64
ART [N PUBLIC PLACES - REST 701-000-255-000 $18,..13
SV13-WrALCONqRUCTIONAINDPLAN CHECK
$3,926.59
LESS .PRE -FAM FEES
$(i no
'TOTAL PERK -11T VEES DUE NOAV
$3,92ti.59
t .
'DATE
FkCEIPT /
BY f 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�Z7
�'
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
—. 9 6'
Compressor
Insulation
/ —3o —9 e { —
Vents '
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
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
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
,g 6
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
•
Final
Final �Lp
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures 00,
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
10
Final
Utility Notice (Perm)
COMMENTS:
DEC-20-1999 16:00 WESTERN INSULATION 909 686 8796 P.17%1E
ESE o
INSULIN, is
4211 Latham Street, Rhenide, CaUforob 92501
- (909).686.8760 .
(909) 6SS•8786 Fa:
INSULATION CERTIFICATE
t THIS IS TO CERTIFY THAT INSULATION HAS BEEN INSTALLED IN CONFORMANCE WITH THE
f 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#: 19
SITE,ADDRESS: 78583 SAN MARINO, LA QUINTA, CA.
EXTERIOR WALLS:
MANUFACTURER: JOHNS-MANVILLE THICKNESS. 3 5/8 R-VALUE: R-13
CEILINGS.- 5 BLOW
MANUFACTURER: HNS-IVANVILLE THICKNESS: 13" R-VALUE: R-38
_CEILINGS: BATTS BLOW
MANUFACTURER: GREENSTONE THICKNESS: 103" P, VALUE: R-38
j GENERAL CONTRACTOR: ROGER SNELLENBERGER r
LICENSE NUMBER:
TITLE:
DATE:
.`INSULATION CONTRACTOR: WESTERN INSULATION, INC. ar
LICENSE NUM : 48127
BY: O
TITLE: oductlo M Haller
DATE: ECEMBFR .1:4qg