9905-332 (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
Date:-fn1 ignatureof.Contractor
OWNER-BUILDER,UECLARATION
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). '
O
lam 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.
and will maintain workers' compensation insurance, as required by
Se,11lo3700 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.
(Thissecton need not e completed If the permit valuation is ffr3$g10000 or less).
O 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 3700 of the Labor
Code, I shall forthwith comply with those provision f f
Daiei:.'r- 21 Applicant %.Y I
/Warning: 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 sand 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.
ignature (Owner/Agent) - Date/•�� /'
BUILDING PERMIT PERMITN
DATE VALUATION LOT 990,4.332 TRACT
05/2711" $122.899.10 33 28458-2
JOB SITE
APN
ADDRESS
78-584 1AN IWARINO COURT
609-074-0,18
OWNER
CONTRACTOR / DESIGNER / ENGINEER
ADVANCED DEVELOPMEN'! CORP.
TRADITIONAL WILDING CO INC
78-615 NAPLES 'DR
:8.6.15 NAPLES DR
LA QUiNTA CA. 92253
LA QUINTA CA 92253
t 760) 77'2-7222 CBL# 5750
USE OF PERMIT
Q tJl1 i! 1' $Zia"/ Ptit
- LOT 33, PLAN 3AR-3 - PEROT DOPSNOT INC:f.t0'i�R. FsLC.WK
WALL OR POOL
TRACT CONSTRUCTION 2,025.00 SF
' PORCRPATIO 52.66 SF
GAR.AGEXARPOW1` 625.00 SF
1 S'1TIMA' EW COST OF 4:C)AA.S1RRU TION
12.2,899.10
PERMIT YT E SU HTWARY
C'ONSTRtTi:1`.1014FES 101-000-4:18-000 S7 10.00
PLAN CHECK FEE 101 -MO -439.318 _5596.33%
NXICHANWAI. FEF 101-000-42.1-0190 $53.50
'81A L ITR1CI'U,.:Fi-E 101 -OW -420 -NO $13.1.88
PI,,[A3l:, INN f]� 1.0.1-000-419.000 $140.75
STRONG MOT•IO:ht FEE = RES[D 101-000-241-000 $:1^.29
GRAWNG FEE 101-000-42-1-000 $-20M
i"t4F.RASTRUC`.IURE'FE 225 0W-443-342 $2,77=19:67
GILT 1N f'TJI3L.fC• E'1,ACES - KFSi>; 701.000-.255-OOU-5
StJ.C4-T( FAr., C0NS'I`.RUCI10N- AND PLAN CHECK
$4,481.07
USS PR1-PAtD FEES
$0.(X)
TO'IA.L PERMIT FE US DUE NOW
S4,481.67
C
A\R
�, hg► ,�
'\E 'IPT\ ��j� DATE
`
BY ^ �'J Y
DATE FINALED
INSPECTOR
\ t.
i r
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
O.K. to Wrap
—2—
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
3
Drywall - Int. Lath
_ y=
Final
Final
Z Z Z
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
p
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
Z —
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 . ,2:
Utility Notice (Perm)
DEC -20-1999 i5:93 WESTERN INSULATION 909 686 5786 P.03i18
J
WESTERN INSULATION' INC.
4211 Latham street, 8ivereide, California 92561 ,
(909) 686$76(1
(909) 6864766 Tax
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#: 33
SITE ADDRESS: 78584 SAN MARINO, LA QUINTA, CA.
EXTERIOR WALLS:
MANUFACTURER: JOHNS -MANVILLE THICKNES4: 3 5/8 R -VALUE: R-13
CEILLNGS :BATTS BLOW
MANUFACTURER: JOHNSQANVILLE THICKNESS: 13" R -VALUE: R-38
CEILINGS: BATTS BLOW
MANUFACTURER: GREENSTONE THICKNESS: 10.3" R -VALUE: R-38
GENERAL CONTRACTOR• ROGER SNELLENIBERGER
LICENSE NUMBER:
BY:
TITLE:
DATE: '
INSULATION'CONTRACTOR; WESTERN INSULATION, INC.
LICENSE N ER: 4812 .
BY:
TITLE: Prod ion ana€;er
DATE: DECEMBER 0,1 399