9905-347 (SFD)�r
s1; 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 #L:ic. Class / ^Exp. Dade
^T: Jay
c., 7I `!
41: `�r r Signature of Contractfo�r. 1e Mit y
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 .6 -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.
STATE FUND 0626355-93
(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°ould become
subject to the workers' compensation pr'sions of Section 3100 bf the Labor
Code', I' hall .fo+ ht1h comply with1hose.provisions.
Date r�Applicant
/`
✓Warning: Failure to secure Workers Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees. .
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon {
the above-mentioned property.for inspect onfp'urposes. 1
1 ,Signature (Owner/Agent),LI Date ;�Tra 144
PERMIT#
BUILDING PERMIT M_SiJ47
_
DATEIl `�.;,��lYALUATION �'��� j$ LOT n^!�.� TRACT 28458-2
r -
JOB SITE
ADDRESS % -: ➢t 1• AV11.).1RjN000U.EiT
I
APN /E+s1
9-070-iD 9
OWNER ,
CONTRACTOR/DESIGNER/ENGINEER
ADVANCED DEVELOPMENT CORP.
TRAD1170NrAL BUILDING CO INC
78-61.5 NAPLES DR
78-615 INAPLES D1;
LA QUDITA, CA 92253
LA QUINTA. CA. 9225-
(760)772-3222 CBL' 5750
USE OF PERMIT
84NOLE PAMILY DWELLING
S D -LOT 18, PLAN 6A - PFRbMT DOES NOT INC -WE BLOCK WALL
OR POOL. -PLAN CHECK. PORTION OF FEE REDUCED 75% FOR Aii fr.7,7PLEs
IS91JA.NCE OF SA VIE PLAN TYPE
FRAC" I` CONSTF UUMOId ry,76:3.{10 SP
PORCIOPAT IO 90.00 SP
i rARAGEICARPOR 1' .`398.00 SF
it ST.I'MA`i`ED COSY' OF COINS S"RUC'd` YN
162.948.711
PERMIT FEE SUMMARY
CONSTRUCTION F%F 101-000-4163-000 $860.00
PLAN CfiECK FEE 1.41.400-439-318 $179-67
MI RCHIWICAL FTM 201-000-421-000 $9200
Ell -Cf FUCAL FEE 10.1.-000.420-000 $157.17
PL U E1INCT FEE. 101-000-419-000 $166.00
STRONG MOTION FEE - R,:ESIli 101-000-241-000 $16.29
GRA13TNQ; FEE 1014)00423-000 $20.00
isN7F'RAST.R.C;Gt;`lURE FEE 225-000-443-342 $3;639.41
PRECISE PLAN 101-000-441.34.5 125.00
MMT :IN PUBLIC PLACES - RES1E 701-000-254.000 5157.37
SUB- OTAI, CONSTRUCTION AND PLAN CBEC1:
$5,312.9.1
LCOS; PRE -PAID -1 -TES
90.(11
TOTAL PEI RMIT FEES DUE NOW
�- I A -Ar
1RECEI�' I \
DATEBY
f;
1
DATE FINALED
INSPECTOR
V
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Back,;
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
TO — -yy
Exhaust Fans
O.K. to Wrap
Framing
p— —� /(t
l3d_Q 6'�_
F.A.U.
Compressor
Insulation
zZ -5— % L.
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulatiai
Condensate Lines
Party Wall Firewall
Exterior Lath
�Z
`
Drywall - Int. Lath
L�
Final
Final �.�-va ,�1�--
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
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
_ 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 -720-1999 16:01 WESTERN INSULATION 909 686 e786 P.1e/18
WESTERN INSULATIONt INC.
4211 Latham Street, Mmoldc, CaUftwzia 92601
(9091 666 756 Fam
INSULATION CER110-CATE
THIS 15 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
LOTA: 18
SITE ADDRESS: 78593 SAN MARINO, LA QUINTA, CA. -
EXTERIOR WALLS:
MANUFACTURER: JOHNS -MANVILLE THICKNESS: 3 5/8 R -VALUE: R-13
CMINGSEIATTS: C----
HATT BLOW,
MANUFACTURER: JOHNS4v1ANVILLE THICKNESS:* 13' R -VALUE:' R-38
CEILINGS, BATTS BLO
MANUFACTURER, GREENSTONE THICKNESS. 113" R -VALUE.- R-38
-GENERAL CONTRACTOR: ROGER SNELLENIBERGER
LICENSE NUMBER:
BY:
TITLE:
DATE:
IN—SULATION CONTRACIOR.- WESTERN INSULATION, INC.
LICENSE N
7
BY: '7
N.
TITLE: rodfionManan;
DATE:
DEC ,
TOTAL P.18