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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 f Exp. Date,
7594'5,/201
Date C. Wit' �r� Signature of Contracto,l�,� �� /,•
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) 1, 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):
O 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:
O 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.
ST.A'!'.E F1J.f9g63�-9FI
(This section need not3'9
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 shoul
Subject to the workers' compensation -provisions of -Section 3706 o the Labor
Code..l.shall-forthwith c6rnDlVW` ith tfiose'brov si o ski �l
Warning: Failure to secure 1Norkers' 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 l 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 -p opertyfor inspection purposes.
f
Signature (Owner/Agent)'si!j_-_ /!l Dateilra*
BUILDING PERMIT PERMIT#
DATE VALUATION LOT -9905-33.1 TRACT �
M. 711" $.141;148.40 34 28458-2
JOB SITE
APN
ADDRESS
8-594'SA4 MARINO COUPI-'"
11119-070-�i3$
OWNER - - - CONTRACTOR / DESIGNER / ENGINEER
ADVANCED DEVELOPMENT CO&n. TKAI3.C[ ONAL .BiTILDWO CO [NC.
78-6115 NAPLES DR 78-615 NAPLES DR
LA QUINTA CA 92253 LA QUINTA CA 9:2253
(76[1)772-02:22 CBL# 5750
USE OF PERMIT
SM -'LOT 34, PLAN 593 - PIMMIT DOES NOT INCLUDE BLOCK W kLL
OR.POOL. ALAN CFJECK. PORTION Or FEE R03110E„D 7s*A I.OR mu `C1PLE
1' f,
TRACT CONS"IRUCT ON 2.400.00 SF'
PORCRPATIO 160.00 SP
CIAR A(MCARPORT 1949.00 «S.F
' E',STIA9M IM COSH' OP CONSTR IC'f`ION
141,248.50
PERNIff PEE SUMMARY
CI NS'T'1 UCT'IO'NkEE 10I-000-419-000 $IAc5.5fi
PLAN CHECK FEE 101-000-439.318 �16i,98
NIECNAMCAL FEE 10.1-000421-01141 $60.00
F,LFf-*rRtC,Ai.:IFES 101-00 0-420-000 $141.48
PIXMftNGFEE- 101-000.119-000 $140.75
STRONG blOTION:FEE, _ RESTD .101-f)t}13r241400
GRADINO FEE 101-000-423.0011 $211:00
WRAS'T'itu'C'f'i RE FEE 22$-000-443-342 $3,130.21
A:R:1' INPUBLIC PLa1..CES - RESIi 701-000-255-0410 $103..92
Sie IB-TOT.AL CONSTROC" I'10N MD PLAN CHECK
$4,558..16
LESS PIS PA1.I3 BEES
$0.00
TOTAL PERMIT FEES DUE NOW
AQ A\ v
ESE T
DATE
BY �i V
DATE FINALED
INSPECTOR
01
t
+
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
JW1
Exhaust Fans
O.K. to Wrap
OV
F.A.U.
Framing
/b_:__Z84W
Compressor
Insulation
8
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
/_,� 17 C-or—
Drywall - Int. Lath
Final
Final
_
/ 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 I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
d
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
/ –2 _ g
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 ZsZ—
Utility Notice (Perm)
DEC -20-1999 15:53 WESTERN INSULATION
909 686 8786- P.02i18
WLSTERN INSULATION, INC.
4911 Latham sheet. Riverside. California 92501
(9091686-8760
(409) ea:
ULATION 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 i TRACT #:28457-1
LOT#: 34
SITE ADDRESS: 78594 SAN MARINO, LA QUINTA, CA.
EXTERIOR WALLS:
MANUFACTURER: JOHNS-"ANVILLE THICKNESS: 3 5/8 R -VALUE: R-13
CEILINGS : cs�TS BLOW
MANUFACTURER: JOHNS -MANVILLE THICKNESS: 13" R -VALUE: R-38
CEILINGS: BATTS BLOW
MANUFACTURER: GREENSTONE THICKNESS: 103" R -VALUE: R-38
GENERAL CONTRACTOIL ROGER SNELLENBERGER
LICENSE NUMBER:
BY:
TITLE:
DATE:
INSULATIONCONTRACTO WESTERN INSULATION, INC.
LICENSE N ER: 4 Lie
BY:
TITLE: Prod ion anal;
DATE: DECEMBER 20,1!99
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