9903-244 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter 9 (ci3mmeneing 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
+W234
Batu 7 C e Q Signature of Contractor
` 6 OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
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:
(:) 1 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
Se., ion 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.
V11=113 FUND
sus.
(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 should become
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, .1 shall forthwith comply with those provisions. j rr�JJ
Date:-, dih i f ' / Applicant��
/ d'
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
aplication.
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 pro perty_for inspectiion purposes,.'
t Hitt I ! ✓l % 'r ` ("
Signature (Owner/Agent) �•- � Date�� %�� ••?
BUILDING PERMIT PERMIT #994111-244
)94>,i,:ate r
DATE VALUATION S130,154,60 LOT A•S - - TRACT 28458-J!
/7
JOB SITE
ADDRESS MU►
APN �i{lr-3973�i�S�`
OWNER
CONTRACTORDESIGNER ENGINEER
( '
REENyHNIC-it:, .1N�
,«yOYI
79-6i5RAP1J>;tS".n1Z
.1.A. Qt)lNrA. CA 92253
i.A i, U1,r ti'A, CA 92:25.;
l'lf�1'i7?-•A'1�'X C;'.4Bt:,t� ti�5ft
USE OF PERMIT
.i3OT X65, I" AN 4Ai.; W -D - P*ERMt'i' DOOSI NOT I'NC"`i.C[DE 13i..C:+CK AU -8
4 �R POOL,. PLAN GMCK ISI;H RJs XICa) I-V49FOK NIULT iUANCIH OJI
fVACT 1.:1JNSTI [Z.T,il.+'114 SV 2,.t,ulom s
f
3'C<it IDTIA't'IO 110.(* Sr � ,
(JAjKAUEJCnldt 0Wf 471.0U tit:'
111J URMIT -VEE SUMMARY
C CYNS11R. 11C rt0N F03 101 -OW -418--000 V148.00
PLAN 007(.,"K T'F», 101,•0 -433
I,E':C•2 Ar(tic"AL , ., I W -WO-1121 115160.00
L1Ek"T`rtI.CAL FFX, ]W-000-420-000 1 i341.92
TIPLIAVIBING FEE 101-000-4, 19-000 $140.75
StTR!111000eYTTON10,F R914Mi(alw(1fi�-?Al-elf)n �ItEYZ
viit�l}yf11`(s tTls 1.0i••tlMI ,-'Pi3•Sf{1(, �LO,fit)
iNi=et rL 'i"oily l tlt2tt d Tri 2:25�0f1#i „ a is 14895.59
AR1 Ifni t• UBLf,O PLAC.HS - ltH811, 701 4W-1255- WO 375.39
UYNSy ME7t';'1 ON AND K AN t;HFICK
$4,242,13
LESS PRE -In M FEES
$10,10
`
Ta fAl, 9" Y?,iiMIT .i!T.0 0!3 :-1JeJ.!', 31OW
.4.54.4•.33
REEIPTI /
DATE�
BY % f jf
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE.
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
aet Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
"feel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall 2
Exterior Lath
Drywall - Int. Lath
Final
Final
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
Neater 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
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels o0v
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Jo
Final
Utility Notice (Perm)
COMMENTS:
N`25=99 MON 1;;; Pia! WF TEPRIi INS'J'LAT'IM .; NO. 16:96856425 • P.
rA -
WESTERN INSUI.A TION 2 ITC e
4211 Latham Street, Riverside, California 92501•
(909) 686-8760
{909) 686.6786 Fox
INSULATION CER`!URC-Al E r
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 - TRACT #: 76412
LOT#: 45
SITE ADDRESS: 43693 1/ERONA COURT, LA QUINTA, CA,
EXTERIOR WALLS:
MANUFACTURER: JOHNS -MANVILLE THICKNESS: 3 5/8" R -VALUE: R-13 -
CEILINGS : BATTS BLOW
MANUFACTURER:. JOHNS. -MANVILLE THICKNESS: 13" R -VALUE: R-38
CEILINGS : BATTS O
MANUFACTURER: GREENSTONE THICKNESS: 1-0.3" R -VALUE: R-38
GENERAL CONTRACT )R: ROGER SNELLENBERGER
LICENSE NUMBER:
BY:
TITLE:
DATE:
INSULATION CONTRACTOR: WESTERN INSULATION, INC.'
LICENSE NUMBER: 481278
BY:
TITLE: Pr duction iia er
�� DATE: OCTOBER 25,1999 10