9903-0235 (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
488234 B 12/31/99
Date Signature of Contractor
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 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.
( ) 1 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:
Camer Policy No.
STATE FUND 626355-98
(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 should become
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions.
Date: 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 inspection purposes.
Signature (Owner/Agent) Date
BUILDING PERMIT PERMIT "3-M
DATIE3 1r0 VALUATION $141,248.40 LOT 5 TRACT 28458-1
JOB SITE
ADDRESS 43-585 ALBA COURT
APN
609-070-038
OWNER
CONTRACTOR/DESIGNER/ENGINEER
THE EXCHANGE GROUP
ROGER SNELLENBERGER A ASSOC.
78-615 NAPLES DR
78615 NAPLES DRIVE
LA QUINTA CA 92253
LA QUINTA
CA 92253
(760)772-0222
CBL# 1858
USE OF PERMIT
SINGLE FAMILY DWELLING
LOT 55, PLAN SA; SFD - PERMIT DOES NOT INCLUDE BLOCK WALLS
OR POOL.
TRACT CONSTRUCTION .. 2,400.00 SF
PORC ?ATIO .160.00 SF
OARAWCARPORT 449.00 SF
ESTIMATED COST OF CONSTRUCTION
141,248.40
PERMIT FEE SUMMARY
CONSTRUCTION FEE 101-000-418-000 $786.50
PLAN CHECK FEE 101-000-439-318 $647.91
MECHANICAL FEE 101-000-421-000 $60.00
ELECTRICAL FEE 1014000-420-000 $141.48
PLUMBING FEE 101-000-419-M $140.75
STRONG MOTION FEE - RESID 1014000-241-000 $14.12
GRADING FEE 101-000-423-000 $20.00
INFRASTRUCTURE FEE 225-000-443-342 $3,130.21
ART IN PUBLIC PLACES - RESIC 7014)00-255-000 $103.12
SUB -TOTAL CONSTRUCTION AND PLAN CHECK
$5,044.09
LESS PRE -PAID FEES
$0.00
TOTAL PERMIT FEES DUE NOW
$5,044.09
IIIIIII VIII III VIII Ilii 55
IE
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
1
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
Profes,-;orals (`lade, and my License is in full force and effect.
License # Lic. Class Exp. Date
p to e� Signature of Contract=='/o� ' ' .4
T
OWNER-BUILDER'DE CLARATION
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 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.
ATE F1 174D 6 2015 -
(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 f',the Labor
Code, I shall forthwith comply with.those provisions,
ate:✓� � i ' Applicant � w t. �
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 inspection purposes.
Signature (Owner/Agent) j—�- Date'!/—')I- dIF
PERMIT#
BUILDING PERMIT
"t X?X5
„fit -1
DATE A_ VALUATION 5141,24840 LOT 5s TRACTJOB
SITE
ADDRESS d 8 ALHA COURT
APN 609-070-033
OWNER
CONTRACTOR/DESIGNER/ENGINEER
THR EXt'HANCT GROUP
ROVER ST'S6'.Lt,t?N(WRi1t?1'. & AMY'
iia -615 N�lt'1.I:S f3li
78oJ5 NAPLES DRIVE
LA QUIWA CA 9253
LA QUIN I -A, f 'A 'W%;
f7nt11772-0?'^ ('f3Ltt 1tS�Si
USE OF PERMIT
SINQL1:FAWLY DWELLING
1,01'35. PLAN 5A.:►F`u - PEAM14 DOM NOT Ftp CLUDE BLCo:K WR1,La
uk 1at"L.
♦lli
IRACT 1 ONS T a UTC 4 eON �,.•tln/. �.+5/ ii
PiJitl:tl PAT 10 160 W) S1'
UARA(0j, CA1(KjW1' 44Y.w 1,4F
P ERlNUT PEE, SUMMARY
C ONSTRUC110N FEE 1()t -000 -418 -OU() if1b v1
P1 AN (41WIV 1:>T 101•f►nf -419.1tf( %fj", 91
,IN1LrIliV41 rAL trz; 101 000•421 M) Sbt1-(rt)
f�d,U,:IRKAt, P ai 101-000-420-000 SWI4u
PLUNUONO PUP 101-000-1194*0 5106 7S
�rl'RO 4VnT;nN F'irt . RRS41) If114W-')A14W 514 17
r3itAVEN0111; lot 004 V3 000 S200)
I tJS 1LAb 1 It(1t_ i l IRf P W� 221-000-413-342 $,t, I W.21
ART IN PIA31.1. PLAt.KS - t&.1411: 701 -(W -255 -OW 5101 12
;qf )13-`IR-ft'Af.. C 0N`-%r1tIK 110N AND PLAN f1HF 'K
LESS 1110. AII) FEES
S000
'I'f, VAL PERMIT iev0s DUE N0W
S.'*.(? 019
IIIIIIIIVIIIIIIVIIIIIII
56
IE
RECEIPT
DATE Crit 1
By'l
D E NA D
INSPECTOR
���
l
INSPECTION RECORD
OPERATION
DATE.
I INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs I
Underground Ducts
Fo66is & Footings OWW Ar__Ducts
Stab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
OX to Wrap
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
Drywall - Int. Lath
Final
Final
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 O
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans.
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection Zllvl 7 7
Encapsulation
Gas Piping
Gas Test
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 _ 9 l�
Utility Notice (Perm)
WESTERN INSULATION, INC.
4211 Latham Street, Riverside, CaUorni& 925131 l
TeL (909) 686-8760 )iax (909) 666.8786
INSULATION CERTIFICATE
THIS IS TO CERTI.=Y THAT INSULATION HAS BEEN 1 NSTALLED IN CONFORMANCE WITH
THE CURRENT ENERGY REGULATION, CALIFORNIA ADMI-NISTRATIVE CODE, TITLE 24,
STATE OF CALIFORNIA, IN THE BUILDING LOCATED AT:
TRACT/ PHASE: BELLA VISTA -- TRACT #284.58-1
LOT # : 55
SITE ADDRESS: 4358.5 ALBA COURT, LA QUINTA, CA
EXTERIOR WALM:
MANUFACTURER: Johns-Manvil e THICKNESS: 15/8" RAIALUE: R-13
.EI GS: BATTS BLOW
MANUFACTURER: Johns -Manville THICKNESS: 11" R -VALUE: R-30
-
GENERAL CONTRACTOR: TRADITIONAL BUILDING CO.
LICENSE NUMBER: -
BY:
TITLE.
DATE:
INSULATION CONTRACTORS WESTERN INSULATION, INC.
LICENSE NUMBER: 481278
BY:
TITLE: PROgYCTION N GER
DATE: SEPTEMBM 22, 1999
ROGER SNELLENBERGER DEVELOPMENT
78615 NAPLES DRIVE
LA QUINTA, CA 92253
(760) 772-0222
(760) 772-0257 FAX
TO:
Apex Interior Source
Unit Price Total
79-553 Country Club Drive
Furnish the following upgraded window
Bermuda Dunes, CA 92201
Fax:
360-3167
covering:
ASAP
Lot & Phase:
Lot 55, Phase 5, Pln 5
Date Required :
Completed
Requested by:
Jim Lynn
Fresno White (Pricing the same as La Jolla
Superintendent Code:
PURCHASE ORDER # 1038
09/28/1999
PROJECT: Bella Vista
Ship to:
43585 Alba Court
La Quinta
Qnty Ord'd
Material / Work Required
Unit Price Total
Furnish the following upgraded window
covering:
Premier Verticals w/ soft white flow valence
$1,552.63
$1,552.63
Fresno White (Pricing the same as La Jolla
White per Dennis)
7) Verticals
6) Horizontals
TOTAL
$ 1,553.63
Roger Snellenberger Development
Apex Interior Source
V D By:
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