9903-0233 (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 excluslvely 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.
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 applicator 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 PERMITN"OXU3
DATE VALUATION 5122,899.10 LOT 57 TRACT 28458-1
ADS 43-616 ALBA COURT
APN
"M7"38
OWNER
CONTRACTOR/DESIGNER/ENGINEER
THE EXCHANGE GROUP
ROGER SNELLENBERGER & ASSOC.
78-615 NAPLES DR
78615 NAPLES DRIVE
LA QUINTA CA 92253
LA QUINTA
CA 92253
(760)772-0222
CBL# 1858
z
USE OF PERMIT
SINGLE FAMILY DWELLING
LOT 57, PLAN 3B-3; SFD - PERMIT DOES NOT INCLUDE BLOCK WALLS
OR POOL.
TRACT CONSTRUCTION 2.025.00 SF
PORCH/PATIO 52.00 SF
GARAGEICARPORT 625.00 SF
ESTIMATED COST OF CONSTRUCTION
122,899.10
PERMIT FEE SUMMARY
CONSTRUCTION FEE 1014000418-000 $720.00
PLAN CHECK FEE 1014000-439-318 5596.33
MECHANICAL FEE 101-000421-000 $53.50
ELECTRICAL FEE 1014000-420-000 $131.88
PLUMBING FEE 101-000-419-000 $140.75
STRONG MOTION FEE - RESID 101-000-241-000 $12.29
GRADING FEE 1014000-423-000 $20.00
INFRASTRUCTURE FEE 225-000-443-342 $2.749.67
ART IN PUBLIC PLACES - RESIC 701-000-255-000 $57.25
SUB -TOTAL CONSTRUCTION AND PLAN CHECK
$4,481.67
LESS PRE -PAID FEES
$0.00
TOTAL PERMIT FEES DUE NOW
54,481.67
IIIIIII
VIII I I VIII III 68
IE
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
.{ LICENSED CONTRACTOR DECLARATION
hereby affirm under penalty of perjury that I am licensed under provisions of
H Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
04 W Professionals Code, and my License is in full force and effect.
Ch License # Lic. Class Exp. Date
t1_ X54
Z �-"'D at Signature of Contractor
CSD (] C) 4f
(D OWNER -BUILDER DECLARATION
J
W 'W I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ Cl) License Law for the following reason:
�Z ( ) 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).
cO
u7 O I am exempt under Section , B&P.C. for this reason
N Date Signature of Owner
ON
C7
CL Q WORKER'S COMPENSATION DECLARATION
o �, Z I hereby affirm under penalty of perjury one of the following declarations:
Hp () 1 have and will maintain a.certificate of consent to self -insure for workers'
X CLI.LL
— compensation, as provided for by Section 3700 of the Labor Code, for the
mi Q performance of the work for which this permit is issued.
Q Q ( )- I have and will maintain workers' compensation insurance, as required by
0, Sec ion 3700 of the Labor Code, for the performance of the work for which this
rn H permit is.issued. My workers' compensation insurance• carrier & policy no. are:
�.'Z Carrier Policy No.
ST IV1'E i UID 526355-93
g(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 37700 f the Labor
Code, I shall forthwith comply with,those provisions. d}
/Dater i no. 1/a. 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.
i 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) f / f A. � Date_y`,Q11! / 41,
PERMIT #
BUILDING PERMIT '
)03.„
DATE VALUATIONy y� LOT . TRACT
DATE
6 q
a ITE7+,"
7=]yS COURT
ADDRESS `4,y^Q,6_ LQA C�Jv'R +
APN ����%����
OWNER
CONTRACTOR/DESIGNER/ENGINEER
T I"INC1INt OL" GROUP
RC7fiFA K1aIf:1 "I f- ERGEft4%ASSOC.
78.615 KiNP .,1 S OR
7861514t1PL Ss .%1L1VE
I:.A. 01J,cNTA CA 9.22-53
LA QU9NVA, CA 922-53
(71;0)77? -0'n22. CK -4 .1858
USE OF PERMIT
F� y7�v �1ffl7yy �y��f�yt f 7�g, �'
�S[1ryCa.LEX'AisJ,ILY1JVVEa.Atl.11' ,
SINGLE
C.Cs T 57, PLAiN 313.3; 5i --D - i'EAiWT DO%:3 N(�ITRAF %LIRE .OLOC,f; WALLS
CJRPOOL
•4 R,tkCT Ci.Jd STRU'CTION 2025.00 6J74
PORC%iIATTO 52.00 SAF
0ARA13ElCARP0Wf 625.W SF
aSMAIATED COST OV CONI Si'I:lJCTTO_N
PERMIT F1v':E SIJh' MAa; V
CONSTRUCTION FIX 101-000-418-000 VEZO.10)
r4lWt T-1KIK►i!F 101 -W -434 -MSI $546:3:3
NR'.C.I L,k N ICAL 1.10 to Is _01001-42 11 -000 353.50
f i,W MIC -AL Fa 101-000.420-000 $l31.38
PLUlVIKIdO FF.9 I01 -000.419 -ow $140,75
STRogan M(r10N VfT 1014)0I7_24y.-OM $12.29
GPQkD[J4(1I rJ7% 101-000-423,000 $20.00
1RMA;f.ti"J%'EJ225-0004b-342 S2,749.67
AHTIN PUBLIC C1ACHS - R.U4 " 01- -255"000 557.25
87.114-TOTted., t' OMKI'1 IIC°1'1ON AND PLAN f„HFVK
$4,4131.47
J O 1°m,1'!ii'::rktNO T 1C.CES DUE NOW
54,011.67
IIIIIII VIII III VIII IIII 69
/
IE
RECEIPT,
�
DA
���/ /
�
CTOR
J, . . ✓ Y 44
INSPECTION RECORD
OPERATION
DATE.
INSPECTOR
OPERATION
DATE
INSPECTOR
v BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms 8t=ootings
Ducts
Slab Grade 6
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 & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath .44
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 I I
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
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
Utility Notice (Perm)
�. V•I rr..... �.— v� r.�.n.•�.. �.r i11n.'J�..1� 1'vrr � ••. �..• VVv.� J�
V V
WESTERN INSULA TION, INC.
4211 Latham Street, Riverside, California 92501
Tel. (909) 686-8760 Fax (9051) 686.8786
INSULATION CERTIFICATE
THIS IS TO CERTIFY THAT INSULATION HAS [TEEN 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 #28*8-1
LOT it
57
SITE ADDRESS:
43616 ALBA COURT, LA QUINTA, CA
EXTERIOR WALLS:
MANUFACTURER:
Johns -Manville THICKNESS: 3 A.,' R -VALUE: R-13
CEILINGS:
BATT BLOW
MANUFACTURER:
Johns -Manville THICKNESS: ill, R -VALUE: R-30
GENERAL CONTRACTOR:
- -
TRADITIONAL BUILDING CO -
LICENSE NUMBER:
BY:
TITLE:
DATE:
INSULATION_CONTRA,CTOR: WESTERN INSULATION, INC.
LICENSE NUMBER: 481278
BY:LV„y..y,
TITLE: PRODYC ION MA GER
DATE: SEPTEMBER 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 57, Phase 5, Pln 3
Date Required :
Completed
Requested by:
Jim Lynn
Berkley, Alabaster
Superintendent Code:
PURCHASE ORDER # 1039
09/28/1999
PROJECT: Bella Vista
Ship to: 43616 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
$1,464.97
$1,464.97
Berkley, Alabaster
11) Verticals
6) Horizontals
Horizontals with Privacy
TOTAL
Is 1,464.97
Roger Snellenberger Development
R r
By: V
By:
Page 1
Apex Interior Source
0
�- Traditional Design
5 White Sun Way
Rancho Mirage, CA 92270
(760) 674-1188 Fax (760) 674-1668
J & S Floors, Inc.
16872 Hale Avenue, Suite A
Irvine, CA 92606
(949) 442-7890 Fax (949) 442-7891
Pager (949) 733-4681
Purchase
Order
DATE
P.O. NO.
9/2/99
2644
LOT/ PHASE PLAN
C.O.E. CLIENT NAME
57/5 BVIS... 5
9/28/99 SANDOR
AREA ITEM
i DESCRIPTION QTY UNIT
Per Diagram 14
Tile -E -Lava Beige 13x13 904 s/y
Grout -(H) Classic Bone
Price per Steve
Per Diagram 14
' Carpet -T -San Clemente #6211 Egg Shell ; 119.67 ; s/y
Pad -1/2" lb
� I
ATTACH A COPY OF THIS
PURCHASE ORDER TO THE
CORRESPONDING INVOICE AND ;
SEND TO THE DESIGN CENTER AT
THE ADDRESS ABOVE
ATTENTION: RITA PURSLEY
Contact
RACHEL
P.C./INVOICE NO.
C-BV57/5-04
RATE i AMOUNT
6.21 5,613.84
36.69 i 4,390.69