9903-0237 (SFD)LICENSED CONTRACTOR DECLARATION
iifiereby L'Mrm 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 J#, Lic. Class Exp. Date
488214 13 12/ 31
Dater t�' 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. 7044,13usiness & 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:
C ) Thave 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.
(�o 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:
Cartier Policy No.
ST ATf 7, FUND P261.55-98
(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 61 the Labor
CVe'J�shall,fort.with comply wit�hAthose.provlslons.
Qateq"�fr Applicant S - �,,i l / ..
, �.
Warning: -Failure to secure,Wo/rkers' 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?
JJSi nature Owner/A ent) Date.
BUILDING PERMIT PERMITp
9903•237 r
DATE_S/2 VALUATION 5 LOT . t �' - TRACT 28AM-1
JOB SITE/ rj
ADDRESS 1�� 5 4�ildSA COURT
APN
0.9-07"38
OWNER
CONTRACTOR/DESIGNER/ENGINEER
78-1615 NAPLES OR
78615 NAPLES DRIVE
LA QUINTA CA 92253
LFA QJHNTA CA 927.
(160)772-0222 CII3LO 1858
USE OF PERMIT
TINGLE FAIMFLY UNNWILING
Lug• 53, PLi%N 3 R. ST -A • PEIZNT DOES NOT .Wart UDC BLOCK WALLS
OR la00L. ;PIANCf DECK ►1 K RHIDUC13D 75% I-kretMt yk..`Q'511,13 1*81JANCLi O
SAME 'PLAN TY► J1&
i7t: S i 1WNrARUCT101%, 2,{},.5.001r
P(X C'1'VPA: 10 52.00 ►r
(_1ARAMf;Atla ACI' 439.00 'alp
Ei I.1A J I) C.YWr 13.F EWST RUC'I'1(3N
CONSTRUCTION Fh'E 101-00-418-000 $709.50
PT -AN CIAECK FEE' 1014V-439-315 5146,"
MUCIIAT4114CAL 1.M 101.000.421-000 e5150
1"i,t:MICA : FIM 101-000-4,20-000
F'LUM1U NG FEE M-000419-000 $140.75
.w.RoN4'11c'vmT oisf nt-RESTD 101-000-741M0M 1%11.93
GRAD ANOFEE 101.000.423-000 $20.00
INV IZASTRUCTLREFEE 225.0M443R342 V.66.7.64
MtT IN VUBL3'C Pl,&CES - REM, 701.000-255-000 $0.13
SI7R-'iWAx, CONSTRUC1,10N .AND 111,AN CHECK
53,021 t�+
LESS Tst 8,41'AF.D FEES
$0.00
IIIIIIIIIIIIIIIIIIIIIIIII
75
��
ff
--IE
RECEIPT
1
DATE j / ry
BY
DAy£M
INSPECTOR
)-f f • I, 6rt1-
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
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
Exterior Lath
Drywall - Int. Lath
�-9i
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
20
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
e A, la a
Pool Cover
Sewer Connection
11f AVI Y I
Encapsulation
Gas Piping
ffe-
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:
SEP -22-99 WED 08;30 WESTERN INSULATION FAX NO. 9056868786
P.08
WESTERN INSULATION, INC.
4211 Laths,, Stmt[, Riverside, California 92501
Tel. (909) 686-8760 Fu (909) 686-8786
INSULATION CERTIFICATE
THIS IS TO CERTIFY THAT INSULATION HAS BEEN INSTALLED IN CONFORMANCE WITH
THE CURRENT ENERGY REGULATION, CALIFORNIi� ADMINISTRATIVE CODs, TITLE 24,
STATE OF CALIFORNIA, IN THE BUILDING LOCATED AT:
TRACT / PHASE: BELLA VISTA — TRACT #284 58.1
LOT # : 53
SITE ADDRESS: 43645 ALBA COURT, LA QUINTA, CA
EXTERIOR WALLS::
MANUFACTURER: Johns-Ma�x�Ci�,THICKNESS: 3 518" R -VALUE: R-13
CEILINGS: �vil.
BLOW
MANUFACTURER: Jo ns- HICKNESS: i 1" R -VALUE: R-30
GENERAL CONTRACTOR: TRADMONAL BUILDING CO.
LICENSE NUMBER:
BY:
TITLE:
DATE:
INSULATION !CO TRACTOR: WESTERN IN5ULATION, INC.
LICENSE NUMBER: 481278
BY: _ ��y.
TITLE: PRODU 411NIla;�
DATE: SEPTEMBER 22, 1999
SL��, 0 21zl
2-A Lam► _%--171-9_
O {�
ROGER SNELLENBERGER DEVELOPMENT
78615 NAPLES DRIVE
LA QUINTA, CA 92253
(760) 772-0222
(760) 772-0257 FAX
TO: Apex Interior Source
79-553 Country Club Drive
Bermuda Dunes, CA 92201
Fax: 360-3167
Aftention: Denise
Lot & Phase: Lot 53, Phase 5
Date Required ASAP
Requested by: Rita
Desiqn Center
PURCHASE ORDER #
2236
October 4, 1999
PROJECT: Bella Vista, Phase 5
Ship to: 43645 Alba Court
La Quinta, CA
Homeowner: Bowles
Cost Code:
Qnty Ord'd
Material / Work Required
Unit Price Total
Furnish the following upgraded window covering:
Premier verticals w/soft flow valence
$ 1,552.63
$1,552.63
Fresno White (pricing the same as La Jolla White)
per Denise
7) Verticals
6) Horizontals
Horizontals with Privacy
TOTAL
$1,552.63
speciai cone tionsnnstructions:
Roger Snellenb rger Development
By: J
c :Design Cenbe
F-061 A 0611114 R 91C] W-1919114 R I l91 C4 C
Hood Plumbing
By:
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 Contractors
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. •
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.
PERMIT #
BUILDING PERMIT 9903-237
DATE VALUATION 5119,253.50 LOT . S3 TRACT 28458-1
ITE
ADDRESS 43-645 ALBA COURT APN 609-070-038
JOB S
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
USE OF PERMIT
SINGLE FAMILY DWELLING
LOT 53, PLAN 3BR; SFD - PERMIT DOES NOT INCLUDE 13LOCK WALLS
OR POOL. PLAN CHECK FEE REDUCED 75% FOR MULTIPLE ISSUANCE OF
SAME PLAN TYPE.
TRACT CONSTRUCTION 2.025.00 SF
PORCH/PATIO 52.00 SF
GARAGE/CARPORT 439.00 SF
ESTIMATED COST OF CONSTRUCTION
119,253.50
PERMIT FEE SUMMARY
CONSTRUCTION FEE 101-000-418-000 $709.50
PLAN CHECK FEE 101-000-439-318 $146.98
MECHANICAL FEE 1014000-421-000 553.50
ELECTRICAL FEE 101-000-420-000 5128.16
PLUMBING FEE . 1014000-419-000 $140.75
STRONG MOTION FEE - RESID 1014)00-241-000 $11.93
GRADING FEE 101-000-423-000 520.00
INFRASTRUCTURE FEE 225-000-443-342 52,667.64
ART IN PUBLIC PLACES - RESM 701-000-255-000 $48.13
SUB -TOTAL CONSTRUCTION AND PLAN CHECK
$3,926.59
LESS PRE -PAID FEES
$0.00
TOTAL PERMIT FEES DUE NOW
$3,926.59
IIIIIIIIVIIIIIIVIIIIIII
77
IE
RECEIPT
DATE
BY
DATE FINALED I INSPECTOR
Signature (Owner/Agent) Date I I I I I '