9903-0238 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby afffrm under penalty of perjury that I am licensed under provisions of
Chapter,9'4'Smmencing with Section 7000)•of Division 3 of the Business and
P�of65sionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
489234 � i' X 1./99
Dae q t 0J 19a 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).
( •) 1, 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 acertificate 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 wtYch this permit is issued.
I have and will maintaintiorkers' compensation insurance, as required by
Sedtion 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.
STA'M MD
6=55 "
(This section need not be completed if the permit valuation is for $100.00 or less).
() (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 Sectionf 3700 of the Labor
Code; I shall forthwith comply -with those provisions. %��
e: ,2 f i a d trt� Applicant°. i' ! �� //
Warning: Failure to secure Workers' Compensation coverage is unlawful and
I
hall 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 propertyfor inspection purposes.
{
IS ature (Owner/Agent)��! n� !� Date r• �/'
PERMIT #
BUILDING PERMIT
MJ.438
DATE VALUATION a �i � LOT52 TRACT 29,459
JOB,SITE AIDA
ADDRESS 41,.U755AIDA COU��.�'
APN +�►
6Q'9-0700 039
i6_
OWNER
CONTRACTOR/DESIGNER/ENGINEER
'Mr. E CHANCE GROUP1tCiC�1r1�
SldE3.L1 NC3FR: if�1Z & ASSOC:,
78.615NAPLES R
79615NAPLES'1 RIVE
1 -A QUKf.A CA *2253
LA,QUE:WA CA 92.253
(760)772-0222 CBL,# IM
USE OF PERMIT
SINGLE FAMILY DWELIANG
LOT 5-2, PLAN 6W- Sly - P1!:i2A43.T I!oM NOT INCLi0.E H1,OCK u'Ai.T S
CA4_ 11,00 .. PLAN CHEM f1W RWVGW 75%, FOR MUl.TiPLV MIAJANCE (YF
SA1MP .PLAN TYPE.
°i`RAC-T CMSTRU&TON Z763.00 SF
f~ ORCHIPATio 90.00 $r
0fL�K_ AQ&CAdR!'•t, Kr :598.00 SF
EST.LtMATF.0 COWS X3;14 CUNISLUC!'ION
162,948.741
PERMIT EE KE S1i MAIARV
C'ONSTECtte. L'IE: IN FETE 101-000418.10M 513tiu.i3i)
01F:C9 FEE $1%3.57
1il1-F.0 +NtCAL IT3 $92.00
0,EC RYCA1. FES T11-000-420-t)4!D 51.57.17
111 CMIfflNOrlit-, 101-000-4J949Y) .t tri
X FRO'Nt, Artti')'fr:.* p9 , RV'RID ,101-( 0-7,0400
011 AD 1MG FSR 10J-000-423-000 �W�.t1ti
342
IN FJkAWf RIXTtYRZ FER 225-M,443-342
PREC.USA3 PLAN 10.i. -000-441-_'M5 S';bS.Us►
AR,'!143j511-17.7f)1_fj .-255-M) (1.57 17
Still- IlkItAL 00NSSTRUC'k"E,CYN AND PLAN CREC'K
X5,1 f Z.91
LESS PRE -.PAID FEES
T0'1'/i:E. PERNUT'+ET-S 01tI IVUW
I��IIII
VIII III VIII IIII 00
A
IE w ;
RECEIPT _1 ./
DAT �,
BY V `(, V
I DATaI AL p
INSPECTOR
INSPECTION RECORD
OPERATION
DATE.
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
et Backs
Underground Ducts
Forms & Footings W,41YODucts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
OX to Wrap
F.A.U.
Framing 7 o _
Insulation
Compressor
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & 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 I I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines /
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 — a 67
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 /pj-_
Utility Notice (Perm)
ROGER SNELLENBERGER DEVELOPMENT
78615 NAPLES DRIVE
LA QUINTA, CA 92253
(760) 772-0222
(760) 772-0257 FAX
PURCHASE ORDER #
2237
TO: Apex Interior Source
79-553 Country Club Drive PROJECT:
Bermuda Dunes, CA 92201
Fax: 760/360-3167
Attention: Denise
Lot & Phase: Lot 52, Phase 5 Ship to:
Date Required ASAP
Homeowner:
Requested by: Rita
Desion Center
October 6, 1999
Bella Vista, Phase 5
43675 Alba Court
La Quinta, CA
Dela Cruz
Qnty Ord'd
Material / Work Required
Unit Price Total
Furnish the following upgraded window covering:
Premier verticals w/soft flow valence
$ 1,464.97
$1,464.97
Berkley, Alabaster
11) Verticals
6) Horizontals
Horizontals with Privacy
TOTAL
$1,464.97
apecial t onamonsnnstrucraons:
Roger Snelle rger Development
V
cc: sign Cent
J
lil.I,NUVVLtUUt: ANU Kt I UKN
Apex Interior Source
By:
SEP -22-99 WED 08:30 WESTERN INSIULATION FM NO. 8096868786 2.07
WESTERN INSULATION, INC.
4211 Latham Street, Rtveraide, Califomia 92301
Tel. (909) 686-8760 Fax (909) 686-8786
INSULATION 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 J PHASE: BELLA VISTA — TRACT #28458-1
LOT # 52
SITE ADDRESS: 43676 ALBA COURT, LA QUINTA, CA
EXTERIOR WALLS;
MANUFACTURER: Johns ,Manville THICKNESS: 3 5/8" R -VALUE: R-13
IL�E_ INGS: BATTS BLOW
MANUFACTURER: Johns -Manville THICKNESS. 11" R -VALUE: R-30
CEILINGS: BATTS / SLO
MANUFACTURER:- Greenstone THICKNESS: 1" R -VALUE: R-30
.
GENERAL CONT ALCITOR: TRADITIONAL BUILDING CO.
LICENSE NUMBER:
BY:
"TITLE:
DATE:
INSULATION CONTRACTOR: WESTERN INSULATION, INC.
LICENSE NUMBER: 481278
BY:
TITLE: PROD TI<5N AGER
DATE: SEPTEMBI_R 22, 99
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.
( ) I have and will maintain workers' compensation insurance, as required by
Section 3700 of the tabor 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.
Signature (Owner/Agent) Date
BUILDING PERMIT PERMIT#9"3-2
DATE VALUATION , 5162,948.70 LOT 52 TRACT 28458-1
3 -1(,0xvDk
ADDRESSOB SITE- 43.675 ALBA COURT
APN,'�
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 52, PLAN 6BR: SFD - PERMIT DOES NOT INCLUDE BLOCK WALLS
OR POOL. PLAN CHECK FEE REDUCED 7.?/* FOR MULTIPLE ISSUANCE OF
SAME PLAN TYPE.
TRACT CONSTRUCTION 2,763.00 SF
PORCIWATIO 90.00 SF
GARAGE/CARPORT 598.00 SF
ESTIMATED COST OF CONSTRUCTION
162,948.70
PERMIT FEE SUMMARY
CONSTRUCTION FEE 101-000-418-000 $860.00
PLAN CHECK FEE 1014X00-439-318 $179.67
MECHANICAL FEE 1014000-421-000 $92.00
ELECTRICAL FEE 1014)00-420-M' $157.17
PLUMBING FEE 1014000-419-000 $166.00
STRONG MOTION FEE - RESID 1014000-241-000 $16.29
GRADING FEE 1014000-423-000 $20.00
INFRASTRUCTURE FEE 225-000-443-342 $3,639.41
PRECISE PLAN 101-000-441-345 525.00
ART IN PUBLIC PLACES - RESIE 7014000-255-000 $157.37
SUB -TOTAL CONSTRUCTION AND PLAN CHECK
$5,312.91
LESS PRE -PAID FEES
$0.00
TOTAL PERMIT FEES DUE NOW
55,312.91
III
II VIII III VIII III 01
IE -
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR