SFD (9904-120)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 Cod'e7and'my License is in full force and effect.
License # Lic. Class Exp. Date
Signature of Contractor
Z
OWNER -BUILDER DECLARATION.
hereby affirm under penalty of perjury that I am exempt from the Contractor's
Li ' cense Law for the following reason:
( )' 1, 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 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 thig permit is issued.
I have and will maintain workers' compensation insurance, as required by
Section 3700 of the Labor C6de, for'the performance of the work for which this
permit is issued'. My workers' compensation -insurance carrier & policy no. are:
Carrier Policy No.
STAITE
(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 shallnot 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 w6rkers' compensation pr6viiions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions.
D4te: . I _I I � v-1,
31
/Warning: Failure to secure Wbrkers' Compensation coverage is unlawful and
Shall subj;ct an employer to criminal nal 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'att.orney'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:
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 h ' ereby authorize representatives• of this City to enter upon
the above-mentioned property for inspection purposes.
S 41 Date"/ h
4gri'ature (Owner/Agg6tl
BUILDING PERMIT PERMIT#
DATE VALUATION �$1,41,24&4 TRACT
LIT 1 '19459-1
JOB SITE
ADDRESS 'Al, ou v,T
OWNER
CONTRACTOR/DESIGNER/ENGINEER
THE EYX.XANC:r8-6R0UP
ROOERSNFILE 12ERQER&,.ASS0C.
ig-613NAPLES .DR
78-61.5 NAPLESDRIVE
LA Q U M' rA CA 92253%
LA (WINIA CA 025Y
(760)772-0722 Gffleft Iss's
USE OF PERMIT
SS1N0LP'.FA)v1ft.Y DWELUNG
AWM.1J0PS
3viULT 1PIX ISSUANCE OF SANIE PLAN YYP13, P -,. ITi, NOT
.f INCLO DF, BLOCK WALL OR fICK)l,
IRACT CON SIRW-TION 2.400.01 5F
0ARACIOCARil"01 449.00 SY
NST1ANL4'1TDC0,3T0FC0", WMION
TR
141,"'W$439140
PERMIT Ff3f,' SUMMARY
C014STRtICTION rilE
PI,AN CHFIX.1k, FRH 9-318
X1f,Q[-1ANf.C.e'vL a�X- 101-000-42.1-01W WSW
114 tAS
PLUMBWO M-39 10i -000 -40 -OW 5140,75
;kTAO.N0, Fr -F 1) 140-24l-( )l1 x+14.12
ORAINNIC VV2 I Q I
2.2-5-000-443-3-12
AEC F (N 14JOMC PL.NGHIS IW SIC 70 $103.1'2
SUFIT14.
J-TMAL CONIFIRUMIGN AND PIAN C34Tt',C
1558, 6
LIES S PRE -PAID FET -S
WOO
I XYf AL *1 CR Al rf F C, CS 0 ILI rf. NOW
$4,558.16
RECEIPT r
BY I
DATE FINALED
INSPECTOR
JDATE
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
6'
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
(J—CI 49F
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
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
17
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas) 2-- —
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 — -
UU14 Notice (Perm)
COMMENTS:
BELLA VISTA
RELEASE OF RESPONSIBILITY
FLOORING
I, Ron or Pauline Henson, purchaser of Lot39, Phase 5B at Bella Vista
Homes, hereby acknowledge that by not purchasing my flooring through the
Roger Snellenberger Development Design Center:
1. The flooring allowance I will be credited in escrow is $2,348.00.
2. Traditional Building Co., Inc. is only sanding the standard tile areas
(kitchen, entry, laundry). Any other floor prep is the responsibility of
the buyer or their subcontractor.
3. Traditional Building Co., Inc. has no responsibility to buyer as to any
cracked floor tiles, any leaks from toilets removed for flooring
installation, or any other damage caused by flooring installation.
4. Traditional Building Co., Inc. has no responsibility to buyer as to any
paint, baseboard or wall damage not noted at orientation.
5. This is considered a "Bare Floor" closing and the flooring will not be
installed until after title has transferred and the escrow is closed.
Date: x Buyer-
_
Date: a sign
NOV-3'0-99 TUE 3:43 PM WE !'FRX I1HULA'TION
P. ISO. 16'3680_6425
WESTERN INSULATION, INC.
4211 Latham Street, Riveraide, California 92601
(909) 686.8760
(909) 686-8786 Fax
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/ PHASE: BELLA VISTA -PHASE 5 TRACT #:2845B-1
LOT#: 39
SITE ADDRESS: 43591 MESSINA COURT, LA QUINTA, CA.
EXTERIOR WALLS:
MANUFACTURER: JOHNS -MANVILLE THICKNESS: 5/8
CEILINGS: BLOW
MANUFACTURER: JOHNS -MANVILLE THICKNESS: ',3'
CEILINGS: BAITS 8LOW
MANUFACTURER: GREENSTONE THICKNESS: 10.3"
GENERAL CONTRACTOR:
LICENSE NUMBER:
BY:
TITLE:
DATE:
INSULATION CONTRACTOR:
LICENSE NUNtM: 4812A
BY: (/L
TITLE: jProdu0on anagh
DATE: NOVEMBER 30,11M9
ROGER SNELLENBERGER
R -VALUE: R-13
R -VALUE: R-38
R -VALUE: R-38
WESTERN INSULATION, INC.
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
Attention: Denise
Lot & Phase: Lot 39; Phase 5B
Date Required : ASAP
Requested by: Rita
Design Center.
PURCHASE ORDER #
2277
December 6, 1999
PROJECT: Bella Vista Phase 5
Ship to: 43581 Messina Court
La Quinta, CA
Homeowner: Hensen
Cost Code: 3186
Hours
Material / Work Required
Unit Price Total
Furnish the following upgraded window covering
Premier verticals throughout
$ 2,036.55
$ 2,036.55
Fresno White
17) Verticals
4) Horizontals
Horizontals with Privacy
TOTAL
r $2,036.55
apeciei %lunuitionsnnstructions'.
Roger Snellenberger & Associates, Inc.
si n Ce r
AUKNUWLtUUt ANU Kt I URN
Apex Interior Source
By: