9904-119 (SFD)LICENSED CONTRACTOR DECLARATION
1 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
2131/99
-13
Daie - 1 { ', . Signature of Contractorr�
i ,.' • . '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 isnot 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 iproject (Sec. •7044,• Business & Professionals
Code).. 4 . -
(•), 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.
0.1 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:
Carrier Policy No.
STM. E171)NAD
(This section need not be completed if the permit valuation is for $100.00 or less).
O 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
P;
subject to the workers' compensation provisions of Section, 3700 of the Labor
Code, I'shall forthwith 'comply wlth'those provisions: y
Date: 1-1JIQ1 � Y -Applicant
Warning: Failure to secureWorkers' 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.1 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 6ove mentioned propertyafoF inspection purposes'.
Ignature (Owner/Agent) f ��e' Datef�/�U/�
BUILDING PERMIT PERT'T-_ - - - -
DATE VALUATION LOT r^-- TRACT 284-58-1
JOB §ITE .. r^_,.� ���--.._.
ADDRESS 43-• 82NEMINA.QQ!Ji!Y —e
APN• r� �r p
Gti�-€�/' •[Ie3
OWNER
CONTRACTOR / DESIGNER / ENGINEER
THE 0KCfa,ANGI; GKOUP
'1 OGE"Z }'1NEL.Y ENVIEl�.eER &ASS0 ;.
78.615 W -x.1'1: S DR
9-615 NAPI:ES DPL'IVE ' -
LA QUINTA Cts. 9.2253
LA QIJIt rrA CA. 9,n o3
g6o)772.0222 CK10 1858
USE OF PERMIT
3FD LOT W40., PLAN 3At'L, FLAN CREXX FM 1uSd lUam" 751ye''OR
tbl'I)1tUPLE :ISSUANCM OF SAME kL.rVh '1' Y PE..PEP- i'r D()E.% Ni T `
INCLUDE BLOCK W AI.1 (.►R. P004
TRACT Cr. N Mi'U a VON Z025.0G^ S
i' �Cikai.T.'tRX11i0 V-00 it
e3A1LAU1 </L A1.tP0 12T 0
.�J.ti A'SVE.i•1��„� 0•�w�� `VCfi 4ldt'ri6d`%afi,�;'A,I�IC,I.�6
�1�,Kr:s.�{!
RE'R` IT rt fl:E i111`1M AR's'
CO1v,�JTRUG 1711"O d FIX, 101-M-418-000
PLAN owl' M:`k M 101.-X1439-1 j g $ 46M
>f.:C1ANICA% V LIT” 101-4400-4.2,140 $53. S
F117 MICAL'FEE 101-MI.420•.000
iILLI1b�8.IT�l0 FEE 101-WO-419--LitlO $140,7b
' `tTRON(;MOTION ME - RESIT) 101-(M) '24.11-1:1! O $1193
MAD ING Ufa 301-000-423-000
iii FIRA YI'1 UC'TURE ME 225-000-4,41.341 �. s
AWI• Ifvf+E1lSi' EC' PLACES - R:ESW, 701 -W -25 -5 -WO y48.1
S1)B-:r+.)tNL CGWS' SUCTION Ate!'► PLAN C14EC,:K
`1�i.ww59
LESS PRE•-PATf? .FEES
$0.00
RECEIPT F
DATE
BY 1,
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
�' BUILDING APPROVALS
MECHANICAL APPROVALS
Set BackiF
Underground Ducts
Forms & Footings S
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap Z
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 D -/ —
Drywall - Int. Lath
Final
Final � _u �—
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 QY9
Pool Cover
Sewer Connection
Encapsulation
Gas Piping _
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:
BELLA VISTA
RELEASE OF RESPONSIBILITY
FLOORING
I, Robert or Marty Monnahan, purchaser of Lot 40, 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 $2,202.00.
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: �a,— ,-� -- Ra(
Date:
x:
Buyer: � �
Design
ROGER SNELLENBERGER & ASSOC., INC.
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 40, Phase 513
Date Required ASAP
Requested by: Rita
Desian Center
PURCHASE ORDER #
2277
December 6, 1999
PROJECT: Bella Vista Phase 5
Ship to: 43582 Messina Court
La Qulnta, CA
Homeowner. Monnahan
r�—f f-.4
Hours
Material / Work Required
Unit Price Total
Furnish the following upgraded window covering
Premier verticals throughout
Berkley, Alabaster
$ 1,764.97
$ 1,764.97
11) Verticals
6) Horizontals
Horizontals with Privacy
Rnnri.l (`-A'M-nl.11—+
TOTAL
$1,764.97
Roger Snellenberger & As ociates, Inc. Apex Interior Source
By:
Cc. D Center
NOV-30-99 TUE _5; 4; PIM Wzl:;TEEK INS:ii.AT ION A.1 NO. 16' _N�836425-
WEST."ERN INSULATION, INC.
4211 Latham Street, Riverside, California 92501
(909) 686-876U
(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 #:28458-1
LOT#: 40
SITE ADDRESS: 43582 MESSINA COURT, LA QUINTA, CA.
EXTERIOR WALLS:
MANUFACTURER: JOHNS -MANVILLE THICKNESS: .15/8 R -VALUE: R-13
CEILINGS:- ATTS BLOW
MANUFACTURER: JOHNS -MANVILLE THICKNESS: 3" R -VALUE: R-38
CEILINGS: BATTS BLU
MANUFACTURER: GREENSTONE THICKNESS: 10.3" R -VALUE: R-38
GENERAL CONTRACTOR:
LICENSE NUMBER:
BY:
TITLE:
DATE:
INSULATION CONTRACTOR:
LICENSE NUMBER: 4812791
BY: le L
TITLE: troducftn anager
DATE: NOVEMBER 0,19�
ROGER SNELLENBERGER
WESTERN INSULATION, INC.