SFD (9904-121)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;
I
} f
/'Date1! Signature of Contractoil�
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury, that l 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 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.
6126155..99
(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 thatlif 1,8hould become
subject to the workers' compensation, provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions.
ate: I I AL1; `'141 Applicant At �&A 1A
i
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 authoriz6/tepresentatives of this City to enter upon
the above-mentioned property for inspection purposes. %}
,Sgnature (Owner/Agent) ' ' %i !r ,`� ,� DatedJIL11
1 ✓/
BUILDING PERMIT PERMIT#
�3'.Uffit-t �• D
DATEI VALUATION , LOT TRACT
JOB SITE y _
ADDRESS vl.1..R�iENS'�t€ A a�..Ol<J�-_
APN
OWNER
CONTRACTOR / DESIGNER %ENGINEER
g
r1'#iii i.. %>.4r'4 �.{fki4'eWt�
r -U- w,III) Ck1FT 1.•T-kIUr0ir'!VT1 V,
9-6i
7814*45NAPA.,ES.IJRIVE
1,h QU114"I A CA 92253
1.A QU1N I'A CA 512253
(76{)077 •02'11 CNIX IM
USE
1OF }PERMIT
�yyA 1 Yw� ra4({.�3
1A L03• A, KAWIAlt, .14AA#4 i,:MCK F RI"DU+ EL) 7.% *0 T Oft
nttlEs'P.II'1,1? 188lJAN,(,T: OF SAliW 1'1.A14 TY1.4i. ! ERA—(1'1 9:1083 lNUF
INCIA WL 131, OCK WALL 0R ")L
TRACT C OZ43TRU(:'CIOIN 2,0z).ar0 s,
140RCH/1'.ATIO 52.00 S1
f.4ARA(AYCARJ-101<1' 4:39.00 3%
ESTIMATED MST OF CcxNSTRIT�:.: ON
119,253.513
i'ERA13T .H'T-,F,'S�€JA1MAitV
c:0NS`FR.L1C'Y10N FM 1014J00-4118-000 $709.50
PLAN i" TC".1 'Fria% 10t -f1(1(1-4,49-318 $146.98
LN1l!X`11A.NY_4AL F1ti 101-000.421.000 $53.50
ELfE "CRICALF—M, 101-000420-000 5128.16
PLUM 0NO C7s'}3 1.01-11110-419-000 $140.75
S'F'ftONQ 1ti1.(TrYDN RTE -1tiil:SIT) 11:1.1-000-241-000 $11.9:1
GRADING" E 101.000-423.000 11.10.00
iNFRA.STRU(:"t`U3tly ;M` 225-0W443-:341 52,667.64
tit'(' XN PI.tf3L 1C KA:t 1 S - RFSH,' 70 t -(?0( 255.00 $48.13
�f,J(;-1�?'AIa(`17�i�"1t1('1iCl At�fjl1,.E1r7CE14C�14.;'1,�1'C+S()
LESS
$0,00
TOTAL PEXMITFEWS 01W, NOW
S3,926.59
RECEIPT
t !
DE
BY it
DATE FINALED
INSPECTOR
,'
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
,S /
Return Air
Steel
Combustion Air
Roof Deck
f
Exhaust Fans
0. K. to Wrap
F.A.U.
Framing®,s
�'�d.
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
16—'19-97
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
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
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)
BELLA VISTA
RELEASE OF RESPONSIBILITY
FLOORING
I, Naomi Boond, purchaser of Lot38, Phase 513 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: Buyer:
Date:
De n en
f,: 1 s4
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 38, Phase 5B
Date Required ; ASAP
Requested by: Rita
rlceinn r'cntor
PURCHASE ORDER #
2278
December 7, 1999
PROJECT: Bella Vista.Phase 5
Ship to: 43611 Messina Court
La Quinta, CA
Homeowner: Boond
Cost Code: 3186
Hours
Material / Work Required
Unit Price Total
Furnish the following upgraded window covering
Premier verticals throughout
$ 1,694.69
$ 1,694.69
Rio White
13) Verticals
4) Horizontals
Horizontals with Privacy
TOTAL
$1,694.69
special conamonsnnsirucuons:
Roger Snellenberger & Associates, Inc.
By:
Cc. ter
/'1lJ f\IVV VVLLL L.JVL 1119V INL- I %JIv•
Apex Interior Source
By:
I
i
i
BELLA VISTA
a
RELEASE OF RESPONSIBILITY
LANDSCAPING
6AI�� I,1�(��purchaser of Lot. agPhase at Bella Vista
Homes, hereby acknowledge_ that by not purchasing the landscaping. fiunish,ed
in the front yard within the price of my home, I will receive $ as
credit. 07 Fl p *
I understand that the City of La Quinta- requires front yard landscape with all
new construction .... Therefore I a.g,= to install any front yard .I5
calendar days of the close of.escrnw_ I will receive, the above credit -through
the Design Center as soon as the, yard is installed_ I also -hereby give_
permission for Traditional Building, Inc-_ to enter my property to install -
the -standard landscaping if I do not complete -the above agreement.
I also acknowledge this action voids any landscape warrantee.
Date: to
Date:/9 9
Buyer:
Design Center:
NOV-30-99 INE 3:43 PM WESi'ELR11 11S:J1-.A'PION 'AvA KO, 16'9683_6425
WESITRN INSULATION, INC.
4311 Latham Street, Riverside, California 92901
(909) 686-876C
(9091686-8786 Fax
INSULAIIQN CER ATE
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 TR/kCT #:28458-1
LOT#: 38
SITE ADDRESS: 43611 MESSINA COURT, LA QUINTA, CA.
EXTERIOR WALLS:
MANUFACTURER: JOHNS -MANVILLE THICKNESS: 5/8 R -VALUE: R-13
CEILINGS: ATTS BLOW
MANUFACTURER: JOHNS -MANVILLE THICKNESS: 13" R -VALUE: R-38
CEILINGS: BATTS BLOW
MANUFACTURER: GREENSTONE THICKNESS: 10.3" R -VALUE; R-38
GENERAL CONTRACT OR: ROGER SNELLENBERGER
LICENSE NUMBER:
BY:
TITLE:
DATE:
INSULATION CONTRACTOR: WESTERN INSULATION, INC.
LICENSE NU�Z481;
BY:
TITLE: Produ ionanager
DATE: NOV MBE 30,199