SFD (9904-118)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
HChapter 9 (commencing with Section 7000) of Division 3 of the Business and
N W Professionals Code, and my License is in full force and effect.
O =) C) License # Lic. Class Exp. Date
Lo
I w 4&;231•I 13 11311 i�: )
ZDate �•�il�l t�'-''' Signature of Contractor. �-
ZoQ'Ir /
J (-) C:) OWNER -BUILDER DECLARATION
W W I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ a0_ License Law for the following reason:
Z_ ( ) 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).
C0 () I am exempt under Section , B&P.C. for this reason
LO
N Date Signature of Owner
Q N
Cn
d Q WORKER'S COMPENSATION DECLARATION
p cr I hereby affirm under penalty of perjury one of the following declarations:
U') H O () 1 have and will maintain a certificate of consent to self -insure for workers'
X W � compensation, as provided for by Section 3700 of the Labor Code, for the
Q J Q performance of the work for which this permit is issued.
m Q U ( I have and will maintain workers' compensation insurance, as required by
Q U Q Section 3700 of the Labor Code, for the performance of the work for which this
it rn f— permit is issued. My workers' compensation insurance carrier & policy no. are:
`41 Z Carrier Policy No.
ob s a-41 t mr• T `T n H1 .t/3f /td
J(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 of the Labor
Code, I shall forthwith comply with.those�provisions.
Gate:/ r /r , f..!• Applicant Y.
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
16-1
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.
1 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 inspectio urposes.
Signature (Owner/Agent) x • - < - Date `-?1
V. i'
.�
PERMIT #
BUILDING PERMIT
9q' 04-
DATE VALUATION N 12Z.Rqyr 11) LOT 1 i TRACT P059 1
4- • 4 -
JOB SITE
ADDRESS .d3-612 MR.S,SINA COUR
APN
OWNER
CONTRACTOR/DESIGNER/ENGINEER
rv.12` r:vr I;3 AAit'Y7I•"Ot,1P
1a ). a..ra♦ /[T1 �.. a• �1\ 1. t
nr�{ra car I! I fT'"'1 ERGI?lt A. ASS -K'
alt �. .. t• ♦ 7 a f fJ.
,F -A.5 NAPLI S DR
%8-015 NAI'LLS DRIVE
(,A QI.)INI'A CA 9225 4
i.A QUINI-A CA 922S3
(70)772-077: CIII.ft IRV
USE OF PERMIT
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,,rig t_! ••t lith , PLAN +I3-3, PERMi t 11JURS Nv t ftL00ft 13L(x K VvAl,l,
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a:..tv��. e
I'V.ttMIT FEE St.MMARV
0.)NSTk11Ct ON t -VE 101.000-41K-100 S7211JR)
P1,AX CiVfK VFF lot 40f1_A`V)-Ai8 11
NUXILV41('Al, VEEI 101 000-12H.-000 SSz. iI►
IslAXTRICAI F01 IOi-000.420-000 SI3I.f3^�
PLUN4131NQ F01 101-000010-000 St,4015
STRONn 141OTICrN F -M. - RFAU) 10114W -74114W %17 11K�
r31tAI' 14117 Ilii 101.000.113 000 320 (!9
1 N1,'RA •t'RtA fURI!f r , 225 -Wt -,14.1-342 $470 t)I
ART IN PUBLICPLACES - RESIt, 101 -000 -255 -MID $57.25
Cf 1(l-' CYPAI. C1(-)N9rRI f 1'6UN ANI) MAN (31 ('K
fi 1 I)t1 n;
I.I;SS, PRY-NUD FEES
$i) f►f)
T(ft'A1,PERMIT IN IF:11A IME N0W
S4,4Ht,67
RECEIPT -'
DATEBY
I .Y
DATE FINALED
INSPECTOR
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 A—,
- 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 hiS j
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
CK 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, Eric or Samantha Bishop, purchaser of Lot 41, 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: t Buyer: �-�_--
Date: (o Des' Center:
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 41, Phase 56
Date Required ASAP
Requested by: Rita
Desian rantar
PURCHASE ORDER #
2276
December 6, 1999
PROJECT: Bella Vista Phase 5
Ship to: 43612 Messina Court
La Quinta, CA
Homeowner:
Bishop
Hours
Material / Work Required
Unit Price Total
Furnish the following upgraded window covering
Premier verticals throughout
Fresno White
$ 1,980.36
$ 1,980.36
13) Verticals
4) Horizontals
Horizontals with Privacy
Snpr_ini rnnr1itinnc/Incfr—+i^—
Af1VK1f%An1j
TOTAL
$1,980.36
Roger Snellenberger & Associates, Inc.
By:
Cc: De ' Center
Apex Interior Source
NOV-30-99 TUE 5:41 PM i9HHE I11S:iI.A'IIOH AV I10, 1E:91310056425 F. 5
WESTERN INSULATION, INC.
4211 Latham Street, Rivetside, Califotnia 92601
{909) 686-8760
J909) 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: SELLA VISTA -PHASE 5 TRACT #:28458-1
LOT#: 41
SITE ADDRESS: 43612 MESSINA COURT, LA QUINTA, CA.
EXTERIOR WALLS:
MANUFACTURER: JOHNS -MANVILLE THICKNESS: :) 5/8
CEILINGS: �f-TA_TTS BLOW
MANUFACTURER: JOHNS -MANVILLE THICKNESS: -:3'
CEILINGS: BATTS LO
MANUFACTURER: GREENSTONE THICKNESS: 10.3"
GENERAL CONTRACML- ROGER SNELLENBERGER
LICENSE NUMBER:
BY:
TITLE:
DATE:
INSULATION CONTRACTOR:
LICENSE NU R: 481
BY:
TITLE: Produ ion Manag
DATE: NOVEMBER 30,19
R -VALUE: R-13
R -VALUE: R-38
R -VALUE: R-38
WESTERN INSULATION, INC.