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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
-W2,34 H 121,1"a1199
Date �� t 1/-Y �' Signature of Contractor 1 ` / L�1 �—
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 Labor Code, for the performance of the work for which this
permit is issued. My workers' compensation insurance carrier & policy no. are:
Cartier Policy No.
(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. 1 `
Date:; I �! j� Applicant �°K �-
1 ;1 -�� r / ) - : -L-/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) Dated 10, 144u
1� _ l 1 ` �' //1
PERMIT#
BUILDING PERMIT
94AW122
DATE VALUATION 5; 3� 1 .f.0 LOT ; TRACT 28 25K I
APN
ADDRESS 4, .UI ��C SINA COURIf
09^070-048
OWNER
CONTRACTOR / DESIGNER / ENGINEER
!'Hr, FK( WAN GE ORC:111'
ROOM' SNIM11NIHIMC,1sR & ASSOC
18.61 S N kPLI S DR
79.61 i NAPUS DRiV 1;
I A. QU1N Nk ('rt 92253
LA QIJiN'CA CA 92253
(7601777-02741 01110 1859
USE OF PERMIT
SINOU t•A.&IIIN DWELIAN(;
4FO LQ f #37, PLAN 4BR, 1'1.AN C1 ffCK FTU; Ri -AxF.G 7516 FOR
A41.11 TU111.1; ISSUANCE 'JF SA&W. PLAN 'i' Y141. 11H_RMIT LXJH3 N(, 1'
114CI,tlD bL(.N_"K WALT. OR PcKX,
TrWIr CON.", MWIMON 1^00 00 SF
t'+: RCI HIATIO 110,00 5F
C AJb%.4,iUC=AR1'QRT 471.00 S
ICST :AM
!'ERMI i FES; SUINIMAR V
C't. NXI'RlR.'TION FEE 101-t)00-4184)00 $74$ (ao
Of AN rfl[170: 1,€+17 1014NV-43t)-319 F.')
1kUXIIAN1CAL FEE, 101 4fi0 121.000 540 00
fd,fit f'Rlt AL KE 101-000-420-4017 S134.9.*
I'1.UINNINO FEF 101-(X)0419-000 $1410.75
:M1()NC1 k1(y€'►r-►N l:TTi _ i?1;�,111 IDl.f1(K).^di-(KKl Til t tl?
t>.tA1)1fJ�i 1'IT 1Q1 .(I{1(1 3?3 0('(? r�7►.►W
INf,RAS1k(1(31JR1,I+1; 2254W -W3-1-12
AH'I IN PUBLIC PLACE". - RES11; 701 -000 -2i`+ -()w S75 W
`+f fiiM)T'Af.(''(_JNStrRtIC71QN ANT) T11,AN C`14PC'1:.
1XSS 111'.1; VAI1:7 I'TTS
$0 00
PERA1 IT PEt/S ! 11E NOW
$4.242.33
'
RECEIPT
DATE
BY f t l/
DATE FINALED
INSPECTOR
t (
f3�
1U
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE f
I INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
s
Ducts
Slab Grade4-11
Return Air
Steel
Combustion Air
Roof Deck
,�
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
Compressor
Insulation
0--./ qI
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
2-99 6 l
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
S
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
A
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
Fodures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors -
Temp. Use of Power
Final 7 - 2 -
Utility Notice (Perm)
COMMENTS:
-
RV -30 99 TUE 5:49 I'M NE;TERK�A*X NO, 16:96036425 p. 9
1. -
WEST, ERN INSULATION, INC.
4211 Latham Street, Riveirside, California 92601
(909) 686-8760.
(909) 686-8786 Fax
k ,+
IN UAL UIOMURTI IF CATE
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#: 37 t
SITE ADDRESS: 43641 MESSINA COURT, LA QUINTA, CA.
EXTERIOR WALLS:
MANUFACTURER: JOHNS -MANVILLE THICKNESS: 3 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
. 4
GENERAL CONTRACTOR: ROGER SNELLENBERGER
LICENSE NUMBER: .M
C7
BY:
TITLE:
DATE:
INSULATION NTRACTOR: WESTERN INSULATION, INC.
LICENSE NUM E :481278
BY:
TITLE: Pr ductoan Ma ger
DATE: NOVEMBER 30,1999
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 37, Phase 5B
Date Required ASAP
Requested by: Rita
Desiqn Center
PURCHASE ORDER #
2280
December 10, 1999
PROJECT: Bella Vista Phase 5
Ship to:
Homeowner.
43641 Messina Court
La Quinta, CA
McComas
Cost Code: 3186
Hours
Material /Work Required
Unit Price Total
Furnish the following upgraded window covering
Premier verticals throughout
$ 1,521.67
$ 1,521.67
Rio White
11) Verticals
4) Horizontals
Horizontals with Privacy
TOTAL
$1,521.67
apeciai a.0na1o0ns11n5uucu0n5: tAk r P1UVVLwut ANN nt i UMN
Roger Snellenberger & Associates, II
By:
Cc: Desig ter
Apex Interior Source
Traditional Design C:ei iter wurcnase Uontract
5 White Sun Way 1 ` ----._.....---------- -..-i
`I DATE CONTRACT...I
Rancho,Mira,ge, CA 92270 L— ---- -
9/30/99 C-BV37/5-01
(760) 674-1188 Fax (760) 674-1668
Mark and Mary Mc C omasC F
44:1510 Cannon Pieter -
6a Quining 64k 9225
Zoo, 92Jo l .
(760) 36e --s49&
(760) 674-9970
PROJECT
BELLA VISTA
AREA DESCRIPTIO
Various Electrical Outlet
Entry Security Outlet
I
Throughout I Pre Wire Security ✓
Kitchen t Std Conan -Cameo White
LOT/PHASE I PLAN
37/5 4
Per Diagram:`:.:; Tile-B-IMO-Magiara Beige 17x17
Grout -(H) Sandstone #7674 1
Per Diagram ; Carpet -Bayview Satin Pearl
Per Diagram Pad -1/2" 61b
' Std Flooring i
i
Tiled ': Seal Grout
i
Per Diagram Verticals -Cadiz White
BR 2, 3, Gar j Std Verticals -NC
Patio Concrete -San Diego Buff -S dt Finish
QTY
2
1
1
C.O.E.
11/15/99
UNIT
ea
ea
ea
TERMS
Due on receipt.
RATE AMOUNT
65.00 130.00
80.00 80.00
210.00
4,347.00
I 718.00 i
ea -1,338.00
i
308.00
I
1 1,318.00
2,100.00
210.00 i
i
i
4,347.00
718.00
-1,338.00
308.00
1,318.00
i
i
Signature Dat Total $7,873.00
I have read, underst and signed the a tached Condition of Sale Agreement -- `_
hUUCK�;.••..•- -- i1$! V!!1 A L�noer �vv
Dec Dc 89 n3 -.,37P :redttio
lqto $rlan (ijt3-7 5