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SFD (9904-123)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 <iis2. ate I; I Signature of Co~n a o , 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). ( ) • 1, as owner of .the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business & Professionals Code). () -J 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 (, ) 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. �XI 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: Canner Policy No. ��aa (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. Date: t i e +Applicant— / pplicant / .y s.-•t-Yr�.�(.� rte- .-�.... vWarnin : 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.,, i,- rte' a Signature (Owner_gent) ` / Date//I/-[ .' / `-'„�-s`�'�t.. 1, L...rr 1-•i` 'f'- g� !. BUILDING PERMIT PERMIT# � "114.12J DATE VALUATION +.� :� y; + LOT - � -`" TRACT 28458-1 ` �-r JOB 61TEAPN ADDRESS !3-�/ %1. i1J.EiaifWA {+i lli f r OWNER CONTRACTOR / DESIGNER / ENGINEER ;S1.6ti [vtO. XIS OR lis,iGb tvAPLE'S [A!.V! !.A i}l.1INI'A CA 92253 LA Qi d3P3`f A -n, CA 91253 f7�iff1772-t)2'�',� (;f'lf,ff i�i4k USE OF PERMIT Si.NLT; SEi,U LOT 11 .16. PLA14163k PLAN Cj.t6i,k: Y J31t�2::OUti Xf> 75 a VO)t M43.i,'.i'1�Lt? 3.SSU,rlfiiu.S t�.l:' SAfyiti,4°i,,tt.N `1'><'ias. Fri•",1t�t!'i' UU}a5 di�:t' iNCLIUI.VE E41.0,Ck WA(A. Oft POOL 7'a.AC7 c,ON0i'Ri3v#.tOiit 1,100 .C;iilVATIO �rfa.e3U sf �frl:Etti.Ul:�J4.:.A?k3,f�t.�ld'.t' +klii,U1: ;j; . cv �a rs•a •( a .Y a r`t� re+F osr%-+ .l:d.b �. Yj�.•J'4.6 Ri�+1..Rfr3.� �1-�i' 1.,1.1 �.a7 Y. ;4DC`u.. ;tl1r,iv 14i CK -Ji iS`iYtL+C3"ION .MS .101 -UW -41840) 886ti oo t�f,n)�1 e~s•ii�rA� 1:1,.1: ifBi•�ifill�d`O+�u'tiF; xt'3u r.7 %3��.:`Cl,v:4)r".5�•'fir� .jfi�-C;fi()�j4i-L'�2td ��'1'.r�? •- E 1-l:T:lWAL. FEE 7, i KtlMf:INGYf'i R }fJf-Uf,=tl.;4i3-Ute $166,00 ftOVt"'NO NicTMOM r.'t,P, _ 1?Fffl11 :+9 03itjLT�tiw4t lit✓ 404,1,.000 -if I -O 10tt 00 )Rt') A.,JTkiXJc)kM. Ers 27,5-000445-32 i Y!<ECiaid;P!,AN 101-000-441-345 525.00 Ati'f IN PITF0,1C, f+f,AC!'-�9 . RES4191701.tlf} 7014005-%-4(0) 1 S7 T? tin)fVFrYI.,'ALCONSM-47110.t+i ANO J>f_AN 4-3 III K 1,5 ii;► c)i OESS PRE -PAID 4 EMS $().t)(► TOTAL PERMIT FEES OUP N0'*W $51312.91 ,•'jQ ,�i' yl RECEIPT,e' J DATE BY (+1. DATE FINALE INSPECTOR �- /,i'"— l 1: i 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 Drywall - Int. Lath Final Final a 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 Pool Cover Sewer Connection Encapsulation Gas Piping Gas Test Appliances Final Final Utility Notice (Gas) — p egZ- 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) - OMMENTS: NOV-30-99 TUE 5, 51 PM WE:�T!ERK 1XS'jLA'I'I0!( 2A.vA A0. 16'36836425 F. 10 01 WES'I'El?N INSULATION, INC. 4211 Letham Street, Mwitaide, California 92601 (909) 686.876C, (9091686-8786 Fax INSULATION CERTIFICATE THIS IS TO CERTIFY THAT INSULATION HAS BEEN iINSTALLED 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 LOU: 36 ` SITE ADDRESS: 43671 MESSINA COURT, LA QUINTA, CA. EXTERIOR WALLS: MANUFACTURER: JOHNS -MANVILLE THICKNESS: 3, 5/8 R -VALUE: R-13 CEILINGS :B�� BLOW �1 MANUFACTURER: JOHNS -MANVILLE THICKNESS: '.3' R -VALUE: R-38 CEILINGS : BATTS BLOW h`'MANUFACT URER: GREENSTONE THICKNESS: 0.3" R -VALUE: R-38 GENERAL CONTRACTOR: ROGER SNE LLE /4BERGER LICENSE NUMBER: 4i BY: TITLE: DATE: INSULATION CONTRACTOR: LICENSE NUMMR: 481278,,`1 BY: IUL TITLE: Vro—uc(+Ma ager - DATE: NOVE BER 36, 1999 WESTERN INSULATION, INC. BELLA VISTA RELEASE OF RESPONSIBILITY FLOORING I, Lee or Nancy Osborne, purchaser of Lot 36, 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 $2,927.00 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: /'����l�� Buyer: Date: Z��/�� Design 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 36, Phase 5B Date Required ASAP Requested by: Rita Desion Center PURCHASE ORDER # 2279 December 9, 1999 PROJECT: Bella Vista Phase 5 Ship to: 43671 Messina Court La Quinta, CA Homeowner. Osborne Cost Cnrio• 41 AA Hours Material / Work Required Unit Price Total Furnish the following upgraded window covering Premier verticals throughout $ 2,027.10 $ 2,027.10 Rio White 14) Verticals 6) Horizontals Horizontals with Privacy TOTAL $2,027.10 vNcmm WIMILIV110 11.7uubu V11a. /1lrNNIVVVLC Ul7C MINIU RCI URN Roger Sn�IeneOiAssociates, Inc. By: By: Cc: Design Cen r Apex Interior Source