SFD (9904-116)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
ate -III ' M Signature of Contrar
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).
O I am exempt under Section , B&P.C. for this reason
bate • 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.
S(�) I have and will maintain workers' compensation insurance, as required by
ection 3700 of the Labor Code, for the performance of the work for which this
permit is issued. Myworkers' compensation insurance carrier & policy'no. are:
Carrier Policy No.
TO
�T- ATE I U11111 11
(This section need not be coiTmpleted 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-shallnot 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. /Jap
Qate'T.A t! Applicant Jz1Zrti�
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
oermit,-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
the4bove-mentioned p opperty for inspection pur` oses. ,,r
Xinature'.(Owner/Agent)�/� s�— Dat
e
BUILDING PERMIT PERMIT#
DATE VALUATION2,S0.` 0 LOT A3 TRACT 284%_1
JOB w'rnwxrw:� •.r`
ADDRESS hii b' tS3f2• a i �Pt�_L1091J {,Q
APN 4
� 09� 07f}� 639
OWNER
CONTRACTOR / DESIGNER / ENGINEER
78-61:3lv'ti.i L S grit
r.
8 -6 15 NAP1,ES ial iVF.
GA 9225:.4
LA QdJl:N1 A CA 922.53
tilifi77?-('iu22 t;):3t,f: i;ZSg
USE OF PERMIT
S '+1"l. ,' .�'tiJ1/,l1 1' tMRl.,LtNO.
SR LiWJ X14), PILM s' 6A, Ra"T Da S :f401* WO LDE :t�7,00,.K WALL
PORCd4I1'A°ffo 90to l Si'
GAtt61.G8(CrVERP0_KT S $'.Up SP
M'A zi'4IA TE1gt CONT 01IF CODNS'xRUCTI M:
1czp, x.79
PERWff FEE SUMMARV
C01%j8'.'fKf>/ ,V10N FEH 10140-418-1,3A
P`t,AN (79FIC,. d, `�frsnz,�1
1l�.1Y-0�(.t4p►..a�3A- pz�(� t
dVIL'ti C'L: n4A vd.'.�`.f F01" ltt 0`VUle a lN:l .�i:+C..VV
k'Li t:.t,� UC.A.LF EE SI57.17
7Ji�d)tVt}311Vis l� i">r I(H-•U -419-00() $166.00
10J -000-24J-000 $ f a 2q
,CRAD O MUT 1 1,000+423 -Adm $20-00
INFRASC'ft'CK:'1`I1RE FV,, 22.5-000-443-342 $3,ts.W.4 I
PI CISEPLAN 101- XXJI °441-.34.5 USMO
AftT IN KBIlic PLACTS .- USIC 70!-W-253-000
Sr 113MTFA[,, CONFROX1,10N AND Ffiffily QHTICK
$%R5t Q1.
I.EM :PRE -PATI) FEES
ry0 '
MW
RECEIPT p"�
DATE` t„
BY
DATE FINALED
INSPECTOR
V
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
S
Ducts
Slab Gre de
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
6efrf
F.A.U.
Framing
_�- ,jy
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
.Z
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
7X73-77- .5�ggg
Appliances
Final
COMMENTS:
�l I
Final
Utility Notice (Gas) Z
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, Matt or Esther Diaz, purchaser of Lot 43, Phase 5B at Bella Vista Homes,
hereby acknowledge that by not purchasing my flooring through the Roger
Snellenberger Development Design Center:
I. 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: / Buyer:
Date: 129 Desi e \)
4
ROGER SNELLENBERGER 8, ASSOC., INC. PURCHASE ORDER #
78615 NAPLES DRIVE 2270
LA QUINTA, CA 92253
(760)772-0222
(760) 772-0257 FAX
TO: Apex Interior Source November 29, 1999
79-553, Country Club Drive PROJECT: Bella Vista Phase 5
Bermuda Dunes, CA 92201
Fax: 360-3167
Attention:. Denise
Lot & Phase: Lot 43, Phase 5B Ship to: 43672 Messina Court
Date Required ASAP La Quinta, CA
Requested by: Rita Homeowner: Diaz
Desion Center
Hours
Material / Work Required
...+.a —.— J 100
Unit Price Total
Furnish the following upgraded window covering
Premier verticals throughout
$ 2,173.00
$
Fresno White
2,173.00
14) Verticals
6) Horizontals
Horizontals with Privacy
Special Conditions/Instructions:
ArIMMui Gnr--G eK1n T
oc11�
TOTAL
$2,173.00
Roger Snelle be ger & Associates, Inc. Apex Interior Source
By: J P By:
C . i n Ce ter
NOV-310-99 TUE 0—:42 Phi WETERK IIi RATION' ;aPv NO. 16'36836425 F.
j
WES1'E]i N INSULATION, INC.
4211 Latham Street, Riverside, California 92501
(909) 686.8760
(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#: 43
SITE ADDRESS: 43672 MESSINA COURT, LA QUINTA, CA.
EXTERIOR WALLS:
MANUFACTURER: JOHNS -MANVILLE THICKNESS: :15/8 R -VALUE: R-13
CEILINGS 'BATTS� BLOW
MANUFACTURER: JOHNS -MANVILLE THICKNESS: i;3" R -VALUE: R-38
CEILINGS: BATTS BLOW
MANUFACTURER: GREENSTONE THICKNESS: 17.3" R—VALUE: R-38
GENERAL CONTRACTOR: ROGER SNELLENBERGER
LICENSE NUMBER:
BY:
TITLE:
DATE:
INSULATION CONTRACTOR:
LICENSE NUMBW: 48127§.
BY: 4caAA 16 /U"
TITLE: P oducti anager
DATE: NOVE ER 51,1999
WESTERN INSULATION, INC.