SFD (9905-052)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
Pre'lessionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
Date iti► -/ Signature of Contractor
OWNER -BUILDER DECLARATION
Thereby 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).
() 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:
()
1 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.
,(V') J 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:
CarrierPolicy No.
FUND
(This secton need not De completed if the permit valuation O'Is6fo 3$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 Se on 3700 of the Labor
1A
Code, all fot iu�I th comply with.th*0 e provisions.
Date: ��f 4 ~JJ Applicantf✓
Warning: Failure to secure Workers' Compensation coverage is unlawful and
Shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application. is hereby made to the Director of Building and Safety
for permit subject to the conditions and restrictions set forth on his
application:
1. Each person upon whose behalf this application is made & each person at is
whose request and for whose benefit work is performed under or pursuant toie'
any permit issued as a result of this applicaton agrees to, & shall, indemnify t
&. hold harmless the City of La Quinta, its officers, agents and employees. °
2, Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the Above-mentioned prrop�erty,for Inspection purp'oseS."
�°' Signature '(Owner /Agent) \ Date/ � ��� �%�
'BUILDING PERMIT
DATE VALUATION LOT
PERMITS#�,;y
YYIIJ-IiSi� TRACT
'.281,5$- t.
JOB SITE APN'
ADDRESS r�
`43-575 MILAN COURT 6ll?1_d371i—ii3�
I OWNER.
ADVANCED DEVELOPMENT CORP
78.615 NAPLES DRJVE
LA. QUINT.A CA 92253
USE OF PERMIT
CONTRACTOR/DESIGNER/
TRADITIONAL BU-ILUNG CO INC
7,8615 NAPLES DR
LA "t413iTN T'A. CA 02253
(760)777-2-0222 CBLY 6750
SM- - LOT 71 PLAN 55.8 ; PERWT DOCS NOT TNCLIME BLO. CA. WALL OR
POOL.
TRACT CO.N.TICRUCTION 4,40.00 SF
PORC HMATIO 160.00 SF'
GARAGE CARPO:R T 449.00 S. !
•L,S1•IMATE'CD COSTOF
CKliNSTRUC'f ION
PERMIT TEE SUMMARY
CONSTRUCTJON'F.FF
101-000-418.000
V 86.50
PLAN CHECK CT_ -E
101-000-439.318
$161.98
NWHAMCA1s FES
101-060-421 000
560.00
FIECTKfCrYL !" FE
l 01-000 .1.20-000
'$141.48
P.LUMB'1NG F'15Ti
101,-0004119-000
$140.75
STRONG MOTION E'er - RES;*L D
101-Q00-1.4.1.000
$14.1.2
GR.Ap.1NG ME
101-0004-2000
$20,00
1Nr A.Si`i'RUCTUU FEE
12-5-011 "342
33,1311." 1
(0-211' ,T.N PUBLIC PLAC# 3 - R.F.1P1: 701:-000=x,55)1100
9.103.12
r
Y
SUBTOTAL CONSF'kr TC1"10N' t1IND PLAN CHEC9—
PAMLESS FIRE -PAW TEES
PAA
_ MAY" 1719999 TOTAL PE'Rr%C1i TELES DUE NOW
,t
RECEIPT
DATE FINALED I INSPECTOR
.141,248,40
$,4,558.16
$0.0(:
4,558,y16
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
I INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & FootingsDucts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck �y�
Exhaust Fans
0. K. to Wrap - Z S-vo 6 l
F.A.U.
Framing �P-,1�=�j �-
Compressor
Insulationa- % UZ1
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath 3F_7 -$fii
Drywall - Int. Lath
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
44
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 I
Encapsulation
Gas Piping
Gas Test -G a
Appliances
Final
Final
Utility Notice (Gas) I f_ �-�
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.F.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
APR -18-2000 09:47 t WESTERN INSULATIONt 909 686'8786 P.07i13
WESTERN INSULATION INC, f
4211 Latham Street, Riverside, California 92501
TeL (909) 686-8760 Fax (909) 686-8786
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 - TRACT # 28458-1
LOT# 31
SITE ADDRESS: 43575 MILAN COURT
------------- 1-- -------------
EXTERIOR WALLS
MANUFACTURER: Johns -Manville THICKNESS; 3 5/8" R -VALUE: R-13
CEILINGS: SATTS BLOW
MANUFACTURER: Johns -Manville THICKNESS: 13" R -VALUE: R-38
CEILINGS: BATTS LOW
MANUFACTURER: Greensione THICKNESS: 10.3" R -VALUE: R-38
GENERAL CONTRACTOR' TRADITIONAL BUILDING
LICENSE NUMBER:
BY:
TITLE;
DATE:
INSULATION CONTRACTOR: WESTERN INSULATION, INC.
LICENSE NUMBER: 481278
BY:
TITLE: PRO TION MANAGWR
DATE April 17, 2000
s
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 31, Phase 5C
Date Required : ASAP
Requested by: Rita
Desiqn Center
PURCHASE ORDER #
9023
April 21, 2000
PROJECT: Bella Vista Phase 5
Ship to: 43575 Milan Court
La Quinta, CA
Homeowner: Hernandez
Cost Code: 3186
Hours
Material / Work Required
Unit Price Total
Furnish the following upgraded window covering
Premier verticals throughout
$ 2,204.00
$ 2,204.00
Fresno White
17) Verticals
6) Horizontals
Horizontals with Privacy
TOTAL
$2,204.00
tipeciai conamonsnnstructions:
Roger Snellenberger Development
V�
Cc: Cent r
AUKNUWLtUUt ANU Kt I UKN
Apex Interior Source
By: