SFD (9903-053)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
c4,LL Professionals Code, and my License is in full force and effect.
O t M License # Lic. Class Exp. Date /�
W 28r 0(
oZ r� Date Signature of Contract -o; �,'
(O0. V
J U 6 OWNER -BUILDER DECLARATION
W W r— I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ a 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).
C'`) () I am exempt under Section , B&P.C. for this reason
Ln
N Date Signature of Owner
O�
WORKER'S COMPENSATION DECLARATION
Z
C) Ir I hereby affirm under penalty of perjury one of the following declarations:
Lo H O () 1 have and will maintain a certificate of consent to self -insure for workers'
X W LL compensation, as provided for by Section 3700 of the Labor Code, for the
O J Q performance of the work for which this permit is issued.
C0 Q C) ( ) I have and will maintain workers' compensation insurance, as required by
p U Q Section 3700 of the Labor Code, for the performance of the work for which this
Il 0. Z permit is issued. My workers' compensation insurance carrier & policy no. are:
Cartier Policy No.
c'C=1 STATE FUND C15''��F:185.9:1
g(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 37 0 of the Labor
Code, I s all forthwith comply with those`provisions!tt �l
[ate: '? Cf a Applicant r - i
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. r,
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. ( E
w Signature (Owner/Agent) R� �� �ra�- Date
PERMIT#
BUILDING PERMIT
DATE VALUATION S1118,61140 LOT �J TRACTJOB
SITE
ADDRESS 414P0 MILAN COURT
OWNER
CONTRACTOR/DESSIIG}NER/E()NGINEyE♦R
(� 7 (jj
{1?��''li+�Y 4•.. CI •r}�tifl�1001k 1t:k IY1, 0flp i�
( /9
Iro ". �.i1k�{1�L j.' a�AMNT�.,.{ "0 t"C
79-613 NAPLES S:+RVE
78635 NAMES DR
1.A 07 1IMA, CA W253
Ltd, tltlMsi CA 92253
i'!F>�)1777-0222 t^t'31F#( X750
USE OF PERMIT
AN0 1? f'AMILI' DWI~1,(ANC,
SI'1~3 - Lr -OT 30 P(,AN 2'ti . - Pf;RMIT ,DOES mo t' INcLuui; iiLoc WALL
4711.1-A.A.. *I5+ ;, PLAN PtEM FEE )tf~iii/t::110N FOR MULTIPLE IDLE ISS DANCE
017 SAME PLAN `E'YP.6, �
i
TRACT' CtiiI3MU TERN 1,834,000 SF
t-ORCH/1" '1.10 76AW SIS
QAR,Ak1WCAR11(.')RT 4011.UO SF
ESTIMATED CONT OF CONSTRUCTION
108,613.40
Y
I'M97IT :FE , SUMMARY
CONS~1'1t! CMION1:gH 101-000-418.0W`i0
P11IAN cyn. X s. n"t. 101.17 0-439-318
;+i9lr01ANICAL its Ian 0fi0 ►�I.(}p� $4700
EL(W- ICA1. FET. 101-000-4.20.000 StAi).87
PLU&IRINO FRE 101-(XV-419-(X?0 $13.4.75
STK)NO MOTTO t I•FY - REM 101-ClW24 - )M WI M
atuxD11401119 1.0I-000.42_3-000
IV!'i2Am'.t2.47C't'X.fEt.r Ftie" 225-000-443.352 52 4`1.cK;
ART 1N PUBLIC PLAC"F3 - RESM 701-Uti{J-2554)00 $2t.53
4t
• x
KI AL C.OWPRT J U11ON ANN Pf. AN r,►lrerhr
LESS PRE-NUDITEES
400,110
P -A -180W .FOTAL F IMP, NOW
PERMIT i+:RS
fi3,iK�.93
MAY 171999
RECEIPT ATEDATE FINALED INSPECTOR
k
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs 17
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck 8—p
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation Zeta
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
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
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring ov
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G. F.I.
Smoke Detectors
Temp. Use of Power
Final 7—oD or
Utility Notice (Perm)
COMMENTS:
APR -18-2000 09:47 WESTERN INSULATION 909 686 8786 ...P.08/13
f{ r.
WESTERN INSULATION, INC.
4211 Latham Street, Riversicic, California 92501
Tcl. (909) 686-8760 Fax (909) 686-8786
INSULATION CERTIFICA'T'E
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
T:TRACT / PHASE: BELLA VISTA - TRACT # 28458-1
LOT# 30
SITE ADDRESS: 43605 MILAN COURT
EXTERIOR WALLS
MANUFACTURER: Johns -Manville THICKNESS: 3 5/8" R -VALUE: R-13
CEILINGS: ATS BLOW
MANUFACTURER: Johns -Manville THICKNESS: 13" R -VALUE: R-38
CEILINGS: 'BATTS LDW
MANUFACTURER: Greenstone 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: PR D CTION MANAG R
DATE April 17, 2000
ROGER SNELLENBERGER DEVELOPMENT
7861.5 NAPLES DRIVE
LA QUINTA, CA 92253
(760) 772-0222
(760) 772-0257 FAX
TO:
Apex Interior Source
April 21, 2000
79-553 Country Club Drive
PROJECT: Bella Vista Phase 5
Bermuda Dunes, CA 92201
Premier verticals throughout
$ 1,954.00
Fax:
360-3167'
Fresno White
Attention:
Denise
Lot & Phase:
Lot 30, Phase 5C
Ship to: 43605 Milan Court
Date Required :
ASAP
La Quinta, CA
Homeowner: Hesson
Requested by:
Rita
Design Center
Cost Code: 3186
Hours
Material / Work Required
Unit Price Total
Furnish the following upgraded window covering
Premier verticals throughout
$ 1,954.00
$ 1,954.00
Fresno White
17) Verticals
2) Horizontals
Horizontals with Privacy -
TOTAL
$1,954.00
Special Conditions/Instructions:
Roger Snellenberger Development
Cc: De ' Center