SFD (9905-049)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
7 5046 f3 0121201
DaePV11 14A rSignature of Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) .1; 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). f '.
() I am exempt under Section B&P.C. for this reason
Date Signature of Owner
a
WORKER'S COMPENSATION DECLARATION
I hereby affirm, under penalty of perjury one of the following declarations:
( .). l 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:
Carrier Policy No.
i.ATE t'"iI r f}(► rt g? -94
is section need not a completed if the permit valuation Is for $100.00 or less).
,1 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-thosefprovisions.
Date:A' f +r Applicant 7W F
`r Warning: Failure to'secure Workers' 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 e}
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 authorise representatives of this City to enter upon
the above meritioned propeity.;for !Inspection purposes.
/Signature (Owner/Agent)-,Datej�
BUILDING PERMIT PERMIT# ,
V '✓V
DATE VALUATION LOT y �OW444, I TRACT
�
$119,253.50 r' 34 284554
JOB SITE - _
ADDRESS
AP.N
r4�44011ELAN COu0
609-'0,7&038
OWNER CONTRACTOR/DESIGNER/ENGINEER
ADVANCED DFIVELcipmEN-r COR.' 'TRADN ICINA.L Ht1ILDINt CO INC
'78-61,5'NAPLFS DP.iR;F 8615 NAPL ES IOR
LA QLTZRA CA 92253 LA t}LUM A CA 9225
(760)i72-0'222 CB 5750
AU
USE OF PERMIT
S ,'D - Lar.34 'PLAN 3B - MNU,T DOES NOT TNCL');)DS BL.00K'WA"L:L OR.
P0C7L.
2,0z5,00
yTt.Taj.�r�. �,yor�7�sTRu`:riot �SF�
S'O.Iv�+.C]7/C.` TIC) 52.00 .7.i'
GARAAMCARPO ° 43'9.00 SF
J
QST 1MAT.ED COST OF CONS'tAUCTION
.119453S)
i,FItl11:iT FE, E SlliiM.ARV
CONSTRUCTION FEE 101.-000-118-000 $709.50
KNO CHECK FEE 101-0004N-',118 $587.90
iti1:I:CH"ICAL FEE 1.0.1-{3l?0 121-0i30 553.50
ELEC RICM,FE.E 191-000,-420.000 11zs:i6
PL t)MSI2J1GM 101-000-419-000
IST RC)N0 N,IMION I -ES - R0.1D 101-000-241-000 $11.9.3
GRADING FEE 1.01AX)0-423 (,000 $20.00
Mr"RA.aUMICTURN,R 225-000-443-342 i21.667.64
ART P1 MBLIC PLAMS-:RESIC?.01.-000-255-000 VSA3
t?,
SLI`B-Wh7 L CONSTRdClION AND PLAN CHECK
$1,367.51
LESS PRE -PAID VEES
$0.00
1'V '
IPAr
TOUL P'1> RNUT .1rEE�S DUE NOW
$4,367.51
MAY 17 1999
�4f
Rt
�'
Y j
, I
DATE FINALED
INSPECTOR
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
11—,2 f_ 9 y
Exhaust Fans
O.K to Wrap
-2--cro ,6
F.A.U.
Framing
—l:'a
Compressor
Insulation
Z -17-4-z> 1EVents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
—0-2>
Drywall - Int. Lath
— Z& ClU
Final
Final — o--
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond r
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground PI . 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 _
Sewer Connection
Pool Cover
Encapsulation
Gas Piping
Gas Test
S !�
Appliances
Final
Final 0 6
Utility Notice (Gas)
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 — q�
Utility Notice (Perm)
COMMENTS:
APR -18-2000 09:46
;b l
WESTERN INSULATION'
909 686 8786 P.04i13
WESTERN INSULATION, INC,
4211 Latham Street, Riverside, California 92501 1
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# 34
SITE ADDRESS: 43640 MILAN COURT
EXTERIOR WALLS
MANUFACTURER: Johns -Manville THICKNESS: 3 5/8" R -VALUE: R-13
CEILINGS: LeATTS BLOW
MANUFACTURER: Johns -Manville THICKNESS: 13" R -VALUE: R-38
CEILINGS: BATTS BLOW
MANUFACTURER: Greenstone THICKNESS: 10.3" R -VALUE: R-38
GENERAL CONTRACTOR: TRADITIONAL BUILDING
LICENSE NUMBER:
BY:
TITLE:
DATE:
INSW ATION CONTRACTOR: WESTERN INSULATION, INC.
LICENSE NUMBER: 481278
BY: '0
TITLE: PROQOCTION MANAGER
DATE April 17, 2000
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 34, Phase 5C
Date Required : ASAP
Requested by: Rita
Design Center
PURCHASE ORDER #
9019 ,
April 17, 2000
PROJECT: Bella Vista Phase 5
Ship to: 43640 Milan Court
La Quinta, CA
Homeowner: Guy
Cost Code: 3186
Hours
Material / Work Required
Unit Price Total
Furnish the following upgraded window covering
Premier verticals throughout
$ 1,764.97
$ 1,764.97
Fresno White
15) Verticals
2) Horizontals
Horizontals with Privacy
TOTAL
$1,764.97
special conditions/Instructions:
Roger Snellenberge & Associates, Inc.
By:
Cc: Desi nter
AUKNUWLtUUt ANU Kt I UKN
Apex Interior Source
By:
BELLA VISTA
RELEASE OF RESPONSIBILITY
FLOORING
I, Christopher or Jacquilin Guy, purchaser of Lot 34, Phase 5C 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 $2,202.00
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: B
Date:
Design en er.