SFD (9905-048)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
75940 B
Date _ 4 +� Signature of Contractor rte`
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). '
() I am exempt under Section B&P.C. for this reason
Date Signature of Owner
WORKER'S COMPENSATION DECLARATION
( 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.
( ) 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.
STATE FUNO 0576-155-93
(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.
D'ate:� / it 110 y U
r !
/Warning: Failure to secure Worke'rs'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 representativ@@s of this City to enter upon
the above-mentioned property for inspection purpdses:
Signature (Owner/Agent)• Date9q
BUILDING PERMIT PERMIT#
9"S.048
DATE VALUATION 5162,94#,70 LOT IS TRACT 79,158.1
JOB SITE APN
ADDRESS 4J-4le70 h111,AN CC3Ui C 60-070-038
OWNER .- CONTRACTOR / DESIGNER / ENGINEER
AIJVANICED UA W',L0PM1I NNrr CORP rl;,3l)i ['lONAu 111URD;P:G CO 1PX:
78-ti.15 NAPLES DRIVE 78615 NAPLES lilt
1,A QUIN'TA CA 92.253 LA QUIN-1-A CA 92253
(760)772.0222 CHLO 5750
USE OF PERMIT
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P0 L,
TRikC-1 CONSWLIK-710,N 2.76100 SF
PORCIMI ('10 . 9li.(4) '3111
OA£3.t,K3(;t(.."•AEtYCaRT 399.110 S
INTIMATED COMS a 01? CONST HON,
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C:'TWSTRUC TION FIX
10,140.)-4118-000
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101-f1(1)-439-319
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INIE0IJu,41CAL•1'7217,
1101.000•.1, 1-000
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101-000-120-M)
$15'1.17
VLUty IN3F[Y,
10140-4.19-01U
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520.00
WT10%,S'Tltt.dCYURk.
:25-000-X143-34.2
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PREC ISH PLAN
101-()00-411-345
$45.0
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1142,948.70
S5,95193
$000
MAY 171999.1-01'Al. PRRMIT FCKS »ref IN (AV
r,
SIT Y OF LA QUINTA
RECEIPT DATE BY r `. DATE FINALED INSPECTOR
s
IV
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
/l `%` 6'66L
Exhaust Fans
OX to Wrap
F.A.U.
Framing
Compressor
Insulation
v
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
I I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Neater 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 yv
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final - (�
Utility Notice (Perm)
COMMENTS:
APR -18-2000 09:46 (WESTERN INSULATION 909 686 8786 .- P.03i13
WESTERN INSULATION, INC.
4211 Latham Sweet, Rivcruide, California 92501
Tcl. (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#
35
SITE ADDRESS:
43670 MILAN COURT ,
EXTERIOR WALLS
- - - -
MANUFACTURER:
Johns -Manville THICKNESS: 3 5/8" R -VALUE: R-13
CEILINGS:
C ATTS BLOW
MANUFACTURER,
Johns -Manville THICKNESS: 13" R -VALUE: R-38
CEILINGS:
BATTS LOW
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 UCTION WANAGER
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 35, Phase 5C
Date Required :
ASAP
Requested by:
Rita
$ 2,179.50
Design Center
PURCHASE ORDER #
9021
April 20, 2000
PROJECT: Bella Vista Phase 5
Ship to: 43670 Milan Court
La Quinta, CA
Homeowner: Braun
r��+ r��o• �� Qa
Hours
Material / Work Required
Unit Price Total
Furnish the following upgraded window covering
Premier verticals throughout
$ 2,179.50
$ 2,179.50
Rio White
14) Verticals
6) Horizontals
Horizontals with Privacy
TOTAL
$2,179.50
V'.I4vIw1 VVIIYIYV11.7I 111.711 Y\rIIVIIJ.
Roger Snellenberger Development
f
Cc: i n Ce er
,'%UNNVVVLCUht ANU Kt I UKN
Apex Interior Source
By. -