SFD (9905-056)LICENSED CONTRACTOR DECLARATION
I hereby firm 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 ft Lic. Class Exp. Date
• 116
i
D tp, �� f c Signature of Contracto �j ' t 4
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
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.
(, ) 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.
(This section need note completed if the permit valuation isf'fdr'$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�p00 of the Labor
Code, I shall forthwith comply withthose provisions. 0/
Date: ✓ ►i I Applicant ±` Nr, - '
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
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.
Signature (Owner/Agent) t • _ Dater
J
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 991)•S t)5b TRACT
$141,248.40?' '78458-1
JOB SITE
APN
ADDRESS7
43-695 MILAN COURT
609-1370-438
OWNER
CONTRACTOR/DESIGNER/ENGINEER
ADVANCED DEVELOPMENI' CORP
TRr DMONAL BUILDING CO INC
18-613 NAPLES DRIVE
78615 NAPLES DR
LA QUINTA CA 92253
I. k QUINT.A CA 13'2253
t 760)7714-0222 72-02'22 CBLY 5750
USE OF PERMIT
SM -1.0 Y .�,7 PLAN PFTN4I7 DOE, 8 NOT INCLUDE BLOCK WALL
OR POOL. f
mkcr CON, iLilb I'ICY 2,4i1[).Otf Si'
PORt""AT16 160.00 sh
GARA(3F ARPOR•r 4-19.00 SF
ES4'IMX:fED C(DM=r OIP CONsTRUc` 110N
14J,Z48.41)
6'FliMIT FEE StMMARY
CONTMUC TION 1'FX 101-000-418-UiX'1 $786,10
PLAN CHiiCK FU 101-000-439-315 $161.38
A*.0 HANICALM 101 -000 -4:21 -OW $60.00
FLf CTRICA[.FEE- 101-000,-120- k $141.43
11l.M.WINO FEF 101 -MOO -119-00{) $140,75
STRONG lklt TION FEE - RLSU) 101.000.241-000 $14.12
GRAIDING Mr 101-000-423-000 $20.01i
INFRAMUC;"1'ORH FFX- 225-GW,143 :?4? $3,130.21
APT tN PUPA, [C PLACES -,RF-51 V 701-000-255-000 $1C►3, !2
a
/
a
SUB-T(YrAL C ONS RUCWN AND PLAN CHECK
54,558.16
LESS PRE -PAID FEES
PAID
$0.001
HIAY 17 1999 TOTAL PER WT FEFS DUE NOW
Sri, -".9.16
RECEIPT
J}'
BY
DATE FINALED
INSPECTOR
4s t i
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Gragide
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
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
Final
Final I
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
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
f
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
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 �lJ
Utility Notice (Perm)
COMMENTS:
Ar'
APR -18-2000 09:48 WESTERN INSULATION ` 909 686 8786 „P. 11/13
WESTERN INSULATION, INC.
4211 Letham Street, Riverside, California, 92501
Tel. (909) 686-8760 Fax (909) 686-8766
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#
27
SITE ADDRESS:
43695 MILAN COURT
EXTERIOR WALLS
MANUFACTURER:
Johns -Manville THICKNESS: 3 5/8' R -VALUE: R-13
CEILINGS:
BATTS 13LOW
MANUFACTURER:
Johns -Manville THICKNESS: 13" R -VALUE: R-38
CEILINGS:
BATTS BLOW
MANUFACTURER:
Gieenstone 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: PRoRu9triON 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 27, Phase 5C
Date Required : ASAP
Requested by: Rita
Design Center
May 12, 2000
PROJECT: Bella Vista Phase 5
Ship to: 43695 Milan Court
La Quinta, CA
Homeowner: Miller
Cost Code: 3186
Hours
Material / Work Required
Unit Price Total
Furnish the following upgraded window covering
Premier verticals throughout
$ 2,173.00
$ 2,173.00
Rio White
18) Verticals
4) Horizontals
Horizontals with Privacy
TOTAL
$2,173.00
Special Conditions/Instructions:
Roger Snellenberger Development P
Cc: Des' enter
ACKNOWLEDGE AND RETURN
Apex Interior Source
By:
MAR -06-00 MON 03:40 FM SNITESFABRICATORS
L I�Y, NO, 7603974724
PATES
k�YTABRI CAT OR S
Residential, Cornmercia! &--Floor Trusses
TO:
ATTENTION:_
FROM:
DATE:
TME:
a
TOTAL NlnMER OF PAGES, LNCLUDWG COVER SHEET: - -a
REGARDING:—
- o�- �Z� �4-1'
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HAVE A NICE DAY!!
$5-435 B IMIDDLETON ST- THER-MAL, CA. 972' 74 -� (760) 397-4122 � FAX (760) 39" -471-4
P. 01
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