SFD (9905-057)LICENSED CONTRACTOR DECLARATION
1 hereby affirm under penalty, of perjury that I am licensed under provisions of
Fes— Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
04 W Professionals Code, and my License is in full force and,effect.
Liceifse # Lic. Class Exp. Date
LLJ
o Z r- Date Signature of Contractorco
( .
J U 0 OWNER -BUILDER DECLARATION
LU W I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ U) 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).
Cl) () I am exempt under Section , B&P.C. for this reason
LO
N Date Signature of Owner
p N
d Q WORKER'S COMPENSATION DECLARATION
O 2
cc I hereby affirm under penalty of perjury one of the following declarations:
Lo H p () 1 have and will maintain a certificate of consent to self -insure for workers'
X W !L compensation, as provided for by Section 3700 of the Labor Code, for the
Om � Q performance of the work for which this permit is issued.
<,Q ( ) I. have and will maintain workers' compensation insurance, as required by
OU Q Section 3700 of the Labor Code, for the performance of the work for which this
LO li H permit is issued. My workers' compensation insurance carrier & policy no. are:
Z Carrier Policy No.
rp
J(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 ith comply with.those provisions.
Date: t i -1 Applicants
1--`%_T-\ Llam'!
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)° 1 i .i 1i"V Date
PERMIT #
BUILDING PERMIT
DATE VALUATION <'- LOT TRACTJOB
SITE
ADDRESS ,) k L'� � s: � 4 iJd'd1��i i
APN 60-9-1170-0.111
OWNER
CONTRACTOR/DESIGNER/ENGINEER
CORP"1'�;
t1�1'1'`[t3;+i��1,11'. ►(Ll�l*. , t'(311�t
716-613 NAPLES DRIW'
78/615 NARLES DR
LA. QAJINTA CA 92,253
LA WNTA CA 92253
/"I f1}X72 t12: t C1?LA 750
USE OF PERMIT
SF'D -,LOT ', , .P.L•AN 4A -13!` RNUT NOT 12it.-1. Tb 0(.CX1X' WALL OR
1K.D(1.L +75°/o PT..lilN C:IViC ;, Ya REDU(`•'f°EON FOR NiULTllft,l ISSUANCE OF
SA1�1 T'i,lllY'1'i'471s".
h RC.tiit�F t.1C3 i til.00t t;
GARAf. i7C]X7RP0KT 471.00 &
F31T%,i V L:D COS f OF CONS''3'.KIM ION
1.311.13-4.611
3'19 RMTf 1+&C'SUMMAR
C`0NS'i'l<.Ut-fION FEE 10t-000-41,144110 SXQt�.tftl
PIAN (:HF Z Y1;1? 10! 11,4 69
MECIIANWAL 1.'f -J -I 1v 1 (31)f3 9 1-( 1Q S60.tk
UEC" RICA -L :Frq` $134,92
PLUMBING F -&ate . 101-(tt 0-41 ►-000 $140.75
`JTRONO NfOT10N Wt. , RFI%i.) 101 0,A
cl na .tact :t 101 t1C14i 123•UQtJ $29 00
1NVRA,�'fR1,fi,®T.Ctf?.1': -FH 22000-443.30,' $2.845,56
ART IN PL1Hy 1 11L,A.0 r:., - KUS11". t'01 -000.255 -OW
n
'tY'Yfm,t'ONSti3.UC �tl3, Flt' b P(,• N (7111171f..
,4.;?t1^3
(�
LESS 1'f1,1 R'i D 1°T,FS
�
(1
V040
MpY 171999 ` fYI°AL P R R M IT FCIE, 8 IznfKNC)W
%4,242J3
OF LA
1.�
N�
RECEIPT
DATE
BY
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
Z _
Exhaust Fans
O.K to Wrap
—z 6=)
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
-3—�
Final
Final
POOLS - SPAS
BLOCKWALL
APPROVALS
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
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
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 U
Utility Notice (Perm)
APR -18-2000 09 48 LJESTERN INSULATION '•909 68G 8785• P.12i13
WESTERN INSULATION, INC.
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: SELLA VISTA - TRACT # 28458-1
LOT# 26
SITE ADDRESS: 43725 MILAN COURT
EXTERIOR WALLS
MANUFACTURER: Johns -Manville THICKNESS: ' 3 5/8" R -VALUE: R-13
CEILINGS: BATTS 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: ti
INSULATION. CONTRACTOR: WESTERN INSULATION, INC.
LICENSE NUMBER: 481278
BY:
,QUA
TITLE: PRODUC ION MANAGEFF
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 26, Phase 5C
Date Required :
ASAP
Requested by:
Rita
$ 1,465.00
n—inn r`cntnr
PURCHASE ORDER #
9027 '
May 12, 2000
PROJECT: Bella Vista Phase 5
Ship to: 43725 Milan Court
La Quinta, CA
Homeowner: Moore
Cost Code: 3186
Hours
J Material / Work Required
Unit Price Total
Furnish the following upgraded window covering
Premier verticals throughout
$ 1,465.00
$ 1,465.00
Rio White
13) Verticals
2) Horizontals
Horizontals with Privacy
TOTAL
$1,465.00
r•vrTr��i
Special Conditions/Instructions:
Roger Snellenberger Development
B
Cc: Des Center
Apex Interior Source
By:
7 d7�7�--
.4-
h -J rdei
- _. , esig - - - - se
P.O. NO.
ju h' DATE
92270
&�..
31-17M 0'�"r":,:i-4147
760)-6 74-1188 Fax (7G0),G7
4:1668'
J & *S Floors, - Inc.
16872 Hale Avenue, Suite A
'CA 92606'.
(940)-44 -7890 Fdx,(949) 442-7891
;Pager .'(949) 7,33-,4681
PROJECT LOT/ PHASE PLAN CLIENT NAME
4,
A Moore
-BELLAINISTAI-Ir '�4 podaca/
.-
AREA `iDESCRIPTION.
QTY-
'Grout -WO Tumbleweed #252
Per Diagram,---'---;'Cail)et-Bayview-Canyoii Saiid" -'136
- -
Padf/2136
- 816
m
5/1b/200O
NIT r,ow RATE -�'.A&IOIJNT
y
43.851--, 1189.65
--5.00 --t-260.00
,425.00r .-380.00
s1f 1)350.00
sfif .775.00
s1f 5.00 540.00
s1f 5.00 140.00
S/f 5.00 100.00
6.00
S/y 3.45
ATTACH A COPY OF THIS PURCHASE ORDER TO THE CORRESPONDING INVOICE AND
SEND TO:
TRADITIONAL DESIGN CENTER
5 WHITE SUN WAY, RANCHOMIRA G CA, 92270
'ATTENTION: SUZANNE GUILLAU
SIGNATURE DATE -
Total
:816.00
469.20
$6,019.85
°S D
Standard, ,Tile da. 12x12 4
r
-309
!Ext. # 1, 14, Extendea-Area.
52
Ext. #2 dAr
Extende eas
76
J Dii�ing-kiii, TrxiQe'd A#as 7-
'�:270
Morning Rh I ixierijid Areasv!'i-T 4.
.155
Hall I VFtEhded Areas
.108
Bath 2r.
EiCetcfed Areas
28
Mstr Toilef! i Extended Afea§'
20
'Grout -WO Tumbleweed #252
Per Diagram,---'---;'Cail)et-Bayview-Canyoii Saiid" -'136
- -
Padf/2136
- 816
m
5/1b/200O
NIT r,ow RATE -�'.A&IOIJNT
y
43.851--, 1189.65
--5.00 --t-260.00
,425.00r .-380.00
s1f 1)350.00
sfif .775.00
s1f 5.00 540.00
s1f 5.00 140.00
S/f 5.00 100.00
6.00
S/y 3.45
ATTACH A COPY OF THIS PURCHASE ORDER TO THE CORRESPONDING INVOICE AND
SEND TO:
TRADITIONAL DESIGN CENTER
5 WHITE SUN WAY, RANCHOMIRA G CA, 92270
'ATTENTION: SUZANNE GUILLAU
SIGNATURE DATE -
Total
:816.00
469.20
$6,019.85
°S D