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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