SFD (9905-058)LICENSED CONTRACTOR DECLARATION
I herehv affirm under penalty of perjury that I am licensed under provisions of
H Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
N W Professionals Code, and my License is in full force and effect.
O =) (n License # Lic. Class Exp. Date
�0
r
1�, �`� d-
6
02128+2X3(
Z F-_ ✓bate Signature of Contracttor 11
O_rl�
J U C OWNER -BUILDER DECLARATION
W 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).
C'') () I am exempt under Section , B&P.C. for this reason
LO
N Date Signature of Owner
O N
d Q WORKER'S COMPENSATION DECLARATION
O Z I hereby affirm under penalty of perjury one of the following declarations:
Lo HO () 1 have and will maintain a certificate of consent to self -insure for workers'
X LLI LL compensation, as provided for by Section 3700 of the Labor Code, for the
O J Q performance of the work for which this permit is issued.
co Q- U (; .) I have and will maintain workers' compensation insurance, as required by
p U QSection 3700 of the Labor Code, for the performance of the work for which this
Z permit is issued. My workers' compensation insurance carrier &policy no. are:
Carrier Policy No.
C)
g (This sectof nRdFn t tie completed if the permit valuationfor$5166.60 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 S ction 3700 of the Labor
ValCode, I sh - II fo hwit comply with those provisions. /f
VD
ate:1 LI � � �fAPPlicant � �,2 . c-.. fi f7
r
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 n
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
therabove mentioned prop�rty.for inspection;purpdses.
'/Signature (Owner/Agent),'/ L. : , /1 ✓ i ✓V Date
I
BUILDING PERMIT PERMIT#
DATE VALUATION LOT MJ -058 TRACT
$141.148.40 21 284158-1
JOB SITE
APN
ADDRESS
43..755 MWAN r''CiURT
601-070•-638
OWNER CONTRACTOR/DESIGNER/ENGINEER
ADVANCED DEVELOPMENT CORP T ADMONAL BUILDING CO INC
79-615 NAPLES DRWE 78615 NAPLES DR
LA QUlNrA CA 92253 LA QUIN'rA CA 92'53
060)772-0222 CBI,# 5750
USE OF PERMIT
SIM - LOT 25 PLAN SAR - PERNUT DO .5 NOT INMUDE tBI.00K WALL.
ort POOL.
TRAC"r CONSTRUCTION :,400.0( SF
PORCKiPATiO 160.(X) SF
GAR,AWCARPORT 349.X10 SF
'ESTIMATED COAST 010 CONSTRUCTION
141,248.40
PERMIT FEE SUMMARY
f.QNSTRUCTION M 101 -MO -118-000 ' S7Ali.SO
PL.AJN C'HKK M 101-000-439-318 E161.98
&WHANTGAL FE8 101.-000-421-000 W.00
F.I.EC'lit1CAL Fl t. 101-000.420-000 $141.48
I LUM)AFNG FEE 101-000-1119.000 $110.75
STROlYO MOVON FEE - RE SID 101-000-241-000 $14.12
GRADING FES 101-000423-000 $20.110
INFRASTRUCTURE 1 RI- 225 -WO -443-342 S3, 120.21.
AP,T IN PUBLIC PLAC13S - RIZIG 701.000-255-000 S1n3.12
S -'TOTAL CONS".rRUC"110N AND PLAN CHECK
$4,558.16
LE&S PRE -PAID Ff'ES
Saw
MAY 171999 TOTt% PERMIT FEE -S DUE NOW
S4,55S36
✓I 1 '1< ®'� LAQUI'NTA.
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
4 mf
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
Exhaust Fans
O.K. to Wrap /— 2 50—'&* t'&—
F.A.U.
Framing 7 Z_C/—t5a re&`
Compressor
Insulation -z>
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
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
117
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
OX 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. 10,
Smoke Detectors
Temp. Use of Power
Final .- —xa 717'
Utility Notice (Perm)
.APR -18-2000 09:48 WESTERN INSULATION 909 686 8786 P.13i13
WESTERN INSULATION, INC.
4211 Latham Street, Riverside, California 92501
Tel. (909) 686-8760 Fax (909) 686-8786
INSULATION CERTIFICATE
THIS 1S 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# 25
SITE ADDRESS: 43755 MILAN COURT
EXTERIOR WALLS
MANUFACTURER: Johns -Manville THICKNESS: 3 5/8" R -VALUE: R-13
CEILING5: BATTS BLOW
MANUFACTURER: Johns -Manville THICKNESS: 1 -VALUE: R-38
CEILINGS: BATTS BLOW
MANUFACTURER: Greenstone THICKNESS: 10.3" R -VALUE: R-38
----------------------------------------------------------------
GENERAL CONTRACTOR: TRADITIONAL BUILDING
LICENSE NUMBER: '
BY:
TITLE:
DATE:
INSULATION CONTRACTOR: WESTERN INSULATION, INC. a
LICENSE BER:481278 '
BY: O Li
TITLE: PR DUC ION MANAGER
DATE April , 2000
a
TOTAL P.13
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 25, Phase 5C
Date Required : ASAP
Requested by: Rita
Design Center
PURCHASE ORDER #
9026
May 12, 2000
PROJECT: Bella Vista Phase 5
Ship to: 43755 Milan Court
La Quinta, CA
Homeowner: Nelsen
Cost Code: 3186
Hours
Material / Work Required
Unit Price Total
Furnish the following upgraded window covering
Premier verticals throughout
$ 2,204.00
$ 2,204.00
Rio White
16) Verticals
6) Horizontals
Horizontals with Privacy
TOTAL
$2,204.00
special Gonclitionsllnstructions:
Roger Snellenberger Develop ent
TP
Cc: Des enter
AUNNUVVLCUUM IANU KC I UMN
Apex Interior Source
By:
Traditional Design Center
DATE CONTRACT NO.
ancho Mirage, CA 92270
(760) 674-1188 Fax (760) 674-1668 01/31/2000 C-BV25/5-2
John and Mary Anne Nelsen
52790 Herrera
(760) 564-:5007
PLAN /
|
310.00
8,541.00
3\O.08
8,54\.00
i
594.00 594.00
'1,398.00 / '!`398�0O
|
004.00 � 604.00
1,188.00 1 1,168.00
'232.00 ! '232.00
/
i
� �E B
|
x '
��'. DATE
'I HAVE READ AND UNDERSTOOD THE ATTACHED CONDMONAL Total $9.917.00
SALE AGREEMENT.
PROJECT
LOT/PHASEBELLA
VISTA
25/5j
AREA
DESCRIPTION
Garage`
Insulated Door
| --*-
'
Kitchen
iBi'LovvSink /l02\
C�
`
lUoougkout
.[uhinat�Nu1uru ()uk#UOO
/|Baths, Luun
Standard Cultured Marble #200
Kitchen
'Codun-CameoWhite w/StdEdge
Kitchen
��9onninnu|uExtension
|
�
Per Diagram
Tl|o'B-[ iaruA|uxond 17x\7
G )K4ohePoud
Grout -( H)
�.
.Per Dia�rum
.' --' iov/ DesedDune#04777
Upgraded Pad -1/2" 61b
�
Credit Standard F|oodne,
:Tiled
Grout Sea]
1
.Vuhous
Standard Vertical Pkg'8n000thOff White
�
x
'
Standard VYindon/Cov�rn�s
PLAN /
|
310.00
8,541.00
3\O.08
8,54\.00
i
594.00 594.00
'1,398.00 / '!`398�0O
|
004.00 � 604.00
1,188.00 1 1,168.00
'232.00 ! '232.00
/
i
� �E B
|
x '
��'. DATE
'I HAVE READ AND UNDERSTOOD THE ATTACHED CONDMONAL Total $9.917.00
SALE AGREEMENT.