SFD (9910-050)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Che,pter 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
755�%J�j t3 f11i?Sl;�41
Vate 1 , q Signature of Contractor
1:
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&RC. 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.
STtiTU1' {`iy1i) W26355.98
(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.
Date: to Applicant
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 /,• ` _ &4," _ Date / `'i
0
BUILDING PERMIT PERMIT#
DATE livem"VALUATION $141,248.40 LOT _ TRACT 280%4
JOB SITE
ADDRESS
APN
OWNER
CONTRACTOR / DESIGNER / ENGINEER
MA11MONAL s:01 UNG CO INC'
18615 NAPLES DRIVE
7Fiti f S iNJP1,ES DR
LA €2i.1IN TA LA, 92..233
25
-A (-,A.. 023
(L,ryi/yQUji�t�t
(`I
)222 750
USE OF PERMIT
SI Nt i L F MiL Y DWELLING
SYD- 1.t:f i3. PLAN SL-1?'t:AY01T•S WT KNCLUDE T3f,tis+(X VtiA1..L OR
TRACE C0145"RUCTION 2,4iXVk1 SF
1'«f(00"ATIO 160.0 S!'
(,.iA1(,it%eC'APW0. l' 449.(* .''iF
141,243.40
C_0N,%NTRU(1V'1 JN FEE 101-OUO-418-M) :1786.50
iyf -A t4 t "FjP/" %moi 101.4X O-131- S t ft $64791
MC1 ANICA1, FIX 1.01 -OM 421,1••M 160.0
I,L1rt;'Tk.1i fi1.1<tsia 101-000-420-M S141.48
PL,UA&311\tt3 ??is 9140.75
1t'rr3rara�fcy3r11�f"'Ft: _ �R�ttI1 Sfta-1)tX�-'3•t+E� $14 12
ORADIN, G FCri 101 000-423-0€10 $X00
OfiVS.0111ii21;4i t1,s i' T3: xl;llt?7.0t3
ART IN PUBLIC PLAC 1.;S - RE= 701-(i(N -255-10W 5103.1:1
SI_!R-'1MA1,ONb"i.'lYilt7n0N AND P1,A•N rlIE(K
711,V0.88
Lf SS PIKE? -PAID €'1w#.S
S0.00.
T C'f.M., PERltMIT FELS DUE NOW
S3,$iBfl,#i�
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
oe
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
- --per ���--
Exhaust Fans
O.K to Wrap
_ _O� �-
F.A.U.
Framing
Compressor
Insulation
-,r-�—
3 -,e 2
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
I
Gas Piping
PLUMBING APPROVALS'
Gas Test
Electric Final
Waste Lines
�b-�2%- 6
Neater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
OX for Finish Plaster
Sewer Lateral
Sewer Connection
-2 "74 �
(�
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Y
1
Final 21 •-®'j)
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
Utility Notice (Perm)
°iAY-18-2000 1151 WESTERN INSULATICIN 909 686 8736 P. 02/13
INSULALTHON, 111,
4211 Latham Str=t, PA ereidc . CE!rcrnia 99501
Tel. (909) 686-8760 Far C?09) 686.87815INSULATION ,
,A9TIN
epa
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 LOI`AI*E[) AT:
TRA(:T I PHASE: BELLA VIS`rA - TRACT # 28458.1
LOTH 13
SITE ADDRESS: 43764 MILAN COURT LA CIUINTA, CA.
EXTE.RIOR' WALL!',:
p
MANUFACTURER: Johns -Manville THICK VI:SE.: 3 5/8" R -VALUE: R-13
CEILINGS: BATTS /� BLOW.
MANUFACTURER: Greenstone THICKNESS: 10.3" R -VALUE: R-38
CEILINGS; BATTS BLOW
MANUFACTURER: Johns -Manville THICKNESS: 13" R -VALUE- R-38
GENERA t)NTRACTOR: TRf' OrrioN,AL BUILDERS
LICE14SE NUMBER:
BY:
TITLE:
. _ I
DATE: A
INSULATIO I CONTRACTOR: WFE;TERN INSULATION, INC.
LICENSE NUMBER: 481278 ,
TITLE: PRODU VON MANA R
DATE May 18, 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 13, Phase 5D
Date Required :
ASAP
Requested by:
Rita
PURCHASE ORDER #
9029
May 18, 2000
PROJECT: Bella Vista Phase 5
Ship to: 43760 Milan Court
La Quinta, CA
Homeowner: Martin
r:nct (nde- 3186
Hours
vcaiyii vc.w.
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
41
$2,204.00
nwuinnn
Cnr--C Akin
RGTI IRM
Special conaltionsnnstrucuons:
Roger Snellenberger Development
By. v
Cc: Desi enter
Apex Interior Source
By: