SFD (9910-052)j
LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that.1 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 # Lic. Class Exp. Date
,,O to Signature of Contractors ? t + "'Y''�%{�
" r
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 not, be completed if the permit valuation is for $1.00.00 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
workerss''' Compensation laws of California, and agree that if I should become
SUN c to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those;, provision s.
,date g9 ,o 0 t Applicant /r� rA• 1
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.
Zignature (Owner/Agent) r`a�� il-2 r is .-01Date
A
BUILDING PERMIT PERMIT#
DATE VALUATIONLOTm TRACT
loo.
JOB SITE
ADDRESS
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OWNER
CONTRACTOR/ DESIGNER ENGINEER
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78615 NA L S DRIVE,
lu15 NARIES I3:R
LA t )UIN't'A (.!A 92153i
LA("WA A CA 92253
(760V774)272 CBI.4. 57so
USE OF PERMIT
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IMPACT F15J-
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LESS €'RL -PAID FEES
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TOTAL Pll#,RMff IT,"- DUE NOW
S3.63l,"
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
±' OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings
Underground Ducts
Ducts
Slab Grade
_
I — % 6'
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
��S �j' _
Compressor
Insulation
pd
Vents
Fireplace P.L.
Grills
Fireplace T.Q.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final —
BLOCKWALL APPROVALS
Final
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
i
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans -
O.K for Finish Plaster
Sewer Lateral
Sewer Connection
e7 z
6-
Pool Cover
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 _ Gp
Utility Notice (Perm)
COMMENTS:
\ IAY-18-2000 11:52 W'cSTEPN I NSULAT I C04 909 666 6786 P. 04/13'
wt
INSULAILION, in �
4211 Latham Streot, Riv¢reitie, culOwmi&\92301
TeL (909) 686-0760. Fax (5109) 686-8786
THIS IS TO CERTLF-Y THAT INSULATION HAS BEEN INSTALLED IN CONFORMANCE WITH
THE CURRENT ENERGY REGULATION, CALIFORNIA .ADMINISTRATIVE CODE, TITLE 24,
STATE OF CALIFORNIA, IN THE BUILDING LOC:ATEC AT:
TRACT / PHASE: BELLA VISTA -- 'TRI1C•f # 28458-1
LOT# 15
SITE ADDRESS: 43820 MIL,kN COURT LA QUINTA, CA.
EXTERIOR WALLS
MANUFACTURER: Johns-ManvilleTHICKNI:SS: 3 518" R -VALUE: R-13
CEILINGS: BATTS �� BLdbN
,
MANUFACTURER: Greenstone THICKAESS: 10:3" fR-VALUE: R-38
CEILINGS: SATT6 BLOW !
MANUFACTURER: Johns -Manville THICKNESS: 13" R-VALUIE: R-38
GE14ERAL Cs)NTRACTOR: TRF,DCi ONAL BUILDERS
LICENSE NUMBER:
BY:
TITLE: '
DATE:
IMU LATI N CONTRACTOR: WIESTERN INSULATION, INC.
LICENSE NUMBER: 461278
8Y. t ,
TITLE: PRODU( I N MANAGER
DATE May 18, 2.000
}
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 15, Phase 5D
Date Required: ASAP
Requested by: Rita
Design Center
PURCHASE ORDER #
9 a1 0-1\ �
May 19, 2000
PROJECT: Bella Vista Phase 5
Ship to: 43820 Milan Court
La Quinta, CA
Homeowner: Thoman
Cost Code: 3186
Hours
Material / Work Required
Unit Price Total
Furnish the following upgraded window covering
Premier verticals throughout
$ 1,664.00
$ 1,664.00
Rio White
13) Verticals
4) Horizontals
Horizontals with Privacy
TOTAL
$1,664.00
5peciai conditionsnnstructions:
Ror e len a Development
By: �')~
Cc: Design Center
AGKNUWLEDGE AND RETURN
Apex Interior Source
By:
ti