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LICENSED CONTRACTOR. DECLARATION."-
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I hereby am under penalty of perjury that I, am licensed under provisions of
Cfspier 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
Date ` Signature of Contractor��`�
OWNER. -BUILDER DECLARATION
I hereby affirm under.penalty of perjury that I am exempt from the Contractor's
License Law for'the following reason:
( ) 1, 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):, .
O I am exempt under Section B&P.C. for this reason
Date Signature of -Owner' '
WORKER'S COMPENSATION '' DECLARATION
I hereby ,affirm:under perialtyoof. perjuryone* 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, f0r.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:
Camer-Policy No.
STATE, -DUNO
(This section need not be completed, if, the permit valuation is for $100.00 or less).
( ) d certify'that in the performance of the'work for.which.this permit'is'issued;
I shall not employ any person in any manner soIas, ;to become subject to tlie
workers' compensation Maws of California, and agree that if l should become
subject to the workers' oompensatlon provisions of'Section 3700 of the Labor
Code,1 sh II o: hwdh comply with those provtsions:;
Date: t << �p Applicant PFl� rl i`ltiptt/
+ e ,
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal'penalties'and civil fines'u'p,to $1'00,000; in
addition to the !cost of co'mpen'sation, damages as provided for in'Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT, Application is hereby made to the.'Direct0r of Building and Safety
for a •permit subject to -the conditions and: restrictions set; forth on his
application:
1. Each person upon whose behalf this application is made & "each person at
whose request and.for whose benef'it,work.is'performed under orpursuant•to
.any permit issued as a result of,this applicaton agrees to,.&, shall; -indemnify
& hold harmless the City of 'La, Quirnta, its officers; agents and employees.
2: Any permit issued as a.result of thisapplication becomes null and void if
work is not commenced.within-180 days from date -of- issuance • of, such
permit, or cessation of work for 180 days will subject permit to' cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
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the above-mentioned propertyfor in)spection'purpJo�ses. f
d.i��.f+ N rte' 1 V�' i f Date 2 `� 9
Signature (Owner/Agent)
BUILDING PERMIT
PERMIT #_
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DATE i9m7 ,"VALUATION LOT
TRACT
JOB SITE
ADDRESS 4"� �HLAN ��
N,%
60.9-070-038
OWNER
CONTRACTOR/DESIGNER/ENGINEER
ADVANCED �r v��.t��9�� ��.���,s�:
•rMDrfIOraAL BIJ.:.116, tr f o me
861$ NAPLES DRJV� E
i8615Iar11 LES OR
LA.(Jf (JUNTA, CA 922-53
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USE OF PERMIT
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ART VV PUBLIC PLACTS -?t1 SIC 701-f}i!{� a5't-000
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RECEIPT DATE BY DATE FINALED INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
li j,7
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Steel
� I=CL 6'
Return Air
Combustion Air
Roof Deck
.-3—da
Exhaust Fans
0. K. to Wrap
F.A.U.
Framing
r %— Gg D
Compressor
Insulation
_ Bea
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
�� — 6'-
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 Linesp-2-7
_g
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Sewer ConnectionZVI-
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final J " ' .0
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 �Q
Utility Notice (Perm)
i1AY-18-2000 1152 hIESTERN INSULATICIN ` 909 G96 8796 P.05!13
WESTERN INSIFLALTION, INC
4211 Latham Strad, Riverside:, CAU forma 91.501
Tel. (909) 686-8760 Fac (909;1 6E6.8786
INSULATIOV c.ERTIFICATE
THIS IS TO CERTIFY THAT INSULATION HAS) BEEN INSTALLED IN CONFORMANCE WITH
THE iZURRENT ENERGY REGULATION, CALIFORNIA ADMINISTRATIVE CODE, TITLE: 24,
STATE OF CALIFORNIA, IN THE BUILDING LIQ X'El) AT:
TRACT / PHASE: BELLA VISTA - TFLkCT # 28458-1
LOTH! 16
SITE ADDRESS:43850 MILAN COURT LA QUINTA, CA.
RIOR WALLA_ ..... . . . .. . . .... . ..
8XTE.
MANUFACTURER: Johns -Manville THICKNESS: 3 E5/8" R -VALUE: R-13
CEILINGS: BATTS 8LO "
MANUFACTURER; Greenstone THICK.NES.3: 10.3" R -VALUE; R-38
TTS SLOW
I
MANUFACTURER: Johns -Manville THICKNESS, 13" R -VALUE:: R-38
- -
(GEDIERAL )NTRACTOR: TRADITIONAL BUILDERS - - - - - - - - - - - - - - - -
LICENSE NUMBER:
BY:
TITLE::
DATE::
INSULATION CONTRACTOR: WES'rEFIN INSULATION, INC:
LICENSE NUMBER;; 481278
BY:
TITLE:: PRODU 71 N MANAGER Ll
DATE: May 18, 2000 _
a
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
Fax: 360-3167
Attention: Denise
Lot & Phase: Lot 16, Phase 5D
Date Required : ASAP
Requested by: Rita
n. (—+ r
PURCHASE ORDER #
90372
May 19, 2000
PROJECT: Bella Vista Phase 5
Ship to: 43850 Milan Court
La Quinta, CA
Homeowner: Lansdorp
Cost Code: 3186
Hours
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
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MCT1 Ir3AI
special Gonamonsnnsirucuons:
Roger Sn Ile tevelopment
By:
Cc: Design Center
Apex Interior Source
By: