SFD (9910-054)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter,9 (commencing with Section 7000) of Division 3 o the Business and
.-Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
DateI (SignatureofContractor
OWNER-BUILDER DECLARATION " r
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:
Cartier Policy No.
(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 shallifortwith comply with those provisions. ,
Date: 17 a6 -Applicant— (_^ s.," �' i :,u 4
Warning: railurf 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 uthorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) Date
BUILDING PERMIT PERMIT J/
DATE IlA�(!1� &�NW�I/Iy VALUATION ��rr.} yyff�, �,,���qq�� �{{®� LOT TRACT
�b'171Gp•U`fiJ,r"J'�I ��
JOB SITE
ADDRESS i
APN
OWNER
CONTRACTOR / DESIGNER / ENGINEER
A VANICED DEVIEf.,OpMjMNrf C (-')KP
TKADMONAL SU;LDTNG :'0 INC
7860 NAPLES DRIVE
77861NAPLt;S DR
4As;UIN'4•A CA. 92253
1.,AQUINT,A, CA 92233
(760)77M222 CBL# 5750
USE OF PERMIT
3FD- I,OTI"I, MAN JA:- 1W_ftM11'L00fi8 NOT timii: UM W OCK 'WALL OR
.P(-i)f,.7S% tfC.~rk0Jr ON PLAN t J� FIX FOR 114U}.'['tt L& 1331.1ANCX
(AT SAME KAN 'nTf
AC i C;�3rS 1"RU�" i �r Z400.00 SF
k.C1E(t'.A.'fT6.3 }GtJ.Oii :aF
CIARAQWcAnx.1KP 449.(19) V
6a%:RMFU FEE SUMMARY
00148MOC?'3OAt PIZ 101-O Y3-41 i4• -M $786.30
VT.,At4 c FWA VFF fffj-{Nit 1.4.' _OTR 1 irtl,9rc
i U- ItA •ttC~A7., F,ts" 101-M42I.-(iUt! 3W.00
6W(7RIC:A Tt1 14;x-C1t -4.24-QOf6 $f4a..+lA
NI.l 3£l�i9 F if}➢ !?Ua �llg-f?t!(e $148.73
511ZON(i WITION PTI .. R9j' ID tlt( X000 -2414-M $1417
:;,}i11D"'NIG �� 101.000-4 t= S.ZQ.00
C.t4,sVELt t O)PAE'T.FEE $1,907.00
�;�.�• f.tV t•�u��.ir. �+1,Ax.�.�i _ .��r;: 'IU#-13(fCE-2S�-Olds ��r�s. is
Si.i1z T•t:tiTAL COMSIRMION AND PLAN CIt1'CX
�3,��1 q't
LESS PRE -DASD IMES
$0.00
TOI AI, Mi: Mff VE04 DUE NOW
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
�� AL1 _ L
—� 1 �T
Underground Ducts
Forms & Footings
Ducts
Slab Grade
_ -.2 �%--
Return Air
Steel
_
Combustion Air
Roof Deck
_
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
.ana 6'
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
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
/0- Z _ 9 g
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
� f�C�GO`�
Pool Cover
Sewer Connection
C/ `
Encapsulation
Gas Piping
Gas Test
Appliances
_a8
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
Utility Notice (Perm)
MAY -18-2(300 11:53 WESTERN INSULATICIN 90'3 GBE) 87•^x6. P.06/13
1
TE IN"SUL,Ac�IdJ 9I
4211 Latham Street, Rilrera:id+:, Giliftornia 92501
Tel, (909) 686-8760 Fac j909" 686-8786
ENSU A TION c.0"t rIFICATE
THIS IS TO CERTIFY THAT INSULATION "IAS BEEN INSTALLED IN CONFORMANCE WITH
THE CURRENT ENERGY REGULATION, CALIFORNIA ADMINISTRATIVE CODE, TITLE 24,
STATE OF CAUP)RNIA, IN THE BUILDING L,O ::A,rEl) AT:
TRACT / PHASE: BELLA VISTA - TRACT # 28458-1
LOT# 17
SITE ADDRESS: 43880 MILAN COLIRT LA OUINTA, CA. -
r
------
EXTERIOR WALL 1:
MANUFACTURER: Johns -Manville TKICKNESS: 3 5/8" R -VALUE: R-13 .
CEILINGS: BAITS I LOW
MANUFACTURER: Greenslone THICKNESS: 10.3" R -VALUE: R-38
CEILINGS: ATTS BLOW
MANUFACTURER: Johns-Monvilie THICKNESS: 13" R -VALUE: R-38
GENEBALQ1 NTTRACT®R: TRS>bl'TIONAL BUILDERS
LICENSE NUMBER:
BY:
TITLE:
DATE:
INSULA TiorI C®NITRACTCR: WESTERN INSULATION, INC.
LICENSE NUMBER: 481278
BY:
TITLE: PR00 c ION MANA ER
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
PURCHASE ORDER #
9034
May 19, 2000
PROJECT: Bella Vista Phase 5
Attention: Denise
Lot & Phase: Lot 17, Phase 5D Ship to: 43880 Milan Court
Date Required : ASAP La Quinta, CA
Homeowner: Lardenoit
Requested by: Rita
r)ecinn CPntPr Cost Code: 3186
Hours
Material / Work Required
Unit Price Total
Furnish the following upgraded window covering
4
Premier verticals throughout
$ 2,173.00
$ 2,173.00
Rio White
18) Verticals
4) Horizontals
Horizontals with Privacy
TOTAL
$2,173.00
Special Conditions/instructions: AL KNUVVLtUhC ANU KC I UKN
Roger Sne enberg velopment Apex Interior Source
By: By:
Cc: Design Center
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