SFD (9910-057)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 of the Business and
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
r 4$� B 02✓2812(u
Date r f f Signature of Contractor%'l' •J; : ✓c, i.+i�'c�( "tr,(/
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.
STATE SSD th 2 353 -
(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 sh 'II fo w'th comply withAhose provisions.
Date: % Applicant},.lt,
{
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 purp ses.
Signature (Owner/Agent) r !`'- ����•�tDate'U_!
PERMIT#
BUILDING PERMIT
DATE 1,711"VALUATION 51'1.54AS LOT TRACT- I
JOB SITEI'il
ADDRESS
APN
60-070.1038
OWNER
CONTRACTOR / DESIGNER / ENGINEER
ADVAT<ICM .lir VELOPMEW COW'S
`t R Ai Ci OVAL BIJU..t ING CO INC
'78615 NAPLES DRIVE
78615 NAPLM DR
LA QUINTA CA 92253
LA QUIN7'A CA 9225-1
(760)-M-0222 CPAA 5750
USE OF PERMIT
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OF SAM; .PL AN TYPE;
f3 FiL' S (�N Tl�.i lrr"T1C;iv 2, 200.00 SF
vA trl,+ F1t't1Ea xJ.�r,°i' 471.011) 3F
PERMIT M, ;,YMM ARY
C0NSTRU<;T10N Ff lO.Id £i-dYli-t)Of) 3748.00
PLAN i' WX'9 FTu? V 14.469
MMIM41C'AL €EM I.J!-t)c?4.9:I->3lii! $60.00
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ixwr R4 iveLic m,A.(' is - tills% 701-000-255-i7W 374.39
{ONAND PLAN CHI .rte
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LESS
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TOXA3, PERMIT VVMS WIF,, N(Y V
53,233.77
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings
t
Underground Ducts
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
—%f =tea
Exhaust Fans
F.A.U.
Compressor
_
O.K. to Wrap
Framing r� Z� era
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
q
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
Gas Test
Electric Final
Waste Lines
/,9 _ 2 7 -. 29
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K 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.
Smoke Detectors
Temp. Use of Power
Final G`rfj
Utility Notice (Perm)
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 20, Phase 5D
Date Required : ASAP
Requested by: Rita
r)esion Center
PURCHASE ORDER #
9035
May 19, 2000
PROJECT: Bella Vista Phase 5
Ship to: 43905 Milan Court
La Quinta, CA
Homeowner: Castle
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
11) Verticals
4) Horizontals
Horizontals with Privacy
TOTAL
$1,465.00
Special Conditions/Instructions:
R r nel en r r evelopment
Bv: �'
Cc: Design Center
Hl+ItfVVVVLCUl7C AIVU RC I URIV
Apex Interior Source
By: ~
'1AY-18-2000 11.54 WESTERN INSULATION �1 f 909 6-86 8736 F.09/13
4211 Latham Stmct, Rilrers.ido, 0woraia 92601
Tel. (909) 686-8760 FELc (909; 626.8786
IN pr CIERTIFICATE
THIS IS TO CERTIFY THAT INSULATION HAS BEEN INSTALLED IN CONFORMANCE WITH
THE -CURRENT E�IE:RGY REGULATION, C/kLIFORNIA ADMINISTRATIVE CODE, TITLE 24,
STATE OF CALIFORNIA, IN THE BUILDIN43 LOCATED AT:
TRACT / PHASE: BELLA VIS'('A - TRACT # 28488.1
LOT# 20
SITE ADDRESS: 43905 MILAN COLRT LA QUINTA, CA.
g2LTE6R10R WALL i.-
MANUFACTURES:
.MANUFACTURES: Johns -Manville THICKN ESE:: 3 5/8" R -VALUE: R-13
CEILING BATTS (( BLOW
MANUFACTUREF: Greensione THICKNESS; 10.3" IR -VALUE: R-38
CEILIINGS: BATTS BLOW \` -
MANUFACTURER: Johns -Manville TH ICKPIESS: 13" R -VALUE: R-38 �
GE14ERAL CONTRACTOR: TFUM1 f10NAL BUILDERS �
LICENSE NUMBER:
BY:
TITLE:,
DATE: ,
IMLI LATIO I CONTRACTOR: WESTERN INSULATIUN, INC.
LICENSE NUMBER: 481278
BY:
TITLE: PROD ;TION MAN ER
DATE . May 18, 2000
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