SFD (9910-055)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
Professic„pals Code, and my License is in full force and effect.
License # LIC. Class Exp. Date
Date ^t' Signature of Contractor A;"If
OWNER -BUILDER DECLARATION
1 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).
( ) 1, 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.
sr"ME
7ri
(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 h 11 o, with comply wit thoselProvisions./I
Date: Applicant
Warning: Failure to secure Workers' Compensation coverage ge 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)./,�0 '•S aAokDate
BUILDING PERMIT PERMITk
DATE mm VALUATION vitms LOT TRACT I
JOB SITE
ADDRESS
APN�
OWNER
CONTRACTOR / DESIGNERENGINEER
/ �{ } { j y�j
+1iA a/[ hi4A•lj 6� k LiLe�/ 4Y 7;11rkT1 �y\.1j\Si
p/
/^ ( / � p�(♦
r� IU AA.�F'5 1.�14V3 1. I:vY1I 1.n J*. �tA CO INC
W-15 NA LFS DRI V C
7861 5 NAPLES .UR
LAOMNIA (:A 92253
LA t; UM..A CA 92253
11 1750
USE OF PERMIT
SJ3'l014,; F.ANDLY Wt%1d.1Nt:!
53.1.1- WT 18, PLAN VJR- >2 E RMI i i ».:,iS NOT INCLUM rA4) K WALL OR
lsf."L.754?olikML1C 1100 ON PLAN tuVWX I -W,: F(A1 , MIXT3.P#.,t4 ISSUAHLf.
a: SAME JPLAN'ITPR
TRACTr��.)NSTRUCTI N Z(r.5.00 5
P%_1R(.T4tt'AT10 $2.1X0 8F
crAIRAO&WRIW' Aff 4 9.w S!r
KN7A` 110 (_= Ir OF C'ON UC"1,10N
119,153.50
PERMff FEE SUMMARY
CIONS'iRUU11710N F 10a-�dx? d# f)liQ $7t?r3.:5t�
Pt. A 14 0Wr`K MF, SDR€>."
N1rNC`HA 1C'Al. lI 353.,3:0
fiLHs010C AJ, f` .-X $129.16
I'LiJt��i3t?�ic1 Ff t: 101-M-+419-000 $140.75
41.140WO gg+-�TJON T'! ltESW i f} r (>S�?.2d 1..{i() 1'1, .93
i"RAD3IdG Fr"€; tad OW42343M x�tr.arl
ART IN PUBLIC AILAC LS - RE -ill: 701•-Oi O-255-000 S48A3
4394Ef.( PEIC :ti4t1}AO-_7 F 1W $1.901110+
Ot t}3.AsII d. VftP R I TC110N AND PLAN CHECK
.3,16S 01,
{) LESS PRE -3-3 AID FEES
$0M
t T;WAL_ PVlt4kT r Tl4.1X NOW
&1,16.t'95
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 �_g �'
Return Air
Steel
Combustion Air
Roof Deck—tea
Exhaust Fans
0. K. to WrapZ y'_�
F.A.U.
Framing 2=&a lam}--
Compressor
Insulation – gyp. p p t6 e
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
r
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 _� f
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral n/
Sewer Connection �U �� `
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final �pO
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures .10 01
Main Service
Sub Panels
Exterior Receptacles
G. F.I. i
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
tlAY-18-2000 11:53 WESTERN INSULATICIN j 90g 686 8786 P.07i13.
urESTERN INSULATION, IN-00
4911 Latham Street,, Rh'ersidt., C ELIft nia 92501 `
Tel. (909) 686-8760 Fw: (909) 686-8786
' 1
INSULATION ('02MI"IFICATE
THIS IS TO CERTIFY THAT INSULATION IiA:> BEEN INSTALLED IN CONFORMANCE WITH I
THE CURRENT ENERGY REGULATION, C;kLIF:CRNIA ADMINISTRATIVE CODE, TITLE 24,
STATE OF CALIFORNIA, IN THE BUILDING LOCATED AT:
TRACT / PHASE: BELLA VISTA - TRACT # 28458.1
LOTh! 18
SITE ADDRESS: 43910 MILAN COURT' LA QUINTA, CA.
EX11al0fl WALL;y_
MANUFACTURER: Johns-Manville THICKNI:SE:: 3 5/6" R-VALUE: R-13
CEILINGS: BATTS / BLOW
MANUFACTURER: Greenstone THICKNESS: 10.3" R-VALUE: R-38
CLIMGS:
�ATS BLOW
MANUFACTURER: Johns-Manville THICKNESS: 13" R-VALUE: R-38
GEl' )NTRACT®R; TRADI-NONAL BUILDERS _
LICENSE NUMB~: ,
r
BY:
TITU:-:
DATIE:
LNSULATIO I CONTR CTOR: WESTEM INSULATION, INC. ,
LICENSE NUMBER: 481278
r '
4PRMON
�TITLE: MANA ER
DATE May 18, 2000
l
C
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 18, Phase 5D
Date Required :
ASAP
Premier verticals throughout
Requested by:
Rita
Desiqn Center
PURCHASE ORDER #
9033
May 19, 2000
PROJECT: Bella Vista Phase 5
Ship to: 43910 Milan Court
La Quinta, CA
Homeowner: Spratt
Cost Coder 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
special uonditionsltnstructions:
Ro er Lellenber e D elopment
By:
Cc: Design Center
AL:KNUWLtUU1= ANU Kt I UKN
Apex Interior Source
By:
May 26 00 1C.2Ga Traditional Design Center
......... ... . ... ...
760-674-16CEI
p.2
.Traditional Design
furehase Order
7 White Sian Way
KinchoMirel.Se1CA 92270
DATE
P.O- NO.
.(7130) 674 -1188 fax (760) 6 74.1668
0 5!25/20[='0
4545
La ffacidUnda Nursery
80-900 Miles Avenue
Indio, CA 92201
(7 60) 342-3427
Fax 34.2-0788
I j0T/ PHASE PLAN CUENTNAIVIF
C.O.E.
BELLA VIS'I'T.
05/25/2000
ARIA DE5CRI11111014 QTY
UN'rr RATE
AMOUNT
As per yo-.ir pvorcmal diated 4/17/CO
Front & back yard Landscaping Packagc
51950.00
.5,550.00
Crcdit W. Landscaping
-1 1[7.00
-1. 1 '810.00
MT : ACI I A COPY OFRES PURCHASE ORDERTC)""HE CORRUSPONVING IN17010E ANI)
S0,H) TO:
RO1.TR SNELLMMERGER DEV.
79-0315 NMI N )F- LA QUINITA, CA, 92253 A'17FN'1'10,N: PjgRRF;Tr1:j1!:mC
S1GNKfLJRL DATE
Total
Lj
$3,740.00