9912-058 (SFD)LICENSED CONTRACTOR DECLARATION
I h,Preby 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
7_59463 H 02i2& 1 20(
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:
( ) 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.
ZA I have and will maintain workers' compensation insurance, as required by
Sects n 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.
STA7Ti YUM 06Y355-93
(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 shall forthwith comply with those prov's'orh .
Date: I`1n Applicant
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 appllcaton agrees to, & shall, Indemnify
& hold harmless the City of La Quints, 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 i spection purposes.
Signature (Owner/Agent) Date t9 w`
BUILDING PERMIT PERMIT
"124111611111
DATE VALUATION S44I.24IL40 LOT 2 TRACT 28458-3
141901
+JOB
SITE � I.
ADDRESS 73-512 NAPLLS DRIVE
APN Q"7
OWNER
CONTRACTOR/DESIGNER/ENGINEER
A!I V ^ Nf'FM 91u1.T1.0P;:1D I' C'0KF
TP.ADMONAL BUILDING CO INC
,8-615 NAPLES DRIVE
778615 NAPLES DR
I.A QUINTA CA 92253
LA t,jt INTA CA 92253
(760)772-W22 CRL# 3730
USE OF PERMIT
SlNol.b FAN111.1 0WELUN6
4b O -PLAN 5B,L4.iTl12.1115RN11T DoOES NOT INCLUDE BLOCK WALLS OR
P(A)L
7t'ZiaCi' COINSMU( 1ION 2400.40 7
i°CA0*13ATIV 1W.W SF
0ARA1kJhA_ AKW.)KI' 449.tN) SF
LMIMATED COST OF C N1 3TRUCTION.
141.M.4
PLRMIT III SUMMARY
t't.)NS'rRUC"rION F"F''E 101-(9W-418-000 S790.S)
121 AN(TW('K T -T -F 1014l(KI-439-11R SM791
14ff"IANICAL ITT 101.000. i21 -0W W.00
IsLEk'TRICAL FEE 101-040-42()--000 $141.48
PLUMBIWi HiE 101 -M -414-0W S140.75
.'MONO W Y110W F"17 - R F.4I1) 101-(1f1()-) 41 -()f}() 314 i ?
GRADING =, 101-000 4413-000 $2U.00
DE:VUi Aq;R WA#..* IF&, 11,90.W
ART IN l?LBLIC PLA(°BS - RESIL 701-OW-253-{ifXi 110:3.12
SI IT44M Af , CONS-M(k:T10N ANI) PIAN CHFCK
$1,8V.88
LF.` S PRE PAID FEES
$0,00
'fMAI, PFIfiMIT IrIKIt..44 DUi NOW
S!.'SMM
I
RECEIPT
DATE
BYDATE
FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
6,
Underground Ducts
Forms & Footings
/
Ducts
Slab Grade
% .�
Return Air
Steel
_
Combustion Air
Roof Deck
30—&o
Exhaust Fans
O.K to Wrap
—
F.A.U.
Framing
_/p _ &C>
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
OF
Final
Final V4 f
BLOCKWALL APPROVALS
Steel
POOLS -SPAS
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
Water Piping
7
Heater Final
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final d -p
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 —vz7
Utility Notice (Perm)
COMMENTS:
SUN -23•-2000 11:29 WESTERq INSULATION 909 686 87e6 F.02/25
IVEsirERN INSULATION, ULATION, ur .
4211 Latham 8tr=t. Eivn:aidc, California 92501
Tel. (909) 686.8760 Far (909) 686.8786
INSULATION CM.RR.TIFICA'TE
THIS IS TO CERTIFY THAT INSULATION HAS BEEN INSTALLED IN CONFORMANCE WITH
THE CURRENT ENERGY REGULATION, CALIFORNIA ADMINISTRATIVE CODE;, TITLE 24,
STATE OF CALIFORNIA, IN THE: BUILDING �LOCATF:D AT:
TRACT / PHASE:. BELLA VI13TA TR/,C i # 28458.3
LOT# 1
SITE ADDRESS: 43950 MILAN COURT.
EXTERIORWALI.B----•-- •---- ---- ------
MANUFACTURER: Johns -Manville THICKNESS: 3 518" R -VALUE: R-13
CEILINGS: EIATTS BLOW
MA14UFACTUREII: Johns -Manville THICKNESS: 13"VALUE: R-38
CEILINGS: BATTS BLOW
MANUFACTUREII: Greenstone THICKNEISS: 10.3"VALUE: R-38
GENERAL CONTRACTOR: TROMITIONAL, BUILDING
LICENSE NUMBER:
BY:
TITLE:
DATE:
INSULATION CONTRACTOR: WESTERN INSULATION, INC.
LICENSE NUMBER: 481278
BY; L Oh" 1A A p
TITLE! PRODUS- ION ANAG
DATE JUNE 2:1,2000.
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
Attention: Denise
Lot & Phase: Lot 1, Phase 7
Date Required : ASAP
Requested by: Rita
Design Center
PURCHASE ORDER #
9041
June 30, 2000
PROJECT: Bella Vista Phase 7
Ship to: 43950 Milan Court
La Quinta, CA
Homeowner: McWilliams
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
Fresno White
11) Verticals
4) Horizontals
Horizontals with Privacy
TOTAL
$1,465.00
5pectat conations/Instructions:
Roger Sn Ilenberge evelopment
By: ` v- tM-
Cc: Design Center
AUKNUWLtUUt ANU Kt I UKN
Apex Interior Source
By: