9912-062 (SFD)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
7N946:3 ci GIM20;
Date �� 1Signature'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
r
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.
�Q 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.
.J n CF..[F� E tJl�l.i ;: A...4.�1.r» • U
(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,l should become
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisin !
Date: E L Applicant
Warning: Failure to secure Workers' Compensation coverage Is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, In
addition to the cost of compensation, damages as provided for In Section 3706
of the Labor Code, Interest and attorney's fees,
IMPORTANT Application Is hereby made.do the Director of Building and Safety
for a permit subject to the conditions and restrictions 'set forth on his
application.
1. Each person upon whose beha)f this application Is made & each person at
whose request and for whose benefit work Is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, Indemnify
6hold`harmless the City of La Culnta, Its officers, agents and employees.
2. Any permit issued as a result of this application becomss null and void if
work is not commenced within 180 days from date of .3suance of such
permit, or cessation of work for 180 days will subject perrhit to cancellation.
I certify that I have read this application and state that the above, information is
correct. I agree to comply With all City, and State laws relating to the building
construction, and hereby authorize 'representatives of this City to enter upon
the above-mentioned property four, iin_ IQ'' 0 - nspection-purposes. �
Signature (Owner/Agent) �1 `,-- FtDate �a ILi 99 j 1
BUILDING PERMIT PERMIT#
DATE VALUATION SJ.J9,Z.531;0 LOT 1 TRACT 29458-3
r. IS r
�o. t •y '
JOB SITE
ADDRESS M-S.KPii+AMES D.I ITO E
OWNER
CONTRACTOR / DESIGNER / ENGINEER
�P1\/A'�i'f•'1'r'j�T�Y; jad t:r P1{79,tVtg9` r,ns)'ti
x :a_. ♦ e. e...c ..i L. �.. r•,,... L*J....b J. �„xwa x
�^e
":�twAD.,aA Lif A}A' Bf rll 7'iTA,�'Y" CQ' PRTC
J a . L raJ..J,,J.. tii a Slv
f.,A QUINT'A CA SY2253
.1,A QWN'lA CA 92253
i7fi0'i71?-A?.22 CRT,#i 5750
USE OF PERMIT
a�itJ.lr.l-: r.l�.tt'3IL4 j4V�i.,L1�1a
s fJ,i°T.�t�t 3A,t.0"Y!a1.l�rsitlbli'I LOOS NOT IN0LUDE i3WCK WALLS OR
P0(X.VLAN C'H€i_X 1,148 tk.'.L�t-UU'ETJ BY '/$:; .FUR IMUL11pu; lu.` UANUE O
SAME PLA4.
0z.00 sr
PORCI-PPATX) 52.11A SF
0A1tA.(JWC;Al2PCiitT 439.00 3F
as a►r r?tie," )��0� r��sac.•{rp�rf.�9aIF
i:n '.\B f..i R.X..4'" A9.T. y' W.IN1106i'-
-P.vlIN'Ii A MR, SUMMARY
418-000
FU101-OW418-000
pt"A .l mTRICK Tmp 1(}1fd tr .9R
EUX111 U.Ciu. i1m .t31-llOU- iZ(HOiIiT $i $. t(i
P-11LFI\1111NOI Ei. 10!-01)(I-419-000 $140.'75
5TROW, t Mf)TIaN F0 - R_I:CiT) 101400-1.41-(M $f , q!
C- iO114C PE rt31-Ot10 r23 fid30 &2fl.t1i)
"I kRASTTiUi;i'iTR[ 171,E 225-000-443-342 �r1,S�a77.ti+)
AXT f PUBLIC PLACES -RESIr 701 -WO -255-000 548.94
Cf 7W!'C1"I :A f,1;01VC'i'R{;i(Mi:)N f -MO PLAtV C!f l .C,k
4,a�I (;i wi
Lt.�l• h.Li Yw-Y .(i�>� 1. ,/d 4e1
•1J.J.(!\1
' 'U'VAL PERMI'! F.I+ UN 9?9.3ENO
$3,1$�,'3S
' l'4ir�j
RECEIPT
�'^•�, +,..� �t
DATE , \ C��
\ \ \
BY � � � -��
=,: "^ � ill..
DATE FINALED
INSPECTOR
V
(,.,' \'°"\
-%
rn
N
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
'—/
Ducts
Slab Grade
=���prb
Return Air
Steel
Combustion Air
Roof Deck
— 30 —ozrib—Exhaust
Fans
O.K to Wrap
—off
F.A.U.
Framing
_
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
110,
Drywall - Int. Lath
Final
3�
Final
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
I C7Plumbing
Heater Final
Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer LateralPool
Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test�—
Appliances
Final
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)
COMMENTS:
:fUN-23-2000 i1:31 WESTERfd INSULP,TIUN. 909 68E)' 878Ei P. 05/25
• r
-
"iIVE vm INE541C11"ATION, INTC.
4211 Iatham Stmt, Mveralde, Ca*n3ia 92501
Tet, (909) 686-8760 Fac (%M) 586.8786
MIULATIO:N CE;Ii:TIFICATE
THIS IS TO CERTIFY THAT, INSULATION HA:i BEEN INSTALLED IN,CONFORMANCE WITH
THE: CURRENT ENERGY REGULATION, CALIFORNIA ADMINISTRATIVE CODE:, TITLE 24,
STATE OF CALIF-.ORNIA, IN THE BUILDING LOCATED AT.
TRACT / PHASE:BELLA VISTA TRACT 28458-3
LOT# ..4
SITE ADDRESS: 79536 WiPLES D,RI\'E.
..--- -.........----------------------------
EXTE ORIAFAL
MANUFACTUREIR; Johns-llManvil/e TFI;ICIvt7ESS: 3 5/8" R -VALUE:: R-13
CEILINGS: BATTS '° BLOW ;.
MA14UFACTUREII: John - vi//e THICKNESIS: '13"VALUE: R••38
CEIIBGS: •BATTS ��BLQVN
MANUFACTURER: Greensrone TRIC KIV iE:R-38,
SEIDIERAL QDNTIRA -TOR: TRADITIONAL BUILDING - - - - -
LICENSE NUMBER:
BY:
TITLE: v.;.•
DATE:
INSULATIOR MNTRACTOR: WESTERN INSULATION, INC:'
LICENSE NUMBER: 481278 ,
BY: Peq" r
TITLd:.: PROD TION MANA09A
DATE JUNE 23,2000
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
Bermuda Dunes, CA 92201
Fax: 360-3167
Attention: Denise
Lot & Phase: Lot 4, Phase 7
Date Required: ASAP
Requested by: Rita
Desiqn Center
PURCHASE ORDER #
9040
June 22, 2000
PROJECT: Bella Vista Phase 5
Ship to: 78536 Naples Drive
La Quinta, CA
Homeowner: Duncan
Cost Code: 3186
Hours
Material / Work Required
Unit Price Total
Furnish the following upgraded window covering
Premier verticals throughout
$ 1,954.00
$ 1,954.00
Fresno White
15) Verticals
4) Horizontals
Horizontals with Privacy
TOTAL
$1,954.00
speciai 1�onaizionsnnszruczions:
Roger Snellenberger Development
U�
Cc: Design enter
A(:KNUWLtUU1= ANU Kt I URN
Apex Interior Source
By: