9912-063 (SFD)LICENSED CONTRACTOR DECLARATION
-i hereby affirm under penalty of perjury that I "am licensed under provisions of
H►� Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
N wProfessionals Code, and my License is in full force and effect.
p =) a License # Lic. Class Exp. Date
ti C3 L,L 759465 B 02/28/201
LU
oZ Date Signature of Contractor
co 0
J U 0 OWNER -BUILDER DECLARATION
HLU r- I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
Z( ) 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).
co () I am exempt under Section , B&P.C. for this reason
LO
n! I 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-inpure 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. k
(NY I have and will maintain workers' compensation insurance, as required by
Sebfiibn 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:
Carver Policy No.
{ r
(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 provisis
Date: �--� � • f Applicant � '
Warning: allure to secure Workers' Compensation overage 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.
A.
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) �✓ DateA4
BUILDING PERMIT PERMIT"32411163
DATE J 1 VALUATION +S13&1�� LOT r S TRACT 28458-3
i.l ir� �Q
JOB SITE
ADDRESS) 7WM NAPLES DRINT
APN ""7"38
OWNER
CONTRACTOR/DESIGNER/ENGINEER
ADVANCED DBTWPMENT CORP
TRADmoNA.L BUILDING CO INC
78-615 NAPLES DRIVE
78015 NAPLES DR
LA QKJ1N'1'A CA 922ti3
LA WtNTA CA 92253
(760)7n-0222 CRI.# 5750
}
USE OF PERMIT
S1NULE NAIVIILY DWELL NO
,
Z D-PLAX 4BRJ.6T45.PtRX"T DGES NO f DiCLUADE RLk. CK WALLS OR
kkj0L.PLAN'0*%'C'K FHE K LXX:ED HY 7'Yq'e FOR MULTWLE I SSUANCAId CW
!GAME PLAN TYPE
o
TRA(.'T ('0143 i c`�U� ► ION " 2w.ix) SI'
&31110 bl',11•lo 1000 0 Sii;
(IAKAUW('AKP(Jif T 471.UU 8F
1'.J 1M, ,%TZD CWT QF CONSTRUMON
P!!:lkI41ff H* S;1f1i MARA
t'tiNSTRUt'rI0N FEE 101-000 4114 -OW ` $7411.00
P1 AN( Wt'K FFV 1014XXN _414_11R J1540)
11, i(?I 001? 4,1111 OW S6A.11()
F LNA`1'K1t AL h NE 101-100-420-000 SO4.92
NLUMNINU FEE 101-00 -419-0W 1140.75
viviowi MoTft•)N RFV. Rtrgil) 16140 -7414(81 343 of
' PR ADING F71' 101 -OW -1234)00 $20.00
U6VELUPER 1MPAC"1' FEL& S1,901.W
ART IN PUBL.W. PLACES - KESiL 101 -(X10 -25,54X)0 575.39
G RA -7 TI'A1, CONS"K-nON ANn PLAN CHFCK
13,253.77
LESS PRE -PAID FEES
$0.00
TOTAL PERMIT EEKS DUE NOW
&1,,253.77
s
RECEIPT
DATE
BY \
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
—
Ducts
Slab Grade
�� —�'d
Return Air
Steel
Combustion Air
Roof Deck
—
Exhaust Fans
O.K. to Wrap
��—r�c�
F.A.U.
Framing
,,6ro
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
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
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 6 ��
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)
:fUN-23-2000 11 31 WESTERN INSULATION 909 E-96 5706 ' P.06/25
ES,P,rE-N iN;�1[r'�,,kTiON, INCe
4211 i.ptttam Street, Rimilde, California 92501
9'e4. (909) 686.87110 Fax (9()g) 686-8786
INSULATION C.o"E ;TIFICATE
THIS IS TO CERTIFY THAT INSULATION FiAli BEEN INSTALLED IN CONFORMANCE WITH
THE CURRENT ENERGY REGULATION, C-ALIFflRNL4 ADMINISTRATIVE CODE, TITLE 24,
STATE OF CALIFORNIA, IN THE BUILDING LOCATi.D AT:
TRACT / PHASE: BELLA VISTA TRI1C'f # 28458-3
L079 5
SITE ADDRESS: 78548 NAPLES DRIVE.
--------------------------------- ----------------------
EXTEFitOR1MALI.6•
MANUFACTURER: Johns -Manville THICKNE5�S: 3 5/8" R -VALUE: R-13
CEILINGS: / BATTS BLOW
MANUFACTURER: Johns- nvi7le THICKNE83S:LUE: R-38
f�
CEILINGS: BATTS f BLOW
MANUFACTURE' . Gveenstone THICKNE! S -3"VALUE: R-38
¢i.E_ANERAL CONTRACTOR: TRADITIONAL. BUILDING
LICENSE NUMBER:
BY:
TITLE:
DATE:
INISULATIP LCONTRACTQR; WESTERN INSULATION, INC.
LICENSE NUMBER: 481278
BY:
TITLE: PRODU{'TPN MANAGER
DATE JUNE 2:1,2000
r�.
ROGER SNELLENBERGER DEVELOPMENT
78615 NAPLES DRIVE
LA QUINTA, CA 92253
(760) 772-0222
(760) 772-0257 FAX
TO:
Apex Interior Source
Unit Price Total
79-553 Country Club Drive
Furnish the following upgraded window covering
Bermuda Dunes, CA 92201
Fax:
360-3167
Attention:
Denise
Lot & Phase:
Lot 5, Phase 7
Date Required :
ASAP
Requested by:
Rita
Desian Center
PURCHASE ORDER #
9044
June 30, 2000
PROJECT: Bella Vista Phase 7
Ship to: 78548 Naples Drive
La Quinta, CA
Homeowner: Konecny
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
13) Verticals
2) Horizontals
Horizontals with Privacy
TOTAL
$1,465.00
Special Conditions/Instructions:
Roger Sn Ilenberge evelopment
By:
Cc: Design Center
AUNNUVVLCUl7t ANU KC I UMN
Apex Interior Source
By: