9808-048 (SFD)LICENSED CONTRACTOR DECLARATION
I herei y 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
4892341 13 12r t.1i9
Date R/��'� Si g nature of Contractor 1F ��� •�'� �,�`�rL
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. '
( .a' 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 FLTNrD 626'355-g'7
(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 provisions.
„D'ate: 911111001' ApplicantT� - , � .'f �� . g J
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 purposes. %
/Signature (Owner/Agent)/ Y - f� OA�^tiDate�,
BUILDING PERMIT PERMIT# _�_ CONTROL#
IMS .4StlFi�l��!
"{
DATE / VALUATION 11122,8".10 LOT TRACT 274,^ O
JOB SITE
-74-60.1. POMPEII C(. -)PW
APN 609-050-013
ADDRESS
OWNER _
CONTRACTOR / DESIGNER / ENGINEER
n.M. EXCHA,NGE, GROUP
ROOM S1i:EL1..HN.TBE RGTER & A.Ss6c.
78-615NAPLE S DR
78615 NI APLES DRIVE
LXC2WN'TA. CA 92253
LA Q JTNTA C:A. 92253
(760)771-0222 C'B; 0 1853
USE OF PERMIT
SINGLE .. AMIi. Y DW-EUNG,
3r -D, PLAjV 3A"3> . LOT A_2, 1?C;—NT DOES Na.17 1aNCZ.UDE 3.LOCK
1adAUS OR POOL.
1 ji1;Ci (;OiVS'T: iT%i'!C)I\" f32- Si
PORCH/PATIO X2.00 SF
Cir.KRAGE/CIV- 1 OR! 625.00 9F
ES':�''si4MfED CDr, t OF CUNS'I'WC rIO10.
12`2,899,10
Pji;.>E1M114EE SFJNWAR
CONSTRUCT ION FES 101-000-418-000 $710.00
PLANT CIKECK.FEE. 101-000-439-3.18- 5596.33
A4EC.Iir LAICAL FEU 101-000-421-000 J 3.30
119A:L.'TRIC:Af Fn- 101-000.42.0-000
fti 1VJf 31N0 r 10t-000=419-000 $140.70
-E-E RE:113M .10.!•�t(100-245.r0$129
t/)0
32
S/v+`{I'I ('),,NCY nAVINC
.
tu)••��r'.ION-
020,00
1XMii.S'MUCTUREi"E1R 225-006443-34:2
ART 1N 131YO IC- Pt, ACES -1ZOStO 701-000-255-0110 $57.25
SiJ13-TOTAL, (-'ON9:1'RUCrION A.ND 1 j,AN C4-I.CCK
5/1,481.67
LESS PP.E-PAID PEES_
$0.1)0
TWAL P'j�;lEt.l1'.iIT FEE.44 P+1JE'NOW
34,481.67
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
Y��
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
_
f
Underground Ducts
Forms & Footings/�
o� ��
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
G
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
Compressor
Insulationva
Vents
Fireplace P.L. ;
Grills
Fireplace T.O. I
Fans & Controls
Party Wall Insulation'
Condensate Lines
Party Wall Firewall .
Exterior lath
Drywall -Int. Lath
l f
ZX7"7]
s
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
�b �r ,(
Heater Final
Water Piping
�/
Plumbing Final
Plumbing Top Out , _
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
A
Pool Cover
Sewer Connection
( L _
Encapsulation -
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Vottage Wiring '
Fixtures
Main Service
Sub Panels
,
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
t.
Final
l9tility Notice
(Perm)
ROGER SNELLENBERGER & ASSOCIATES, INC.
LAND DEVELOPMENT
78-615 NAPLES DRIVE
LA QUINTA, CA 92253
(760) 772-0222
FAX (760) 772-0257
May 25, 1999
Mark Harold
Building & Safety Manager
City of La Quinta
78-495 Calle Tampico
La Quinta, CA 92253
Re: Bella Vista - Lot 32, Phase 4
Tract 28457-4
Physical Address: 78601 Pompeii Court, La Quinta, CA
Dear Mark:
Roger Snellenberger & Associates, Inc. hereby acknowledges that if the homeowner of the above
referenced lot does not comply by completing the landscaping within 20 working days, there will be
no city inspections scheduled until all corrections are made.
Roger Snellenberger & Associates, Inc. will install our standard landscaping package if the
homeowner fails to complete his landscaping within the 20 day period.
Sincere ,
Rogge nellenberger
President
RS/kaa