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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