9905-362 (SFD). a .1 I ..Y
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 -- zz
759465 !3 01
Date/--/11i"Y Signature of Contractor.-- 02. 8'3 •
!! 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 pr6perty, 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.
t ) I have and will maintain workers' compensation insurance, as required by
Seatitn 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.
(This sectio . eed of becompleted if the permit valuation is f r $100.050 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 agre-e-that-if-I-should-become
subject to the workers' compensation provisions of Section,3700,of the Labor
3
Code, I hall forthwith comply with te p
hosrovisions.
DateM'/ k-0PPlicant
Vilarmng: 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 applicatort•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
thea ove-mentioned property for,inspection purposes.`
J
YS' nature (Owner/A ent)'� k r+� !� + Dated Ar��2�
1 ..
BUILDING PERMIT PERMIT#
DATE VALUATION LOT _- TRACT
t
05d2 7A $130,154.60 3 i RISK -2
JOB SITE
APN
ADDRESS
Lr7�- 7f, Fil a ; f'CtliJ'R fi
609-07 4-038
OWNER L-- - -- - - �, ..� CONTRACTOR / DESIGNER / ENGINEER
ADVA:tlICED DEVELOPMENT CORP. TKADMON.AL B'UII..DiNu CO INC
76-61.5 NAPLES DR IR 615 NAPLES DR
LA QiUDITA C.A. 92253 LA QUINTA CA 92253
(760)772-0272 CBL# 5750
USE OF PERMIT -
h
V,NG - RAW4 DWELMINIG
S1 I) - LOT 3,'PAN 41�1'c-1>Si13.Nl.t L" DOES I�OT 1'NCCL�1TJ.k: BLi�t°`s� W ALL
OR .POOL. PLAN CHECK PORTION OF FIES,, KEIDLTCEO 75%'FOP, WIM IP1.e
T&STIANIr"F Or SAWV P .A1u TYPF
TRAC V COIUSTPIWF10,14 ZVJQ.00 51•
PORCIi1 ATTO 110.00 :,IF
GARACOCARPOR:P 471.00 .iia
1+,'s4'i1VDATLf) con Or CONS'iRUC-1-ION
1.30,I S-4.61
PERMIT FEE SUMMARY
CONS'1RUCTI.ON !"F..E 101-004418-000 $'748-00
w : 101-000-439.318 5154.69
MECHANICAL FFX 1.01.00-421-000 W.w.
L11.C,"1 RlCAL F08 1 U. } ,0f►0.420-001l $1.1i.92
PLUMBING FEE 101.000-419-004 1.140.75
S RtYNG MOTION IFEE - RESID 101-000-241-000
GRADING FEF 101-000-423-000 SIN -1.00
iNFRAASMCI'Uf E PEE 225.00W443,342 $2895.56
ART IN PUBLIC PLACES - RF.sS]'Ir' 701-000-255.000 $7.5.39
SUB -TOTAL. C"ONSTRUCf[ON AND PLAN CHECK
LESS i�ft&P ;li� FEES
TOTALL PERMIT FEES DUB. NOt3i'
�8,247.3:i
" \ e -NA
R_FiCEIPT�
\f`\�
DATEVi `
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs A
'eUnderground
Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap iZ
ea
F.A.U.
Framing
Compressor
Insulation
'1g.cr-0
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulatioi
Condensate Lines 4.
Party Wall Firewall
Exterior Lathtot
Drywall - Int. Lath
Final
Final
BLOCKWA
—
L APPROVALS
POOLS - SPAS
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
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:
,
ROGER SNELLENBERGER DEVELOP
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 3, Phase 6-2
Date Required :
ASAP
ed window covering
9
Requested by:
Rita
Design Center
PURCHASE ORDER #
9018
April 1'7, 2000
PROJECT: Bella Vista Phase 6
Ship to: 78571 Pompeii Court
La Quintal CA
Homeowner: Nasman
Cost Code: 3186
Hours
Material / Work Required
Unit Price Total
Furnish the following. raI
9 P9
ed window covering
9
Premier verticals throughout
$ 1,465.00
$ 1,465.00
Rio White
13) Verticals
2) Horizontals
Horizontals with Privacy
TOTAL
$1,465.00
special conditionsimstrucUons:
Roger Snellen berger & Associates, nc.
Rig (F
Cc: Design en
AUKNUWLtUUt ANU Kt I UKN
Apex Interior Source
By:
e _
_ 4 -
Traditional Design Center,: Purchase Contract
. 7 -White Sun -way -- - —. . ,� ;
Rancho Mirage, CA 92270 `t DATE CONTRACT NO.
(760) 674-1188 Fax (760) 674-1668. 3/20/2000 C-BV03/6-1
J Nasman t
122 Castellana West
t _ t Palm Desert, -CA -92260 • , .
' (760) 341-5033 j
#
t PROJECT LOT/PHASE PLAN TERMS
BELLA VISTA 3/6-2- 4 BR Due on receipt
AREA# � DESCRIPTION QTY ,-UNIT RATE AMOUNT
` Exterior Stucco -Sierra Tan
Baths, Laundry Standard Culturedarble N/C
Throughout . White Wash Mapl'7C
abinets=Aspen 020 N/C
Lvg Rm V Maple Media Cabinlet :; N/C
Maple Wer Bar Cabinet r N/C
Maple Bar Top - N/C
Kitchen , r' Corian-Cameo White w/No Inlay N/C
g I Per Diagram; ` 1 Custom Penninsula Extension 465.00 465.00
C:ooktop Full Splash @Coo jtop I 310.00 310.00
-Kitchen- ; Std Appliances-wite N/C
k Per Diagram, Tile -B -IMO -Magi ra hnon`d 17x17 ' . 8,593.00_ _8,593.00
Grout -(H) Mo6e P�arl S 1-- 1209 I
Per Diagram Car et-Bayview-_SI'tin Pea r N/C
Pad -1/2" 81b 550.00 550.00
Credit Standard FI 1g I -1,730.00 ^ -1,730.00
1
BIZ 2, 3. 'i Std Verticals -Smooth Off White N/C
t. MAR si i 2000 :.
; y I1k bqq
SIGNATURE DATE
I'AVE READ D ;UN ERST THE -ATTACHED ONDITIONAL 'ro��l S8,188.0o
SALE AGREEMENT. Crr� I GZ I
I
MAR -02-2000 12!02 WESTERN INSULATION 909 686 8786 P.04i18
WES ERN INSU.LATION, INC.
4211 Lathan Street, Rivaraido, CWXOrnia 92601
"
TeL (909) 686-8760 Fax (903) 686-8786
IiO SULAI TION CERTIFICATE
THIS IS TO CERTIFY THAT INSIULATION HAS BEEN INSTALLED IN CONFORMANCE WITH
THE CURRENT ENERGY REGULATION, CALIFOR141A ADMINISTRATIVE'CODE, TITLE 24,
STATE OF CALIFORNIA, IN THE BUILDING LOCATED AT: '
r
TRACT / PHASE: ELLA VISTA- TRACT #28458-2
BLDG # 0 '
SITE ADDRESS: 18571 POMPEII COURT.
EXTERIOR WALLS -
MANUFACTURER: Johns- lanvX& THICKNESS: 3 6/8" R -VALUE:. R-13
CEILINGS: IBATTS BLOW
MANUFACTURER: Johns -Manville THICKNESS: 1`3" R -VALUE: R-38
CEILINGS: E TTS LOW
MANUFACTURER: GREENSTONE .THICKNESS: 10.3" R -VALUE: R-38
------------ --------------------- ---.------------ ----------
GENERAL CONTRACTOR: TRADITIONAL BUILDING
LICENSE NUMBER:
.BY:
TITLE: _
DATE: I `
INSULATIOPI CONTRACTOR; WESTERN INSULATION, INC.
LICENSE NUMBER: 481278
BY:
TITLE: PRODLJCITION. MANA R
DATE MARC 2, 2000