9905-351 (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
�'S 465 13 -� ! 0 t2dii
L, ee ignature of Contractor =t K" 3 �t-
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.
(�) 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.
(This secAn neje ro86h completed if the permit valuations"f6rf'�MOS 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
subject to the workers' compensa
C
ode;1'shaltforthwith comply with
Date:).1 N�451 Applicant
of the Labor
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.
Pi 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 propert�y,foF inspection,purposes.
ignature (Owner/Agent) 1 .' '� Date-- !
BUILDING PERMIT PERMIT#
DATE VALUATION LOTTRACT
05/27/.1." $141.249.40 14 284511-2
JOB SITE
APN
ADDRESS
`7W5562 FOrkfPE1i1 COMf r
fi3Q-i1iI�,I�3R
OWNER CONTRACTOR / DESIGNER / ENGINEER
ADVANCED DEXTLO.PNIEl`+T CORP. TRAD11.10NA;L .BUILDING CO INC
78-615 NAPLES DR. 78-615 NAPLES DR
LA QUiNTA CA 92253 LA QUINTA CA 92253
{760}772-0222 C.13L## 5750
USE OF PERMIT -
. f
..`-
5FD - LOT 14 PLAN �,NR - .PERM T DOFIS NOT INCLUDE BLOCK. WALL
OR k' _X G
9
TRAC"I' CONS"1`RLICTION 2400.0 ';
PORCWPA°T-10 160.00 SF
C1.ARAOF)CARPOR 449.003F
ESTIMATED COST OF C'ONSTRUC1'ION
141,248.491
iPE-ft11T FEE SUMMARY
CONSTRUCT ION ' 101-000-418.000
101.000-439-318 $161.98
WCHANICAL F 101-000421-000 s6o.o0
ELECTRICAL FU, 101-000-420-00.0 $141A8
PLUMBING :t -FX 101-000-419-000 $1411.75
-MON.G 141OTRIN FEE • .t ESID 101-000-241-000 $14,12
GRADING, 1.0:1.-000-423-000 320.00
1141 A.STRUCfURF. PEE 225-1100.2443-312 $3,.130.21
AR'1 1N PUBLTC PLACES-,RHS'IT.= 70.1-000-255-000 $1.413.12
SUB -TOT -AL. CONSTRilC ION AND PLAN CHECK
$4;558.16
LESS PRE -PAID FEES
$0.00
TOTE1.I. PERMIT T FEES DUE NOW
S4w558.16
r1RECEIPT\' j `
BY
DATE FINALED
INSPECTOR
tt\4!
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set BacksUnderground
Ducts
Forms & Footings
Ducts
Slab Grade
azA M_Return
Air
Steel
Combustion Air
Roof Deck
99--13- 9�p I&
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
J- rd 6d--
Compressor
Insulation
P25 6
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 —3 —
BLOCKWALL 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
7
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 -- Q-�
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 b?�
Utility Notice (Perm)
COMMENTS:
ROGER SNELLENBERGER DEVELOPME�
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 14, Phase 6-2
Date Required : ' ASAP
Requested by: Rita.
Design Center
T. PURCHASE ORDER #
9007
February 29, 2000
PROJECT: Bella Vista Phase 6
Ship to: 78562 Pompeii Court
La Quinta, CA
Homeowner: Marquez
Cost Code: 3186
Hours
Material / Work Required
Unit Price Total
Furnish the following upgraded
window covering
Premier verticals throughout
$ 2,173.00
$ 2,173.00
Rio White
15) Verticals
6) Horizontals
Horizontals with Privacy
TOTAL
r $2,173.00
5peciai conditionslinstructions:
Roger Snellenberger & Associates, Inc.
Cc: Design
AUKNOWLEDGE AND RETURN
Apex Interior Source
By:
MAR -02-2000 12:.0? WESTENh•I I SULATION\ 90y 686 8785 P.15i18
WES'i ERN INSULA,TION, INC,
4211 L aibatp Stmt, Riverside, ::alit mia 92501
1't11 (9 , ) 686-8760 Fax (903) 686.8786
THIS IS TO CER1-IFY THAT INSULATION HAS BEEN INSTALLED IN CONFORMANCE WITH
THE CURRENT ENERGY REGUL� 1TION, CALIFORIJIA ADMINISTRATIVE CODE, TITLE 24,
STATE OF CALIFORNIA, IN THE BUILDING LOCATED AT.-
TRACT
T:TRACT / PHASE: BELLA VISTA- TR4CT iV28458-2
BLDG # 14
SITE ADDRESS: 78582 POMPEII COURT.
I
EXTERIOR wpLLS
MANUFACTURER: Johns- i anville THICKNESS: 3 518" R -VALUE: R-13
CEILINGS: TTS BLOW
MANUFACTURER: Johns- I anville THICKNESS: 13" R -VALUE: R-38
CEILINGS: BATTS t BLOW
MANUFACTURER: GREEN TUNE .THICKNESS! 10.3" R -VALUE: R-38
l
i
I- GENERAL CQNTRAC'QiO13 TRADITIONAL BUILDING
LICENSE NUMBER:
BY: y
TITLE,
DATE:
i I
INSULATION CONTR . T WESTERN INSULATION, INC,
LICENSE NUMBER: 481278
5Y: -� Y J✓l'
TITLE: PROD{UC 10N MAP
DATE MARCH 2, 2000
�4
•i
�1
�1
y
•