9905-359 (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
39465
VDate g: t;ySignature of Contractor,
r .r/
i
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.
(Q 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:
Carver Policy No.
-93
(This secti n€ eed not be completed if the permit valuation is forr $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 37300 of the Labor
Code, I.shall,forthwith comply with,tho`se provisions. r� %,r
Date. dry/ 1' %��pPlicant�
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
r 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.
J. 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) ! --' Al F' f' Date2'
.
BUILDING PERMIT PERMIT#-
t
DATE VALUATION LOT 9965-41.,59 TRACT
1115rz7/1 $141,248.40 284513-2
JOB SITE
�a
APN
ADDRESS JW-� Yy—� yyy�i/r y�/� y■,
(• 511541 •! ON&FJ11. OURIr
�j� �%(�
6?!./ Q70-038
OWNER ` CONTRACTOR/DESIGNER/ENGINEER
ADVANCED DEVE CORP. TRADUIONAI, BUILDINts CO INC
78-615 NAPLES DR 78-615 NAPLES DR
LA QUINTA CA 92253 LA QU .NTA CA. 922253
('750)1720222 CBL* 5750
USE OF PERMIT i
Sr`"')f. -LOT 6. fILAN .5A - PE RMIT DOES NOT01Ci.UD BLOCK WALL OR
POOL. PIAN CHECK PORTION Ot X13 REDUCED 75%.FOR, NfULTIPLE
JJ1q.qT 1 A Wl'r,l C A kfF P1 AhTTVPU
TRAC' CONSTRUCITRON 2,400.00 4F
PORCH/PATIO 160-00 SF
' ,0ARAGFICARPORT 4--199.00 SF
ESTIMATE, 1) COST OF COON-S!4'fiIXli IaN
",941,248.411
PERMIT FFE, SlU.NIAUL Y
coNsutu "Tfow 101-090-1118-00() $786.36
PLAN CHECK FEE 101.000-439-315 $I61.�i8
NERCl3IV OCAL FES 101-000-421-000 6t).00
f iECI TCAL PTT, 1.01-000-420-000 3841A8
P1.171L1k1IN3 FIX 101-000419-000 $1,10.' 5
s,rRO GM(Y I0N':.'FX_ - REs D 10,1-000-24.1-000 $.11.12
GRAMNG FEE 101-000-423-000 $20,00
!:I*lFF~AS1 r` tlC l t11 .0 ksE- ?25 t100-�14Z 342 $3..130.21
ART IN PUBLIC 'PLACES - R:ES= 101=000-2_+5-000 $103.12
Sii'B-7'CfAl, CONS`"t'iW000N AND PLAN CHECK
r
s'1,558.16
LESS PRF -PAID FEES
$0.00
TOTAL., PERMIT FEES DV NOW
$4,"8.16
r r r"A
RECE eC i�\ '
DATE t
By !
DATE FINALED
INSPECTOR
0
vAp,
N
INSPECTION RECORD
OPERATION j
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
c7— V
Exhaust Fans
O.K. to Wrap
Z— 7-99
F.A.U.
Framing
— —470
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
a ®L
r
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
POOLS -SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
PLUMBING APPROVALS
ool
Gas Test
Electric Final
Waste LinesHeater
Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Piaster
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
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G. F.I.
Smoke Detectors
Temp. Use of Power
Final —Ca
Utility Notice (Perm)
COMMENTS:
MAR-02-2000lil2:03 WESTERN INSULATION 909 636 8786 P.07/18
m
TE R. NINSULATION t INC*
4211 Latham Street, Riveredde, CaDfarnia 92501
Tel. (909) 6N6-8760 Fax (9050 68&-8786
EMULATION RTIFICATE
THIS IS TO CERTIFY THAT INSULATION HAS BE SN INSTALLED IN CONFORMANCE WITH
THE CURRENT ENERGY REGULATION, CALIFORNIA ADMINISTRATIVE CODE, TITLE 24,
STATE OF CALIFORNIA, IN THE BUILDING LOCATED AT:
TRACT / PHASE: BELLA VISTA- TFLkCT #28468-2
BLDG # 6
SITE ADDRESS: 78541 POMPEII COURT.
EXTER OR WALLS
MANUFACTURER: Johns-Manville THICKNESS: 3 518" R-VALUE: R-13
CEILINGS: BATTS BLOW
MANUFACTURER: Johns-Manville THICKNESS: 13" R-VALUE: R-38
CEILIIILE+S: BATTS LO
MANUFACTURER: -GREENSTONE THICKNESS, 10.3" R-VALUE: R-.38
GENERAL.--UNTRACTOR: TRADITIONAL BUILDING
LICENSE NUMBER:
BY:
TITLE:
DATE: -
y ,
INSULA�J CONTRACTOR: WESTERN INSULATION, INC.
LICENSE NUMBER: 481.278
BY:
TITLE: PROD C ION MAN ER
.DATE MARCP2, 2000
M
ROGER SNELLENBERGER DEVELOPMENT
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 6, Phase 6-2
Date Required : ASAP
Requested by: Rita
Design Center
PURCHASE ORDER #
9013
March 21, 2000
PROJECT: Bella Vista Phase 6
Ship to: 78541 Pompeii Court
La Quinta, CA
Homeowner: Lee
Cost Code: 3186
Hours
Material / Work Required
Unit Price Total
Furnish the following upgraded window covering
Premier verticals throughout
$ 2,036.55
$ 2,036.55
Rio White
'
15) Verticals
6) Horizontals
Horizontals with Privacy
TOTAL
$2,036.55
Special Conditions/instructions:
Roger nellen r er Associates, Inc.
By.
Cc: Design Center
AL:KNUWLtUCit ANU Kt I UKN
Apex Interior Source
By: