9905-354 (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 # Liic. Class Exp. Date�y yp iTt
� lr7J�9�1ly Z) r...•r"�f � -'-�. � �� 4/6076 Jt
Dat�V—;' r Signature of Contractor '/
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 contractirig 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.
STATE Fti� ) "Q6155M..
(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' F ]
Date r/. -i (� Applicant
—
[Date
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 pu'rpo'ses.
Signature (Owner/Agent).-'! �_A V
� Date � ^. �►G-�
BUILDING PERMIT PERMIT#
DATE VALUATION LOT �, .9905154 TRACT
051',171199 5:1.11,253.50 11 284.58-2
JOB SITE
APN
ADDRESS
79-53210,A'11PEU CO RT 7
609-070-038
OWNER
CONTRACTOR / DESIGNER / ENGINEER
ADVANCED DEVELOPMENT CORP.
TRADMONAL BUILDING CO INC
78-613 MAKES DR.
78-615 NAPLES DR
I.A. QUINTA CA 92,1253
LA QUINTA CA 92.253
(71+0;1772-022a CBL# 5750
USE OF PERMIT
gv T '.0 -`Y ' r Y yY'T C YAT
SFD -.LOT .11, PLAN N-3 --r-JERMIT DOES NOT INCLIUDEDLOCK, WALL
OR POOL. PLAN CHECK PORTIOtl OF FEF RMUCED 750,� FOR MI rr,.'I`W E
Q.1n? KTr37 % SAPT.AW'1*VPr
TRAC IPy/C��OpN�•r UCT101i 2,02w5.f['�0•�
[SAF'
iO1Z�{7.1 PATIO 52.0) Sly
GAR,AGSICARPORT 439,00 SF
ESTiNWITA)COST O:F CONSTRUC"!"RYN
7.19,253..51)
PERA11T FE; SUMMARY
CONSTRUCTION FEE 101-000418-1)00 $f19.�ti
PLAN CHECK ;FEE 101.000439_,318 $aa6,9s
NIECHANIC'A1. F73F 10I -001;-427.000 %S3<50
EI.BG". RICAL FEE 101-000420.000 $1213.16
PLUMBING FEE 101-000-419-000 $:150.75
STTtO:++it".' M(3'!'1(,ll FIFE - RES ID 101-000-241-000 $11.53
ct�Al r1vGi 101-000-4ZM00 $20.10
19FRAS9°:itWI' AE FEIR 225-000-44, -342 $2,667.64
AR'r IN PUBLIC 701-000-255-0013 �fS.l3
SUB-71WAL CONSTIWC.D.ON i1ND PI IU4 CHECK
$3,924.99
LESS VRE-PAID FEES
$0-W
TClTAI,1 ERIVIIT.FEES DUE iYOW
53,926.59
rFliC
DATE
By `
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
lezReturn
Air
Steel
7
Combustion Air
Roof Deck
—/4/- 67
Exhaust Fans
0.K to Wrap
/-3
F.A.U.
Framing
- 60 6'li-
Compressor
Insulation
-6&z
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath -
Z• -Z 2 G'
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 Plbg. Test
Final
I
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 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
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
,MAR -02-2000 12:06 WESTERN INSULATION 509 686 8786 P.12i18
r y x
WEST"EM INSULA'T'ION9INC*'
4211 Latham Stmt, Riverside, Caffomia 92 50 1
TeL (909) 686-8460 Am (90,a) 686.8786
1NSXiLATI0N CERTIFICATE
THIS IS TO CER"IFY THAT INSULATION HAS BEEN INSTALLED IN CONFORMANCE WITH .
THE CURRENT ENERGY REGULATION, CALIFORNIA ADMINISTRATIVE CODE, TITLE 24,
` STATE OF CALIF:ORNIA, IN THE BUILDING LOCATED AT:
TRACT / PHASE; BELLA VISTA. TRACT #28458-2
BLDG # 11
SITE ADDRESS: 78532 POMPEII COURT.
- --- - - - - - - - - - - - - ---------------- - - - - --- - - - - ----------- - - - - --
EXTERIOR WALLS
MANUFACTUREIR: Johns -Manville THICKNESS: 3 5/8" R -VALUE: R-13' -
CEILINGS: TTS BLOW
MANUFACTURER: Johns -Manville THICKNESS: 13" R -VALUE: R-38
BATTS BLOW
MANUFACTURER: GREENSTONE THICKNESS: 10.3" R -VALUE: R-38
GENERAL CONTRACTOR: TRADITIONAL BUILDING
LICENSE NUMBER:
BY: -
TITLE: '
DATE:
INSULATION CONTRACTOR: WESTERN INSULATION, INC.
LICENSE NUMBER: 481278
BY.
TITLE: PROD!�(CTION M GER
DATE MARCH 2, 2000
r •
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 11, Phase 6-2
Date Required : ASAP
Requested by: Rita
Design Center
PURCHASE ORDER #
9010
March 2, 2000
PROJECT: Bella Vista Phase 6
Ship to: 78572 Pompeii Court
La Quinta, CA
Homeowner: Keefe
rntt-C:nr1a• 'A1 RR
Hours
Material / Work Required
Unit Price Total
Furnish the following upgraded window covering
Premier verticals throughout
$ 1,664.00
$ 1,664.00
Fresno White
15) Verticals
2) Horizontals
Horizontals with Privacy
TOTAL
$1,664.00
Special Loonamonsimstruciions:
Roger Snellenberger Associate Inc.
Cc: Des enter
AUKNUWLLUGt ANU RETURN
Apex Interior Source
By:
A
T''
SCALE 1/16'*=l'—O"
=41to