9905-358 (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
7594t55 13 / / f=8/201
ate �Signature of Contractor`Y +. / r . e i a
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 t 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.
(k) I have and will maintain workers' compensation insurance, as required by
,Se`tion 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 KIM 0626155-95
(This section need not a 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 provisios . j �r
vDate: 0 r, `f & Applicant—
Warning:
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
work is not commenced within 180 days from date of issuance of such
tg 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
c�nstruction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes!
fr
Signature (Owner/Agent),- }x<y= 4 /1 �N: Date
, ; � .. .. .. .,
BUILDING PERMIT PERMIT#
1s r
DATE VALUATION LOTr TRACT
_
05/27/199 $11912,53-150. if 28458-2
JOB SITE_
APN
_
ADDRESS .+�,T�.i.�Y�PO.f1f'�1t Ca3UFtT �.
60,9-070-038
OWNER CONTRACTOR / DESIGNER / ENGINEER
l
ADVANCED DEVELOPMENT CORP. T RALIfflONAL BUILDING CO WC
78-615 NAPLES DR 78-615 NAPLES DR
LA QUINTA CA 92253 LA QUIN'TA CA 92253
(760) 7 72-0^.22 CBL#' 5750
USE OF PERMIT
C'7 Vi. %,I'11 V otljPtt i';
SFU - LOTt 7, PLAN MR - PFAW s DORS N(T INCIAME ALOC€; WALL
OR FOOL. PLAN (."M K. PORTION OF FEE RMUC% D 75°'a .F'OR MIXT'IP.L.E
1:r IJAN _.1 QF SAW PLAN TYPP,
TRACT CON STRW,, fION 2,025.00 SF
PORC�VPATIOJ 52.00 SF
GA%A,0FJCARF0:RT 439.00 SF
ri-bTIMA TED CUffirt OF CONST RUCTION
I I9,vem5la
PERMIT FEESUMMARY
CONV UCITION FEG 1.01-000-418-000 $709.50
PLAN CfffXK FEF 101-000-439-:318 31405
NIF CH AN IC AL FEE 1014)00-42,1-000 $53.50
F_LEC.IRICAL `F'EE 10.14)011.420-000 $.>:25,16
Pi. L1NtBf7NQ'FEE 101-000-41,9-000 $140,75
STRONOt N:10110N FEE • RFSU) .101-000.241-000 S11.93
GRA77'MIG HY 101-000-4.23-000 $iil.fi0
INFR.AS'.PIIUC"C 91� -11 22.5•000-443-:342 52,667.64
ART .1N.PUBLIC.P1W ACCs - RESM 701.000-25521110 $48.13
S1J13-"IV1t1.1.. CONS'T1t1J(7 lGf4 z1.ND PLL1N CkIECK
$3,9-2(i.59
LESS P:VZr PAID FEE;S
,O,:,';1
TOTAL PERMIT FEES :DUE NO'""
S3,926.59
RECEIPT
DAT /► / f/�
BY f/'
DATE FINAL
INSPECTOR
Jq1,`
Ir V ` . - / 1g , � , ._ . 1V
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab GradeReturnAir
Steel
Combustion Air
Roof Deck
jD -2.0-9.7
Exhaust Fans
0.K to Wrap
F.A.U.
Framing
Compressor
Insulation
—/ -pa
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
7 W -::ate 6' --
Drywall - Int. Lath
z• -Z Oa -
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
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste lines
Neater 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 r
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole C -p
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final 705
Utility Notice (Penn)
COMMENTS:
M ,4
MAR -02-2000 12:04 WESTERN INSLLLATION
909 686 9786 P.08i18
WE'�`Rl� I'�SiLA'I'IOIv, INC*
4211 1Arbatri Street, Riverside, 13311 mia92501 ,
ToL (904) 686-8760 Fax (90D) 686-8786
INSULATION CERTIFICATE
THIS IS TO CERTIFY THAT INSULATION HAS BEEN INSTALLED IN CONFORMANCE WITH
THE CURRENT ENERGY REGULATION, CALIFOR141A ADMINISTRATIVE CODE, TITLE 24,
STATE OF CALIFORNIA, IN THE BUILDING LOCATED AT:
1
TRACT I PHASE: BELLA VISTA- TRACT #28468-2
BLDG # 7
SITE ADDRESS: 78531 POMPEII COURT,
EXTERIOR WALLS
MANUFACTURER: Johns -Manville THICKNESS: 3 618" R -VALUE: R-13
CEILINgfi; ATT BLOW
MANUFACTURER: Johns-Manv/lle THICKNESS: 13" R -VALUE: R-38
CEILINGS: BATTS BLpW
MANUFACTURER: GREENSTONE THICKNESS: 10.3 R -VALUE: R-38
-------------------------------------------------------------------
GENERAL CONTRA TOR: TRADITIONAL BUILDING
LICENSE NUMBER:
BY:
TITLE:
DATE:
INSULATION CONTRACTOR: WESTERN INSULATION, INC.
LICENSE NUMBER: 481278
eY: � I z�rJ •
TITLE: PROD .TION MA AG3ER
DATE MARCH 2, 2000
t
,
u:
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 7, Phase 6-2
Date Required : ASAP
Requested by: Rita
r)esinn Center
PURCHASE ORDER #
9014
March 21, 2000
PROJECT: Bella Vista Phase 6
Ship to: 78531 Pompeii Court
La Quinta, CA
Homeowner: Carlos
Cost Code: 3186
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
speciai onditionsimstructions:
Ro S elle rge & Associates, Inc.
By:
Cc: Design Center
F UNNUM-CUhC /11VU mr- 1 URIN
Apex Interior Source
By: