9905-355 (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
vDat� m sf ,.�� Signature of Contractor
���
1
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 tfie 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:
Cartier Policy No.
(This section eed no 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 I7f should become
subject to the workers' compensation provisions of .Section 3700 of the Labor
Code Lshall,forthwith comply with those provisions. 11
Applicant,_-
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
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 propertyfor iiispection'purposes. i
,,Signature (Owner/Agent)!, _ ' j .';j -+ Date /^' "J'
BUILDING PERMIT PERMIT/t
DATE VALUATION LOT TRACT
05f27/i".W X10 ,ba]. m 101 •28458-2
JOB SITEAPN
ADDRESS =
713 .-522 POURM COii.it
ei#�3-i17(i f33f3
OWNER -- —'- — -- -
CONTRACTOR / DESIGNER / ENGINEER
ADVANCED DEVELORNI.ZiNT CORP.
TRADMONAL BUTLEII1tiG CO INC
78-61 j NAPLES DR
'78-613 NAPLES Dalt
LA QUINTA C.t1 92253
LA (,)MNU 1 C.A. X2^:53
(160)7772-0222 C18L9 5130
USE OF PERMIT
i
SFD - L GT 10, PLAN �J311. -PERMIT L)Ceo NOT iNt"'I 1JD—RBLOCCK. WALT.
O>1.',PCIL, PLAN Cf:1FCT: PORTION OF FIFE R9DI C.'FD 750,14 FOR NIULTIPIX
ecrrAVrT nIZ 1,1 A ]UP PT.A t TVVIT,
TRACT Ci. NST, UCT1 11 1,1334.00 S
POPICWPATIO 76.11,) Sr.
GAR.kGJ (CARPORT 409.00 ST
LS'i i.MA M) COST OF MN- i RIJI(I JOLN
108,6.13.401
PE1211 IT .FE3+.'• SUM1e RY
CONSTRUCTION FEE 101-0004,18-000 $6 11.00
PLAN CBECK FEE 1014004)39-M $138.35
MEICHAs`V' ICAL FEE 10:1.Aw-421-000 $47.00
Firl"W RIGAT. FFP: 101.•1100-420-000 $120.87
,
PLi aT'1f13dIa(,r FIS 101 -NO -419.000 $134,75
STRONO MOTION FEE - RES -11) 1431-000-241-000 $10.86
c:RADING.F'IX 101 -OW 423.000 $20.00
1NFRAS' RUCC fU18 'SEB 225-000-443-342 32,421.06
ART IN PURL TC.PI:ACES - Rrzsuc 701.-000-263-000 $21.53
SUB -TOTAL CON'STltCIL✓" .HON AND :PLAN CHECK
$3,585.93
L SS PIM -PAID FEES
$0.014)
TOTAL 1PTRATr1' i1'EMS DUB: NOW
S33585.93
1 , IW4l�
RECEI T
At. E
BY I
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
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
67 ,W
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
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
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 i
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
Coe
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 12:05 WESTERN INSULATION` 909 686 878E P.11i18
vV-ESTERN INSULATIONS INC*
4211 Latham Street, Riverside, ( aWbrnm 92501
Tel. (909) 686=8760 Fax (909) 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:
TRACT / PHASE: - ' BELLA VISTA- TRACT #28458-2
BLDG # 10
SITE ADDRESS: 78522 POMPEII COURT.
C-XTES112A WALL
MANUFACTURER: Johns-Min ville THICKNESS: 3 518." R-VALUE: R-13"
CEILINGS; ATTS BLOW,
MANUFACTURER: Johns-Manv/lle THICKNESS: 13" R-VALUE: R-38
CEILINGS, BATTS BL
MANUFACTURER: GREENSTONE THICKNESS: 10.3" R•VALUE. R-38
GENERAL CiMTRACTOR: TRADITIONAL BUILDING
LICENSE NUMBER:
BY:
TITLE:
DATE:
INSULATIOPI CONTRACTOR: WESTERN INSULATION, INC.
LICENSE NUMBER: 481278
BY:
TITLE: PROD 'ION MANA
DATE MARCH 2, 2000 .
ROGER SNELLENBERGER DEVELOPMENT
78615 NAPLES DRIVE
LA QUINTA, CA 92253
(760) 772-0222
(760) 772-0257 FAX
TO:
Apex Interior Source
Unit Price Total
79-553 Country Club Drive
Furnish the following upgraded window covering
Bermuda Dunes, CA 92201
Fax:.
.360-3167
Attention:
Denise
Lot & Phase:
Lot 10, Phase 6-2
Date Required':
ASAP
Requested by:
Rita
Design Center
PURCHASE ORDER #
9012
March 7, 2000
PROJECT: Bella Vista Phase 6
Ship to: 78522 Pompeii Court
La Quinta, CA
Homeowner: De Villa
rnct
Hours
Material / Work Required
Unit Price Total
Furnish the following upgraded window covering
Premier verticals throughout
$ 1,954.00
$ 1,954.00
Rio White
a
15) Verticals '
4) Horizontals
Horizontals with Privacy
TOTAL
$1,954.00
v'+va " vwig VI10 1WN U%,LIVI Ia.
Roger Snellenberger & Associates, Inc.
��
Cc: Desi nter
/ k,f\1NUVVLCUI�t HNU Kt I UKN
Apex Interior. Source
By: