9903-313 (SFD)A LICENSED CONTRACTOR DECLARATION
I hereby affirn% 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.
Licd se # : Lic. Class Exp. Date
X02.34 VA) ,199�
Signature of Contractor /� -�'��' ' •�
OWNER -BUILDER D CLARATION
1 hereby affirm under penalty of, perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) 1, 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 insurahce•carrier & policy no. are:
Carrier Policy No. "
X'i41TE .17. UNIO
626-155-901
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 3700of the Labor
Code, I shall forthwith comply with those'provisions :r,;�
.Pate: ,1 Applicant r /
N r
Warning: Failure to secure Work6rs' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000,,ih
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 purposes.
Signature (Owner/Agent). Date
BUILDING PERMIT PERM T#
DATE VALUATIONf ' ^ • / TRACT
LOT 47
14!
I -..ILS
JOB
JOB SITS I
ADDRESS � �I,;j,���,� ���J�`�'
APN
"91^074-038
OWNER
CONTRACTOR DESIGNER ENGINEER,
AHF EXOrYGC GROUP
& .A S`O '.
7fi 6'►5t�f 1W.i. S'd7RtV
78615 NAPLES
L.A.QUIN7t1, C -,A. 922,53
1A Q IN -FA CA 92,253
(7614)772,0222 C'et,# 1.858
USE OF PERMIT
SFta'OLE, FAN La' pt1/RLUKO
,LOT 4`r PLAN 5B, SFD » PUPLNIff DOES NOT iNCL'UM 13LOCk 1Altil;;1, /
Cik. i�ii1JL.. ,
f
i'ORCIMAX-10 160.00 &
(IMA!38 AXPORT 619.00 W
,
TrVINIMM 0031" Ort COrNST;RvCTICIN
145,168.40
i E,P.ivfvf Ful.t"+,'.SUMMA:R
CUtd�;'C'1ttlG"f.'1�Af.tE'E 1t1.1=f,3(3t1-4111x000 $731111:30
i 1..151 x32 YG eiL T 1 :. 10i -OW -420-000 $1,46,48
PLUM81,1140 I -It 1? 101-000-4194M $.1.40.75
1 - (ff�(1,') 41M $14_52
ORADIM, FEN tO1-ft`1-473-()00 M.0
€Aft'RASTRi3'C ME FL -6 225-000443-342 C3. �1t3.�E3
.ATO CN PUBLIC PLAC2S - RESM 70 1'_1.v2
SIJB-TOT.A!;, (:'CIMS'Mk"IMYN AND IPLAN CHECK
$5,171.50
T.,Ls " €'R:�-iaArD FEES
$0.00
TOTAL PFRM1`.1?' FI:'t S M '' NOW
ss n1.:569
y11
RECEIPT
DATEBY%
74
i
DATE FINALED
INSPECTOR
(:l
l
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Becks
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
571114V4
Exhaust Fans
OXto Wrap
Framing
/f. /
Q
F.A.U.
Compressor
Insulation9
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
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 Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit r
Rough Wiring OF
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G. F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
ROGER SNELLENBERGER DEVELOPMENT
78615 NAPLES DRIVE
LA QUINTA, CA 92253
(760) 772-0222
(760) 772-0257 FAX
TO: Apex Interior Source
Fax:
360-3167
Attention: -
Denise
Lot & Phase:
Lot 47, Phase 5
Date Required
ASAP
Requested by:
Rita
$1,464.97
Desion Center
� I
PURCHASE ORDER #
2248
October 22, 1999
PROJECT: Bella Vista
Ship to 43583 Verona Court
La Quinta, CA
Homeowner: Leitch
Qnty Ord'd
Material /Work Required
Unit Price Total
Furnish the following upgraded window covering
Premier verticals w/soft flow valence
$ . 1,464.97
$1,464.97
Alabaster (Berkeley)
10) Verticals
6) Horizontals
Horizontals with Privacy
,
TOTAL
$1,464.97
apeciai %,unumonsnnsiruc[uons:
Roger Snellenberger D v opment
By: `
cc: Design er
HI:IKNUVVLtUUt ANU Kt I UKN
Apex Interior Source
By.