9903-241 (SFD)t 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 a4C4
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
+Zi.Z Ise / r 12%: t/90
Dato "r . Signature of Contractor
w 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.
^()) 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.
(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, 1 shall forthwith comply with•thoseyprovisions.,..
Date:'A1'96 y 41 !� Applicant
✓1Warning: 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 6 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 tor insp�ecttiion purposes. �1/
Si nature (Owner/A ent) "� Date/�``ty4?
BUILDING PERMIT PERMIT# '
5-248 1
�` VALUATION y�•xtfp LOT �- TRACT 29458»,
DATE��(y
�--
JOB SITE » &
ADDRESS �I�.g-
APN
V�,+J.�C�JrNA CMUT
OWNER
CONTRACTOR / DESIGNER / ENGINEER
tltzilx ii-vf t4Aarrl+ j -!v,
/Q .. I.. i. I.. I. E 4Y• s, i.. �, tlai„ 1 J,(
11)(1C:,170 c1rrrr r
Ibdaw[\ at 1. i.. 1,. f.J 1„ A,�f 1[ 141��,4
"161-6115 NAPUIS DR
8015 Nt1:PLES DRIVE
iA(;PI t'k ("A 92253
I.A(,►U191': CA 92253
USE OF PERMIT
iZ[hia•I. F FAMILY WPOLLIN0.
LOT 49, P�L'j%N 3.A, fir13 •• d t�V"0..'II.rUD,13 idl:.00K U'AL LSI
(.3( P10,01— K,.AN i;Mf.:',k,..i tsY�.1�1* ;4.1iwf?tJ 75",oFOR iWdJl,1'1i': Y. ISSIJANC E 0F
SAN .Pl;e.�3d TY..PF,
4iut4_7l.ONwCslTi.iRY.1CT1101.4 4,rbs.00 SIF
t+tITts"ir`Ple.`.ii+ S�.t3Q SF
ria.(tu SH
PRIZIS T .F.rM. alSi3MtlrlE`:ARV
C,(-)NSfi'1tUC'r10N NEE I01•-000-4111-0013 37130.00
n^41~CII.AMCA;: VEZ $53.50
Ml%(;`. RICr1.L� ME 101-000( 420000 S13.I.83
f'i.(NNING Y.F.H. 1,01 -000,414 -Mo $'140"75
STF2OWO,WVrT(- OFF-'RRSID 101mS}t►f't-7414W
ORAIDIRG Ms 310.00
04F'1;•ZAST.Ru furti.l'IX 225-000.11IG-112 $2,149.67
ACCT M PUN- A(; .PL ACES - tZiiSKO* 70 t A00-255-01 $517125
,9UA— (YTAf. r'(iNK1'12(K:71M AN11 PLAN C'NKN
$4,034 4"
r
LESS PRE-PluD I'I:ES
T10.00
1743TAL PL:ith'iR FIRS S DU C NOW
$4,11:34.442
n:
RECEIPT } J(�
DATE `//}/)
BY jj\\ Jjtt`� '
DATEFINALED
INSPECTOR'
g tg . r r e c
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
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
/
Compressor
Insulation
_ _
NIA
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
POOLS - SPAS
BLOCKWALL
APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Gond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. 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
fl 77 4iv
Encapsulation
Gas Piping
Gas Test
.e='
Appliances
Final
COMMENTS:
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 S'=
Utility Notice (Perm) v —
Vl.l LL VV wt., _/ 1I L1./1 111 a11V'JLlll •Vll
WESTERN INSUIATIO
N, INC..
4111 Latham Str.et, Rivtmide. California 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, CALIFORNIA ADMINISTRATIVE CODE, TITLE 24,
STATE OF CALIFORNIA; IN THE BUILDING LOCATED AT:
TRACT / PHASE: BELLA VISTA — TRACT #28458.1
LOT # 49
k
SITE ADDRESS: 43614 VERONA COURT, LF, QUINTA, CA
EXTERIOR WALLS:
MANUFACTURER: Johns -Man a THICKNESS: 3 5/8" R -VALUE: R-13
CEILINGS: C3ATTS BLOW ,
MANUFACTURER: 1.ohns-Manville THICKNESS. 11" R -VALUE: R-30
GENERAL CONTRACTOR: TRADITIONAL BUILDING CO.
LICENSE NUMBER:
BY:
TITLE:
DATE:
INSULATION CONTRACTOR: WESTERN INSULATION, INC.
LICENSE NUMBER:481278' "
BY: y
TITLE: PRODUPION MMI GER
DATE: SEPTEMB:R 22, 1999
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 49, Phase 5
Date Required ASAP
Requested by: Rita
PURCHASE ORDER #
2243
October 15, 1999
PROJECT: Bella Vista
Ship to: 43614 Verona Court
La Quinta, CA
Homeowner. Harrison
Qnty Ord'd
Material /Work Required
Unit Price Total
Furnish the following upgraded window covering
1
Premier verticals w/soft flow valence
$ 1,552.63
$1,552.63
Fresno White (pricing the same as La Jolla White
per Denise) "
Horizontals with Privacy
7) Verticals
6) Horizontals
TOTAL
$1,552.63
n ncTic�u
Special conal snnstrucuons -•� ^ -�
Roger Snellenberger Development Apex Interior Source
By:
cc: Design Center