9903-240 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chap?pr 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
442-Wl is l:x9
Da"AIQL
14 j Signature of ContractoYLARATION OWNER -BUILDER D
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 ani 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.
( 1 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.
<a'1'ia I'E t f 11'1 i+s �i3`i3-9R
(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) !r
Daie::i ;,�a!':.� sal Applicant
/sv.-f! F.. v..
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.
.11,. 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.
Y
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
theabove-mentioned property for inspection purposes.
' J /'
Signature (Owner/Ag�t) f it 1.'V4 Date'— !
BUILDING PERMIT PERM
I
-M,3 240
DATE VALUATION�� p�•�5 s(i LOTS TRACT �IZ45�-
12-&Iq_So
JOB SITE
ADDRESS 43-644ERry A COli1
APN
609M70,038
38
OWNER
CONTRACTOR / DESIGNER / ENGINEER
"i'.HE EXCHIkNOE GIIZOU'P
ROGER SKh:l.LENJ If3ERGER & ASSOC.
78-615 N.APLES DR
78615 NMLES DRIVE
IFA QUINTA CA 92253
LA. QUIV.- A CA 92253
fyoo)77:2-0222 C .4 1.85fi
USE OF PERMIT
SINGLE FXMILY WELLING
[.OT 5t7. FLAN 3.8, SOD - PT39ART TtCWS NOT INC.:.(.1.FDE .BLC X',K,' WALLS
OX POOL. PLAN Ci. k. SEE FOR MULTIPLE ISSUANCE OF
Wvffi PLAN TYPE.
Pita E' Ci3:� +I"Rih'"1`iC' N 2,{i25,00 :i
P ,iRMPATIO 52.00 SIS
GARA!WC;.f RIl 439.00 W
'D CQ TION
1',ETtl4iIT F r98b.IVLMAi V
(,'tt:DNS11MIC-1 WN FEE 101 -WO -418 -OW Dt} s7w):50
PT,AN("Ett
1W,G'I1121N(CAL FM $53,50
1;ii;,.lI TRICAiA 17! 1133-Cll i-= 2ft 0 $128,10
t'I.Llfl+ INQ F E 101-000-411M U S00.75
k'F!?.41PJY1 fu1(3y ura F71»,- lZH,lD7 1()i -f3) ?8y>fDtin1,1.91
4�i:'�3�17Tt�i 1�A:; 1� a.•OI��<��?i-t�Q{) �"tt.00
ft4FitAjY!'R0 E`tlRE-114 i 225OW444 -.l4 ��,�ti�.F�►
AT4'T' M PUf' WC° PLAC S - $48,13
1St1 -'M, TKL CONSTKI.Ut-MON A1`Ii-D PLAN (7,14E(:'K
$3,926.59
,ESS ,,'1 E-3'AI4, FI BS
$0.00
TOTAL PERl11: T F.580S:t IXe NOW'
$3,026,59
RECEIPT .`
DATE sr�i r'
BY
DATE FINALED
INSPECTOR
J p RJ
INSPECTION RECORD
OPERATION
DATE.
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
b
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
OX to Wrap
F.A.U.
Framing
Compressor
Insulation
_
Vents
Fireplace P.L.
Fireplace T.O.
��J`
Grills
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
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
A
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 Q
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
79-553 Country Club Drive
Bermuda Dunes, CA 92201
Fax: 760/360-3167
Attention: Denise
Lot & Phase: Lot 50, Phase 5
Date Required ASAP
Requested by: Rita
Desian Center
PURCHASE ORDER #
2239
October 7, 1999
PROJECT: Bella Vista, Phase 5
S
Ship to: 43644 Verona Court
La Quinta, CA
Homeowner: Van Laeys
Qnty Ord'd
Material /Work Required
Unit Price Total
Furnish the following upgraded window covering:
1
Premier verticals w/soft flow valence
$ 1,379.36
$1,379.36
Fresno White (pricing the same as La Jolla White
per Denise)
Horizontals with Privacy
a
7) Verticals
6) Horizontals
TOTAL
$1,379.36
Roger SnellentergEr Development
cc: Design Center
1'1VnIYVVVLCUVC NIVU KC I UKIV
Apex Interior Source
By: __
SEP-22-99 WED 08,29. WESTERN INSULATION Flak NO,. 9096868786 P.05
Y r
WEST. ERN INSUI,ATI
OST, INC*
4211 Latham Sheet, Rivefsidc, California 92501
'Cel. (909) 086-8700 FaX (909) 686-8786
INSULATION CERTIFICATE
THIS 15 TO CERTIFY THAT INSULATION HAS BEEN INSTALLED IN CONFORMANCE WITH
THE CURRENT EI4ERGY REGULATION, CALIFORNIA ADMINISTRATIVE CODE, TITLE 24, .,
STATE OF CALIFORNIA, IN THE BUILDING LOCATED AT:
TRACT / PHASE: BELLA VISTA - TRACT 428458-1
LOT # 50
SITE ADDRESS: 43644 VERONA COURT, LA QUI NTA, CA
EXTERIOR WALLS:
MANUFACTURER: lvhns-Man THICKNESS: 3 5 R-VALUE: R-13
CEILINGS- BATTSBLOW
MANUFACTURER: Jo nvill, THtCKNE55: R-VALUE: R-30
-
GENERAL CONTRACTOR: TRADrr,;ONAL BUILDING CO.
LICENSE NUMBER:
BY:
TITLE:
DATE:
INSULATIONCONTRACTOR: WESTERN INSULATION, INC.
LICENSE NUMBER:- 481278
BY: :Y
TITLE: PRO TION . NAGER
DATE: SEPTEMBER 22, 1999