9903-239 (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
1' 3109
DAe'la' lC✓ ,C�q Signature of Contracto r
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.
S f ATErs i �, ND 4..26355-98
(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 Calif ornia,tand agree that if I should become
subject to the workers' compensation provisions of Sectidn 3700 of the Labor
C66J. shall forth..'wcomply with those provisions.
Date; %4.-1 (r I ` i �th 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.
I :,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 prropertyifor inspection, purrp�As.
Signature (Owner/Agent) /tf �fi-"�• Date 1210
BUILDING PERMIT PERMIT
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DATE/ VALUATION1),4.70 LOT rl 1 - TRACT1013
S 7 iA�
ADDRE 34 i��K
APN
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OWNER
CONTRACTOR/DESIGNER/ENGINEER
CVf'T.YA*( 1171 -1140110
c
1� 117Q -mi"I 1 t7Att�Ct9(:�Sia . �iUef
�1 n.r4,14�<a1,r-. L•1+:7lJt.a\Ad ,¢l.L WV �.
14.61.5 Wi tLES UR
r8G1g NAPLES DRIVE
LA QUINTA C:•A. 92.29
1.,A QUII+t FA CA. 9;1243
r7*titi11'ix- 22? C'1�1,1t I.858
USE OF PERMIT
tL'�i�1tVG.
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d �. .n.�i /�:L''0L �� i.% i
f
1: v t" 5I, PLAN 6A; SIl t3'f 1'M– &UT 1 0E—, S NOT Nk OI; UC)E BLOCK WALLS
fA PU(X. PLAN. i,'3*i(A:-.k FX iJ3UiJC. i 5% CXAt Ntr»a.'UPLH I.SS4IMCIF Of,
"M PLAN TYPE.
T!'Q% i C NVIIIWX Z"063.00 ;yip
PORC''IMPATIO We() Sir
0ARACW1 C r#M►Ui;('i' 598.(X) Sr.
E''TINATED C(AT UFf CONS•r.I IC"TI.G"N
162,9w8T70
PR,>C ArlI.T FER SUUN. AIt
(_'0N 'fRUC rJON :k.%Y 101.000-418-iJU() 5860.00
f**�l�I>"•A`?704 (7HEyypPC4. Kqq t+"[.:yy.�' 7 8 S11119,6,(7�
�A)1.0il�?}/�1-�1y�4-33/!
AV/aJL..t"w�Y./�.`11 AL I+'�'2s �:441-V00.421.-0x!0 aU.Y100
Ui ihCITI` UC AL r -Er. 101-000.420-000 $151.11
100
P.LUNIBINO :I'ER 101.000-41.0-000 1166100
STR<')NO MOTION FEE - .RESM, ! 01...13iN 74 i 0 glfi.�I
iN ilIWTRUt:'I'URF, i -W. 225-000-443-342 $3,09.41
PRECISE PLAN 101-000441-345 $25.)ti
AST (N PUBLIC PLAC6S - RHSTC 701: -000 -2S5 -0m $157.37
S[?i3 IDTAL C'a"J1 STRUC1' ON MY.) PLAN CHECK.
LESS PKE-AAiDIFEES
R5QEIP
Lq15ATL
D
Bl
I
DATE FINALED
INSPECTOR
,� ,
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab GradeReturn
Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Insulationp/�
8 ���' G _
9 6'
Compressor
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
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) Q —!Y-- 4 Ow
COMMENTS:
SEF22-99 WED 08,29 WESTERN INSULATION FIX NO, 9096868786 P. 06
�iTE57C�RN INSULATI
0N, INC.. .
4211 LathRm Street, Riverside, California 92501
Tei, (909) 686-8760 Pax (909) 686.8786
INSULATION CERTIFICATE
THIS IS TO CERT!FY 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 #28438-1
LOT # 51
SITE ADDRESS: 43674 VERONA COURT, Lft OUINTA, CA
EXTERIOR WALLS:
MANUFACTURER: Johns -.Manville THICKNESS: 3 518" R -VALUE: R-13
! S: BATT5 BLOW
MANUFACTURER: Johns -Manville THICKNESS: 11" R -VALUE: R-30
NGS: BATTS BLOW.
MANUFACTURER: Greenstone THICKNESS: '� R_VALUE: R-30
--------------------------------------------------------- -------
-GENERAL CCIN TOR: TRADITIONAL SUILDINC CO.
LICENSE NUMBER:
BY:
TITLE:
DATE:
INSULATION -CO JTRACTOR: WESTERN INSULATION, INC
LICENSE NUMBER: 481277
BY:
TITLE: PRODUV ION AGER
DATE':. SEPTEMBER 22, 1999
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:
ASAP
Lot & Phase:
Lot 51, Phase 5
Date Required
ASAP
Requested by:
Jim Lynn
11) Verticals
Superintendent
PURCHASE ORDER #
2243
October 14, 1999
PROJECT:. Bella Vista
Ship to: 43674 Verona Court
La Quinta, CA
Homeowner: Strange
Qnty Ord'd
Material/ Work Required
Unit Price Total
Furnish the'following upgraded window covering:
Premier Verticals w/soft white flow valence
$ , . 1,464.97
$1,464.97
Berkley, Alabaster
11) Verticals
6) Horizontals
Horizontals with Privacy
TOTAL
$1,464.97
apecial �.ona�uonsnnsirucuons:
Roger Snellenberger Devel pment
/AUN VUVVLCUl7t HIVU Kt I UKN
Apex Interior Source
By: