9905-047 (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 CodeM1yta�In.d my License is in full force and effect.
License # -4." Lic. Class Exp. Date
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Datet �. Signature of Contractor'
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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. .
-WO 'RKER'S COMPENSATION DECLARATION
Thereby 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.
rtimp
(This section need not be completed if the permit valuation is for $T00. O 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, l shall forthwith comply with -those 'provision
Date:' :x; flll/moi: Applicar%,.:i.,t
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:
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1. Each person upon whose behalf this application is made & each person ate
_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;
r permiessation
t, orcof work for.180 days will subject permit to cancellation.
I certify thatI 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. I) r
Signature(Owner/Agent ; . Date
BUILDING PERMIT PERMITN
DATE VALUATION LOT "90"47 TRACT
JOB SITE APN
ADDRESS
Mi09 TOl INO DM �Ib7 13
OWNER CONTRACTOR/DESIGNER/ENGINEER
ADVANCED DEVFLOPkIENT CORP TRAD1Y ONAL BUILD= CO INC
'78-61 NAPLES DRIVE 78615 NAPLES DR
LA QUINTA CA 92253 LA. QU[NTA CA 92253
(760)77:2-0222 ( ---BLft 5750
USE OF PERMIT
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SM - LOT 12 PLAN SAR PRnfiT D09S N(.a'P• INCLUDE BLOCK WALL Oft
POOL,
a,
TRACT CON'STRCiC:'I'TON 2,400..Ot? gF
PORCWP'ATIO 160.00 SF
GARAGWCARPORT 449.00 Sr
0811MATE0 COBS' OF CONS'li'RQC.`flOIN
PERMIT FEE SUMMARY
CONSTRUMON FFE
101-00041"00 $786.50
PLAN C13EC1 FEE
101-000439.3113
ECHA:NICAL FM
1014100-421-000 �t►0.4te
.I1L'EC TR.tCAi..£
101-000-4.20-000 S141,:48
PLUIMING krw
101000-41.9-000 S140.75
STRONG MOTION M- - R -:SW tO.1-000-241-000 514.12
ORADING FEE -
101-000-423400 $20,00
94FRA SfRUC UR , FEE
225,x.000--443 x•42 33,1.30:2.1
ART INPUBLIC BLIC PLACE,S-}PJRSW )bl-('100-dg5-000 $103.:12
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SUB -MLA. CCIINS4T� 710N AND PL—AN CHECK
S5,044.0�
6q i A 1i
LESS PkEPA,1D PEES
$0.00
TOTAL PEI:t1VMfT FEES DUE NOIR
S5 {144,09
MAY 171999
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AA0tilt
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BY j
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
_ ��� /'
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
POOLS -SPAS
BLOCKWALL
APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
I
as 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
COMMENTS:
Final ® -
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole s.
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbituies
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)_
t APR-18-2000 09:46 '• r. WESTERN INSULATION' f' „ 9091686,8786 P': 02/13
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WESTERN-1NSULATION , .-INC
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f , 4211 Latham Street, Riverside;'California 92501
} TeL (909) 686-8760' . Fm (909) P8"786 n C
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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#' 12
SITE ADDRESS:-78609,TORINO<
.---- -- - -- -
• -EXTERIOR WALLS•--------------Y- f-`
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MANUFACTURER: Jahns-Manville THICKNESS:.- '3 5/8" R4ALUE: R-13'
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CEILINGS ATTi f BLOW s
y
(THICKNESS:
' MANUFACTURER:.'Johns-Manville 13" R-VALUE: R-38.
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CEILINGS: BATTS
' - MANUFACTURER:' Greenstone THICKNESS: .10,3" R-VALUE: R-38
- - - - - --- - - - - - - - -♦- - - - - - - - - - - - - - - -
GENERAL`CONTRACTOR: TRADITIONAL BUILDING' ' 1
- - - - - - -
tLICENSE NUMBER: .4
ti BY:
x,TITLE:
_. ,r � .DATE: _ wi , • " .
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INSULATION CONTRACTOR: • WESTERN INSULATION,, INC'
LICENSE NUMBER: 481278
BY:
- TITLE: PRO CTION;MA AGER
,
DATE April 17,, 2000
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ROGER SNELLENBERGER DEVELOPMENT f PURCHASE ORDER #-.
78615 NAPLES DRIVE ' 9018
LA QUINTA, CA 92253
(760) 772-0222
(760) 772-0257 FAX
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TO: Apex Interior Source r April 17, 2000
79-553 Country Club Drive, PROJECT: Bella Vista Phase 5
'Bermuda Dunes, CA 92201
Fax: 360-3167
Attention: Denise ► �; -
Lot & Phase: Lot'12, Phase'5C `3 Ship to: 78509 Torino Drive
Date Required : ASAP. La Quinta, CA '
tHomeowner: Coulson
Requested by` Rita
' Design Center- Cost Code:' 3186
Hours
Material /Work Required
Unit Price Total
Furnish�the following upgraded window covering
Premier. verticals tFiroughout '
$ 2,173:00
$ . 2,173.00
Rio White
17) Verticals
4) Horizontals ;
.
Horizontals with Privacy
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special conditionslinstructions:
Roger Snellenberge & Ass ciates, Inc.
By:
Cc: Design. ter
i
k
.TOTAL $2,173.00
ACKNOWLEDGE AND RETURN
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Apex Interior Source ,
By: r
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BELLA VISTA "
RELEASE OF RESPONSIBILITY.
tr FLOORING
I, Scott or Desiree'Coulson, purchaser of Lot 12, Phase 5C at Bella Vista
Homes, hereby acknowledge that by not purchasing my flooring through the
Roger Snellenberger Development Design. Center:
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1. The flooring allowance I will be credited in escrow is $2,348.00
2. Traditional Building Co., .Inc. is.only sanding -the standard the areas
(kitchen, entry, laundry). Any other floor prep is the responsibility of
the buyer or their subcontractor.
3. Traditional Building Co., Inc. has no responsibility to buyer as to any
cracked floor tiles, any leaks from toilets removed for flooring
installation,' or any other damage caused byiflooring installation.
4. Traditional Building Co., Inc. has no responsibility to .buyer as to�any
paint, baseboard or wall damage not noted at orientation.
5. This is considered a "Bare Floor" closing and the flooring will'not be
installed until after title has transferred and the escrow is closed.
Date: "04- I (2,100 ..,Buyer:-
Date:
.BuyerDate: , Design
•
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