9904-115 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter 9 (commen6nb with Section 7000) of Division 3 of the Businegs and
Prbfessionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
."At
Date *1111 t4i Z-- Signature of Contractor` 41
7)
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
(,)' 1, as owner *oVthe 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).
( ). 1, as owner "of. the, property, _am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
am exempt under Section B&P.C. for this reason
Date Signature of Owner
X
WORKER'S'COMPENSATION. DECLARATION
I hereby affirm under penalty_.of perjury one of the following declarations:
O 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 ( ) I have and will
maintain workers' compensation insurance, as required by
� V,
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).
-1 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' Sectib ' n 3700 of the Labor
Code, Ishall forthwith comply with,th?Se'pr6visi6ns.
Date: Applicant—,
IF
Warning: Failure to secure Worker;' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000' in
addition to I 'the cost of compensation, damages as provid*ed'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. t
.A. 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
anj-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, authoriie representatives of,this City to enter upon
the abo've-mentioned property for, inspection-purpos
,Signatuie (Owner./Agent) D a t
BUILDING PERMIT PERMIT #
DATE VALUATION LOT TRACT
1
/.1 -14 -AQ
JOB SITE ' ' I '
ADDRESS l-&-517 TOMNO DPJ%Ti
APN
OWNER
CONTRACTOR/DESIGNER/ENGINEER
IBM C, t"Ciul,
ROGER RITHA-ENRERGER ASSOC.
78-61-5 NAPLES -CA
'79-615 NAPLES DUNE
LA O , I I WA. CA 92253
LA QULWVA. CA. 922-53
(76077M.2-17 CROV VIM
USE OF PERMIT
8INGLE FAkftLY DWELLIN61
SM LOT 011, PLAN 4A, PERMIT DOES N01'DidLUM BI. iX is WALL OR
Pool-
17ZA,C,r CONSTRUCTVDIN Z -200M SF
P.-MCHAIATIO' I10.00 W
47t -W qF
F-MMATIE'D MT OV COMSTRUCTION'
130=4.60
PFLUMff
COINSTRUCIIION FSE 101-000,418-M
Pl"Alq CF_Er.XFPF S6 I R 74,
PMICUANICAI.F-M,
151ECTIUCAL FEI.E. 101-000-4.204)0
I'L(MRINO FCC 101 -M* -419-000 $140.75
GRADINO M -M 101.000423-000
f MrRASTRUCTUREIF M 225,0W443-341
AWf IN PILIMAU PU\C.88 - VJ,38.113' 701 -M-253-000 $75.39
SURM)TAL C0NMUCrION AND PLAN CHECK
$4,700338
LESS M -PAID FEES
$0,00
"LIEN0W
TOTAL PVRMIT FERS O
$4,706.38
FRECEIPT-_
DATE
BY/DATE
3
FINALED
INSPECTOR
A
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs t,
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
j
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
o
F.A.U.
Framing
.. Z,19
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
�_ Q
Drywall - Int. Lath /,x,¢(47
Final
Final ^Z--
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
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
-17 /11
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas) 7_ Z —
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 o —
Utility Notice (Perm) Z — Z — Or
COMMENTS:
• r
WESI'ERN INSULATION INC.
42,11 Latham Street, Riverside, California 925o1
'(9091696-8760
(909j 666-8'786 F.ax
' INSULATION CERTIFI_ CA,TE
THIS IS TO CERTIFY THAT INSULATION HAS BEEN INSTALLED IN CONFORMANCE WITH
THE
CUR.RENT ENERGY REGULATION, CALIFORNIA ADMINISTRATIVE CODE, TITLE 24, STATE
OF
CALIFORNIA, 1N THE BUILDING LOCATED AT:
TRACT/ PHASE:.. BELLA VISTA -PHASE 5B TRACT #.'2845&l,'
'
LOT#: 1
-SITE ADDRESS: 78517 TORINO DRIVE, LA QUINTA, CA.
EXTERIOR WALLS:
NOTE: OFFICES :
MANUFACTURER: JOHNS 1VIANVILLE THICKNESS: 3 5/8 R -VALUE: R-13
CEILINGS.: BLOW
... ATTS -
MANUFACTURER: JOHNS -MANVILLE THICKNESS: 13" R -VALUE: R-38
;
_ CEILINS1S ; BATTS •� LOW
MANUFACTURER: GREENS'fONE THICKNESS: 10.3" R -VALUE: R-38
.GENERAL CONTRACT01t; ROGER SNELLENBERGER
LICENSE NUMBER:
BY: w
TITLE J
;
.:.DATE
'
INSU TI CONTRA TOR: WESTERN INSULATION, INC,
LICENSE NUN
IQER-481278
r
r'
BY:
'TITLE: roductio luta ager
DATE: OVEM Bt R 5,1999 ,
y
BELLA VISTA ;
W. RELEASE OF RESPONSIBILITY
FLOORING
I, Dennis Carbone, purchaser of Lot 11, Phase 513 at Bella Vista Homes,
hereby, acknowledge that by not purchasing my flooring through the Roger
Snellenberger. Development Design Center:
1. The flooring allowance I will be-credited in escrow is $2,486.00
2. Traditional Building Co:; Inc. is only sanding the: standard tile 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
nycracked floor tiles, any leaks from toilets removed for flooring
installation, or any other damage caused by flooring 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:
LL Date: // 1.Buye
Date:
:'11 bql, Desig nter: • v� ,,.
'� ``
Hours
Material / Work Required
Unit Price Total, .
Furnish the following upgraded window covering
ROGER SNELLENBERGER & ASSOC., INC.
PURCHASE ORDER # '
78615 NAPLES DRIVE
2271
LA QUINTA, CA 92253
(760)772-0222
(760) 772-0257. FAX
TO:., Apex Interior Source
November 29, 1999
79-553 Country Club Drive
PROJECT: Bella Vista Phase 5
Bermuda Dunes, CA 92201
TOTAL
$1,361.00
Fax: .360-3167
Attention: Denise
Lot & Phase: Lot 11, Phase 513
Ship to: 78517 Torino Drive
Date Required ASAP
La Quinta, CA
Homeowner. Carbone
Requested by: Rita
Desiqn Center
Cost Code: 3186 -
Hours
Material / Work Required
Unit Price Total, .
Furnish the following upgraded window covering
Premier verticals throughout
$ 1,361.00
$ 1,361.00
Fresno White
15) Verticals
TOTAL
$1,361.00
apectat onaiuonsnnsuucuons: AL r NUVVLtuut ANU Kt: i UKN
Roger Snellen erger & Associa`telnc. Apex Interior Source
By. 3 r a
Cc: n Center
t ,