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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 ,