9904-112 (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
Y- d
Date Signature of Contractor .)L
/ i! '
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.
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:
Lanier Policy No.
S,TATE I!L 6762155 _911
(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 3 y00 of the Labor
Code, Is
h II forthwith comply with -those provisions.'
Date: i-1
Applicant—
Warning:
pplicant
r... .. .,vim,,..
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.
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
th "above-mentioned property for inspection purposes!'
Signature (Owner/Agent) y�;'"� �`� % �/ a^, Date
,PERMIT #
BUILDING PERMIT
DATE VALUATION $,141'2¢13,40 LOT 9 TRACT tl1.0,11 A
JOB SITE I
ADDRESS 73-541 T;! 07RI O UWE,
APN
609-070-013
OWNER
CONTRACTOR/DESIGNER/ENGINEER
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io-111.3 NAPLES DR
78-61 N 10IX,S Dk11VE
LA QUINTA CIA 922,5 3
LA Q11fWrA CA 92.,!S3
USE OF PERMIT
SINtsi.,.E VAMIL1 Oi+vh'IXIN(i
410 110T as, PL, , iv 5iiii, i°iLlitvi£'t° DOES iNOf .tj` CLOTAiA..4. 0t;'K WALL
«„4iitl,it(I31
16()4k Sl;
t�A(EtRL£F�(:'Aitf'Lf}t`1' 4tly.ijt/ 8F
R�; I 4.:D S Int,(,IT L3N
f4L,1411.40
P1,11RI QVC FEE SUWAIxi►RY
CONS"(`RUC'('ION.VEY, 101 -000 -418 -WO
Fdf • AN 11TF. ! 0'"t(i(1_419-"3 t K
MtICHA.'*J1CIAL TITTI, 401 -rte -421-000 $60.60
#:Lc:C's.:li£C'AL M 101-tZt)1T-{320.000 8141.48
£'L1it�113f�1t'r �: 101.000-419-(34341 3.140.7+
T�t'p'VF.-RV,310 )()1 -("..?4140)
GRAMNO rte: 10.1,000-423.000 s ft,rta
i' FRAS' TR�i`:iMiE :i
ART 103. 11
ANT) K AN f:f4i�-(-'fi
i UA 014
1 XS -S PRE -PAID ( TEES
$0 019
i'(3'kAL L'EhMIX Fp;RS DUE, iVti4V
ss,(W.w)
RECEIPT
DATE
BYDATE
FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
r BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grana
S et
Return Air
Steel
Combustion Air
Roof Deck
/
Exhaust Fans
O. K. to Wrap
F.A.U.
Framing
Compressor
Insulation
6
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
./ . 9 C 1%;;Z–
Drywall - Int. Lath
9_ _
---------------
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
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
COMMENTS:
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)
ROGER SNELLENBERGER DEVELOPMENT PURCHASE ORDER #
• 78615 NAPLES DRIVE 2257 a:
LA'QUINTA, CA 92253' +}
(760) 772-0222 u
(760) 772-0257 FAX ,
TO: Apex Interior Source November 12, 1999
86695 Avenue 54, Ste L PROJECT: Bella Vista
Coachella, CA .92236
Fax: 760/399-1103
Attention: Denise
Lot & Phase: Lot 8, Phase 5B Ship to: 78541 Torino Drive` T.
Date Required ASAP La Quinta, CA
Homeowner: Loeser/Mallot
Requested by: Rita
Desian Center
;4
Qnty Ord'd Material /Work Required Unit Price Total
Furnish, the following upgraded window covering:
Premier verticals throughout $2,173.00 $2,173.00
Rio White
16) Verticals
4) Horizontals #
Horizontals with Privacy': -
TOTAL $2,173.00
Special Conditions/Instructions:. ACKNOWLEDGE AND RETURN
BELLA VISTA
RELEASE OF RESPONSIBILITY
FLOORING
I, Milo Malotte/Deborah Malotte Loeser, purchaser of Lot 8, 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 $2,348.00
T 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 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.
Date: Buyer:
f Date: Desig ente
. NOV-05-99 FRI 10', 52 WE:>TERN' INSULATION FI�k NO. 9096868786 P. 09
INSULATION, -WESTERN INC.
4211 Latham Street, Riverside, California 9250j.
i (909) 686.876a
.(9091 686.8786 Rax
INSULATION CERTIFICATE
THIS' 15 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—PHASE 513TRACT: 2$458-1
LOT#c
SITE ADDRESS, ` 78541 TbRINO DRIVE, LA QUINTA,"CA. K : _
EXTERIORWALLS:..
NOTE: OFFICES
MANUFACTURER: JOHNS-PAANVILLE THICKNESS:' 3 5/8 R -VALUE: R-1'3' < +.
CEILINGSATT'_ .' BLOW' -
MANUFACTURER: JOHNS -MANVILLE THICKNESS. 7 'R -VALUE: R-38
CEILINGS; BATTS BLOW �
MANUFACTURER:: GREENSTONE THICKNESS: 10.3" ;REVALUE: -R-38
GENERAL CONTRACTOR,_ ROGER SNELLEN:BERGER
,LICENSE NUMBER: „
BY: '• `
TITLE:
DATE:
INSULATION CO_ NTRAC r0R: WESTERN INSULATION, INC. '
'LICENSE NU R: 487278
BY: G
TITLE:roductio ger
DATE: NOVEMB 5,19'99