9904-113 (SFD)a
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
488+34 J3
Date It l ` d r Signature of Contracfor - / ✓ �� ,f
OWNER-BUILDER,DECLARATION
1 -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 construchhe •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 8700.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 i /�.`.e'I . TNO 6'6355-513
(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 worke.rs'.compensation provisions•of Section 3700 of the Labor
Code,.-[ shall forthwith comply with, those/,provisions.
Date. {_ ���• • with,
°�- - �• �-
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000,•in
addition to the cost of compensation, damages as provided for in Section 3706
of the'Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the.Director of Building and Safety
for a' permit subject to the conditions and restrictions set forth„on his
application. -
A, Each person upon whose behalf this application'is made & each person at
whose'request•and for whose benefit work is performed under or pursuant to
;. any.permit issued as a result of this applicaton agrees to, & shall, indemnify
„. & hold harmless the City of La Quinta, its officers, agents and.employees.
2. Any permit issued as a result of this application becomes null and void if
work' is. not commenced within 180 days from date of issuance of such
permit, or cessation of work .for 180 days will subject permit to cancellation.
I certify that l have. read this application and state that the above information is
correct: I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the
ababove-mentioned property f�inspection purposes`..
Si' nature (Owner/Age ) --7. A Dated y la 8:
BUILDING PERMIT PERMIT#
t
DATE VALUATION LOT i *� TRACT
cf
JOB'SITE' ' I
ADDRESS V U:533 1*0 0Ny D91W, ,
APN _
i► i ••� PI� �8.);�
OWNER
CONTRACTOR / DESIGNER / ENGINEER
THE i::Xt"HAN10f GROUP
'R, 0 GE t S;I'FI,Lr,. N B8RCIC, R h3. ASS t -)C:.
78-615 NAPLESDRAT
LA Q171WN CA 92253
LA. QUIKIA. CA. 02253
CB119 18.1%
USE OF PERMIT
SUNGLE P.AN ILY ISyMIN63
SFD id:>'T V 9, PLAiN 21311, FIFERMIT DOES NOT INCLUM BLOCK WIWI
OR. P001,
TRAC r'"CW5TRUC” 4(, N 1,834.00 aI,
PORC1'.i11'.ATIO 76.00 SF
C1ARAOk: CARPOFf 409.00 SF
UTUMA T ED COST OF CONSTRUCTION
1€3$,611.3.441
CONSTRUCTION, E 1111. -0W-418-00 $671,00
C.HEt'K T."W 10140-4314-118
Alt -C, LAICAL VM lilk-ti(ila-4i .P a4 3,1 .00
c aXcs l WAL Mc 1,t?,I-t1Ci�-�i24-U0Cf $ 20.8'7
PLU"4M,CI FEX 101. -OW -419-000 $.104.74
ITRf;ltvji3 ktt�T :IC)1V i Gip r - 'R t7tii]f� 101 •-11(t�.74'1-11 n
NOR N'7i G FEE 10140-423-000 $213.110
it's FRA,9T 7tic"iURii .F1 225-0130443-142 S2,42` L06
jWf IN f?IJk9l.I KACES - RE -SI ; 70 -000-25S-u00
9U T{.!''AI,t"ONSI'{eQC'• ON A;NV)PIAN C11F'.
$4,002.44
LESS ME -PAID FEES
$0.00
RECEIPT,),.. ; t
DATE `
LAtt
BY 77
DATE FINALED
INSPECTOR
,f �k.
` .,
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings d
Ducts
Slab Grade
Return Air
Steel 7
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap 6 1
F.A.U.
Framing
Compressor
Insulation — G
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath g /7,9 6'
Drywall - Int. Lath
Final
Final f —
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
Neater 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
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final v —
Utility Notice (Perm)
COMMENTS:
~
DEC- 3-99 FRI-. 3:52 AM WE:;T'ERN IN,sULAll, ION A NO. 1:6' 36811'.6425
�.
.. WESlrERN . IN SU'L.kTI0N, IN C o ,
4211 Latham Street, Riverside, Califoraie 94601
r (9091 68641760. ..
'•x < .�'. .fir, (909) 686-8786 Far
INSULATION CERIIIF E
THIS IS TO CERTIFY THAT INISULATIO�y'_HAS BEEN INSTALLED IN CONFORMANCE WITH THE ?'
CURRENT'ENERGY REGULATION, CALIFORNIA ADMINISTRATIVE CODE, TITLE 24, STATE OF: v
CALIFORNIA, IN THE BUILDING'LOCATED AT:
TRACT/ PHASE: BELLA VISTA -PHASE '5 TRACT #:28458-1,
LOT#: . 9
SITE ADDRESS: 78533 TORINO DRIVE, LA QUINTA, A.
EXTERIOR WALLS: -
MANUFACTURER: JOHNS -MANVILLE THICKNESS: 35/8 R -VALUE: R-13
CEILINGS : _ TTS BLOW
MANUFACTURER: JOHNS -MANVILLE THICKNESS: 13" R -VALUE: R-38
CEILINGS: BATTS B W
.MANUFACTURER: GREENSTONE 4 - THICKNESS: -.10.3" R -VALUE: R-38
GENERAL CONTRACTCOR: ; ROGER SNfELLENBERGER
LICENSE NUMBER: =
'BY:
TITLE:
4 DATE: • � ,• - �. � � -
INSULATION CONTRACTOR: WESTERN INSULATION, INC. t
LICENSE NUMBER: 481278 _ J
a
BY:'c
TITLE:. VECEMBER
cti M Lager
DATE: 3,1999 -
Hours
Material /Work Required
Unit Price Total
Furnish the followirig upgraded window covering
ROGER SNELLENBERGER & ASSOC.; INC.
PURCHASE ORDER #
78615 NAPLES DRIVE
LA QUINTA, CA 92253
k `.
(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
Fax: 360-3167
Attention: Denise
Lot & Phase: Lot 9, Phase 5
Ship to: 78533 Torino Drive
Date Required ASAP
La Quinta, CA
Homeowner: Wiley
Requested by: Rita
$1,954.00
Design Center
Cost Code: 3186
Hours
Material /Work Required
Unit Price Total
Furnish the followirig upgraded window covering
Premier verticals throughout
$ 1,954.00
$ ' , ,n 1,954.00
Rio White
13) Verticals
6) Horizontals
-
Horizontals with Privacy
t
TOTAL
$1,954.00
opeciai �,onaluonsnnsuucuons: " /AL r%NVVVLtUUt HIVU Kt I UKIV
Roger Snellenber er �Associat �esIn�c. Apex Interior Source
VT By. i
Cc: Center -