9903-252 (SFD)LICENSED CONTRACTOR DECLARATION
I4hereby 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 C621e, and my.License is in full force and effect.
License # - Lic. Class Exp. Date
Signature of Contractor+,
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law forthe 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
cohtractoes 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.
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.
(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 3700`of the Labor
Code; I shall forthwith comply with those provisions/
Date `
: /,16? c aI Applicant
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
bf 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
t 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
the abdve-mentioned'p (perty,for mspection)purppooses. / /
gl/.-,, ; �
ture (Owner/ ��' ""� Date llt,f�11
99
BUILDING PERMIT PERMIT#
DATE VALUATION LOT TRACT
S131,154.40 7 1 2 4 -1
JOB SI• E
TPN
ADDRESS 7 TO.RWO DR.MP, s
609 -070 -OU
OWNER
CONTRACTOR / DESIGNER / ENGINEER
tl.,e.7.Fc\\,.1.LiiwiibOUP
\OG13R, likL[:d7:M1G1P,titNSO,
78-1151 IS NAMES R11
�1FW415 R&PLES DRIVE
LA QiJlWrA Q.;A 92253
LA QUM'A C::ti 9222
f+760Y171.-0227 CRI.f:
USE OF PERMIT
S1NiiL1^':i?"M•r<IL'i DWELUNti
List 7. !• U%N 4A; SIS D -P.—TAAMIT UES NO, T ,IN4.LUDE WLOM Uri1US OR
i`C W_jL. PLAN CHBUK FiX FOR Mf 11:11PLe ISSUANCE C
SAW PLAN 1A 1',K'
T A7'.iX7`1�`.�CINTS itUCTIOAY M2,00,00 yC
PORCH/ PATIO `, 110.00 SF
caAitA.i36::1CA.€tI>OIA`l� ..• 4'�>.c�u ��
PERM.117M, SUMMARY
CONS'I.RCX1. E10N ¢ f IU1.-(DUt3-4.1X-t)QEi J748.00
M AN CFifiC~h f1 t 01 <fj(}().4 } -31 3154.69
MSC11A111Crk.L FOE 1C!-iiOU 42l.«flU0 $60.00
ds.L3:t. fRICAL F110 101-000-420-000 S'04.92.
PLUMB..M0 ki l;' 101-000-419--000 $140,75
&MONl�T?iTD ! ()1-fl(Ii?-241-000 $13.02
Otft1 ING FLP 1111-000-423-000 $20.00
INFR&I�'3`12iJiCTUR:1J.Fka 2215-000-443-342, S2.f .546i
ART'IN POBLIC PLACES - RESID 701-000-255-000 V7539
81.,034017V, CON INK R1uj1"TION AND PLAN ("R CK,
$4,2142.33
LESS PRE -PAID FEES
$0.00
MIA(, (, PEk4M11T.@'ERN Dur, 'Now
54,242.33
.
RECEIPT._/r�
DATE
' av
BY I y
DATE FINALED
INSPECTOR'
t -I
ems.
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
a BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings /L
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
6
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
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
i
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 -97
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm) d i•—
COMMENTS:
Qnty Ord'd
Material /Work Required
Unit Price Total
ROGER SNELLENBERGER DEVELOPMENT -
PURCHASE ORDER #
78615 NAPLES DRIVE
22511. -
LA QUINTA, CA 92253
$ 1,260.78
(760)772-0222 -
(760) 772-0257 FAX
TO: Apex Interior Source
October 29, 1999
79-553 Country Club Drive
PROJECT_: Bella Vista
Bermuda Dunes, C.A.92201
Fax: 760/360-3167'
f `
Attention: Denise
Lot & Phase: Lot 7, Phase 5
Ship to: 78549 Torino Drive
Date Required ASAP
- La Quinta, CA
Requested by: Rita r
Homeowner: Thompson/Kriegel 4 '
Design Center
TOTAL
$1,260.78
Qnty Ord'd
Material /Work Required
Unit Price Total
Furnish the following upgraded window covering:
'
Window coverings - Berkley, Alabaster
$ 1,260.78
w$1,260.78
14 verticals
1 ,
,
TOTAL
$1,260.78
Special Conditions/Instructions: ACKNOWLEDGE AND RETURN
Roger Snellenberger Development` f Apex I nterior Source" i
>ccr Des' Center ,
'JG" -29-99 FRi �. a RM WE jF.RN I�S7i P,'� IO�i `�,d.� � 0. i6:9ES3�4?5 F. 3
TES' E1�rT Iii I�L,A'T'IONJI - INC.
} w 4211 Latham Street, Riverside, (,alifornia 92601 - -
(909) 686.8760 ;•.
„ (909) 686.8786 Fbx
` INSULATION CERTIFICATE
THIS IS.TO CERTIFY THAT INSULATION HAS BEEN INSTALLED IN CONFORMANCE WITH THE
CURRENT ENERGY REGULATION, CALIFORNIA ADMINISTRATIVE CODE, TITLE'24, STATE OFT
CALIFORNIA, IN THE BUILDING LOCATED AT:
TRACT/ PHASE: BELLA I/ISTA-PHASE-5A•• TRACT #:28458-1
LOT#: 7
SITE ADDRESS: 78549 ;;ORINO DR., LA QUINTA,, CA.
EXTERIOR WALLS:. ,
MANUFACTURER: JOHN5MANVILLE THICKNESS:' 5/8" •R -VALUE: R-13,-
CEILINGS : BLOW
MANUFACTURER: JOHNSyMANVILLE THICKNESS: .,3" R -VALUE: R-38
CEIL G : BATTS B L 0
MANUFACTURER: GREENSTONE THICKNESS: - '10.3'• R -VALUE: R-38 "
GENERAL CONTRACT JR• ROGER SNELLE!\jBERGER
LICENSE NUMBER:
TITLE:
DATE
INSULATION CON�LIM: WESTERN IINSULATION, INC.
LICENSE NUMBER: 481278 a
DATE: OCTOBER 29,1999
onal Design',,
e Suri Way
Jbo Mirage, CA 92270 i
a
.V 674-1188 Fax (760) 674-1668
J & S Floors, Inc.
16872 Hale.Avenue, Suite A
Irvine, CA 92606
(949).442-7890 Fax (949) 442-7891
Pager (949) 733-4681.
Purchase
Order
DATE
P.O. NO..
8/12/99 I
2596
7/5 BVISTA '
4
LOT/ PHASE i
PLAN
C.O.E. (CLIENT NAME i
i P.C./INVOICE NO.
7/5 BVISTA '
4
9/29/99 I THOM:PSON
1562-081299
AREA
ITEM
! DESCRIPTIONi
.
QTY
I UNIT !
RATE
AMOUNT
1
; CONTACT PAUL FERGEN
I L_..._._.._........_-
......I
._..._.....- ....
.
' @360-9879 FOR SCHEDULING AND
j
AVAILABILITY
I.
'
FStdAreas
14`
'Tile -Lucca 12x12
i 309
i a/f.
3.85
I 1,189:65
Per Diagram
; 14
:. .ITile-Lucca 12x12
797
s/f !
5.00
3,985.00
` Grout -Antique White
Per
Per Diagram
14
' }
3' 6
! 1/f
28 ;09
f6854 -
Per Diagram
14f;Carpet-Bayview
�Listello-PLM-201
s
Cashmere'Bisque
.
I 126
I s/y. 's
6.00
I 756.00
14
-'Pad-1/2" 61b
126
I
s/y : ;
3.00
378.00
A'17AC11 A COPY OF THE
PURCI 'ASE ORDER TO THE
CORRESPONDING INVOICE AND
SEND TO'THE DESIGN CENTER AT
THE ADDRESS ABOVE
ATTENTION: RITA PURSLEY
DATE
g� 9 Total $6,477.;9
° D