9903-250 (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
Profes�onals Code, and my License is in full force and effect.
Lice i64 Lic. Class ` Exp. Date
4W234 33 , ��� 'W33i A)9
� "' f%
�D 'ate '"? ignature of Contrac�or� , / !;
r 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' construct the project (Sec. 7044,, Business & Professionals
Code).
( ) Lam exempt under Section B&P.C. for this reason
Date Signature of Owner a
WORKER'S COMPENSATION DECLARATION
• n
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'
R
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
(W� I have and will maintain workers' compensation. insurance, as required by
Section 3700 of the Labor Code, for ttie,performance of the work for which this
permit)s issued. My workers' compensation insurance carrier & policy no. are:
Carrier - Policy No.
S'ile 1Q) r,: t;155-98
(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.Ahould become
1.
subject to the workers' compensation provlsflons of Section 3700 of the Labor
Cod I shall forthwith comply
p with, those provisions.
ARts-111 t'
L
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 tdthe 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 notcommenced 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 above-mentioned property for�inspection purposes., fr
Signature (Owner/Agent) Date11_2 _/`
V
BUILDING PERMIT ?ERMIT#
DATE VALUATION LOT TRACT
JOB SITE __ g���
F`�-��%-0.�
APN
,==rr
ADDRESS "7 TOWN()
�1v11� R
OWNER
CONTRACTOR / DESIGNER / ENGINEER
THE UNC"HAN01 ' 0t.OLIP
RIMER SNi�/€1..3xt1 B RG.ER &A.LS'80C.
8-615 NAPLES R
7$615 KAPLES DRIVE
LA QLil NTA. CA MMI
l.i1.QCs1WYA CA. 92153
(760)712.0772 CBL # 1858
USE OF PERMIT
MOLE FAMILY 1:AVELI. NG
`
Wi�"uls(*,
PIC)OL. PLAN Cl- EC FFE !tECiil(:ED 73-4 ir<'C;d'( K4MA 1i?LE ISSUANCE OF
SAlvf.E PLAN llePh
i,,R.A.w;7.CO•n:i1ar ri.oN 1,83 .00 SF' /
,
PORCH!£ ATIO 761X1 SF
0,AR.A1Q..1:JC;xtiftta0JV1° 4090) SF
ESTs'e` ATEM COST OF CONSTRUCf TON
103,613.40
1% RMIT F'U.E SGAIMW
C,ON.T:tRUC'6'1.rON FL'r .101-(110 4184 9A $671.00
P1. AAf 101401-434-11R $1138 86
!';GCI Alw' CAL FEE 101"000-421-000 00
ELr-,C7Fd_1CAL FEX- i lv000_420_000 6120,87
RLt'1Pcf[lING F 17h 101-000419-000 SP 34.7
S'6'? at,S(Y Af()T!C;)N Fi7f,- RES 1117) ,it`ll,-f1()li ?41-(0,)
iP:J�t}!'l�I�",a' , +e 1�Y•�l�11�4�3�iQ('d �:L�,.tft)
Aftr IN PUBLIC* PLAC'L:S - R F,.'•11" 703.A)W-2554)00 321.53
S(f!Y Yc7T'? Lt`"t'RUC_1J0N AND PLAN fifF%r;.CK
LESS MFUE-43AiD FEES
$0.00
/71
^� M, rf
RECEIPT ,/
DATE
BY y%
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE.
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Slab Grade
Ducts
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
OX to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
C. 64
Drywall - Int. Lath
sed
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
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
$6
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure -
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
7 7
Encapsulation
Gas Piping
— 49
Gas Test
Appliances
Final
COMMENTS:
,•
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring 07
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
i
li'i
ROGER SNELLENBERGER DEVELOPMENT PURCHASE ORDER #
78615 NAPLES DRIVE 2255 '
LA QUINTA, CA 92253
(760) 772-0222 -
(760) 772-0257 FAX -E
TO: Apex Interior Source November 5, 1999
79-553 Country Club Drive PROJECT: Bella Vista
Bermuda Dunes, CA 92201 `
Fax: .760/360-3166
Attention: Denise 1
Lot & Phase: Lot 5, PKase 5 Ship to: 78565 Torino Drive
Date Required, ASAP La Quinta, CA
Homeowner: Bernstein -
Requested by: Rita
Design Center
Qnty Ord'd
Material % Work Required
Unit Price Total
Furnish the following upgraded window covering -
+
Premier verticalsthro_ughout
$2,173.00.
$2,173.00
Rio White
16) Verticals
4) Horizontals'
Horizontals with Privacy
TOTAL
$2,173.00
opeciai %,onaitionsnnsuuctions:
Roger Snellenb rger Developrr(en
CC:
t
/At,r%NUVVLtUUr- ANU Kt I UKN
Apex Interior Source
By:
MOV -05-99 FRI 10:50 WESTERN INSULATION.. FAX NO. 9096888786 P. 06
WESTERN INSULATION""
v.INCo
4211 Latham Street. Riverside, C"oraia 92601
(909) 6868760
(909) 6864786 F;ut _
INSULATION CER CATS .
THIS IS -TO CERTIFY THAT INSULATION HAS BEEN INSTALLED IN CONFORMANCE WITH THE
CURRENT ENERGY REGULATION, -CALIFORNIA ADMINISTRATIVE CODE, TITLE 24, STATE O.F.
CALIFORNIA, 1N THE BUILDING LOCATED AT:
TRACT/ PHASE: BELLA VISTA -PHASE 5A TRACT #: 28458-1
LOT#: 5 r
SITE ADDRESS 78565 TORdNO DRIVE,.LA OUINTA,,CA.
EXTERIOR WALLS:
NOTE: OFFICES
MANUFACTURER: JOHNS-MANVILL& THICKNESS: 3518- R -VALUE: R-13
C_ EIIal.NCS : ATTS BLOW '
MANUFACTURER: JOHNS -MANVILLE THICKNESS: 1.:" R -VALUE: R-38
C LINOS : BATTSly, LOW
MANUFACTURER: GREENSTONE- THICKNESS: 10.3" R -VALUE: R-38- ,
GENERAL CONTRACTOR; ROGER SNELLENI3ERGER .
LICENSE NUMBER: -
BY:
A
TITLE:
DATE:
-INSULATION CONTRAC-lb WESTERN 1NSULATION;.INC. ;
LICENSE NUMBER: 481278 "
BY:
TITLE.P oduction na ,!r
DATE: NOVEMBER 5,1999 '
Traditional Design Center Pui-rchase. Co'
ntraC
S White Sun Way
`DATE ) CONTRACT:..
Rancho Mirage;, CA 92270
9/21/99 C-BV5/5-02"
(760) 674-1188 Fax (760) 674-1668
Amy Berristein
44089 Oran Court (00"kPY
Palm Desert, CA 92260
(760) 7664945
(760) 836-3680
PROJECT LOT/PHASE PLAN C.O.E. TERMS
i
BELLA VISTA' 5/5 2 10/22/99 Due on receipt
AREA DESCRIPTION QTY UNIT �- RATE AMOUNT
Throughout Enamel Baseboards 1 ea 215.00 215.00 i
Various Tile-B-IMO-Magiara Beige #43B 17x17 3,320.00; 3,320.00
Grout- H Sandstone.#76747
Carpet-Bayview-Spun Sugar N/C 0.00
Pad 3/8" 51b
' Flooring Credit I -947.00 I -947.00
BR 3 i Std Verticals N/C
jw
5
inA
Signature Date
have read understood- Total $2,588.00
o and signed the attached Condition of Sale Agreern