9903-251 (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.
Licem j # . {' Lic, Class Exp. Date
4SK3 1 i 3 / Cil
..''/
7
/Dale � � /Ji
Signature of Contractorry(-41
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
(J 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 Secy n B&P.C. for this reason
Date. Signature of Owner
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the foliowing 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
Se
�tion 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 -,7 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. %
D te; til nCF� Applicant -
Warning:
a .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
additiori 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 lawsi relating to the building
construction, and herebyauthorizer4resehtat v ep of this City to enter upon
the above mentioned property fo`r^inspection ur ose's.
r ose 126A
nature (Owner/Agent) +✓ v Datel
PERMIT #
BUILDING PERMIT.��,_
DATE n I,,, VALUATION $141.. Q �r LOT 14� — TRACT ?84%1
JOB SITE (
ADDRESS *WS 17 OAA ;11RIVII
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APN /� <
( ��fj • o (Jft ✓ (J
QC,/ t
OWNER
CONTRACTOR/DESIGNER/ENGINEER
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ilt"'1'''t'•'P h'�'tt.'I IET�.P,�;'tJi''"17 j:1 '+: �CfOY�
l,i, ASSOC,
JO`ti.l) reF�k l+t+t31�.IC
WiB NAii
LA QUIN` A t,A -42253
JA, Q SIN iA CA 42253
i7ri(iR7 7 -il � '1, COM 'i tiff{
USE OF PERMIT
ii4fil.f: i?A&ia3�'Y`f3lVEsL'{.liiit;t.
LOT u. PLAN 51-�, SFU a4c.Li:. ir'. 'nf,OC +i m.us t_rt`".
.(?4,X.A_ -VLAV e fiLOK A 1IE1Ui1.A CUD °i?'90 1001'C N1UL,'{'iPL 1tSSUANCH OF
: ANV PLAN `! IYPF.
iI
ikJFP4:I:It"[?i1.`],kti;9 {(;Sj.{tf1 u1:
44fr,00 8F
pitftfly SUMMARY
C0 N181PRU`C: P3N rfi i{)i-4#3ii-X31.1 - t)L► $"It1t�. i1
('f jr .9 re f 91
.ME-0i.ANWA Fries 101.-.900424.0 0 SGIOX t
M Iit;'TRICf L (-'EE I0i-000-42"W y141.49
Tv.,1111Tt3 NO JIFF -13 101-000-4141.000 eS'103S
SITR `)1v(l 1r(0T!0N .- Rl an rt1(: flOf)„ :?<1-??.tnl -o14 1?:
MIADINr. 1.1M, 1.01 000421000 $14).00
1'1yT")'tA.=5TRU .T(Arr POE 225-000,4443.342 i
.ART (M.PtU13.LIQ PLACE - L1W s_W '101-OW255-1(m x:103.12
11 ti7-"{Y1•t'A?, i (» t'( KTrff;1N r�idr` P1 • A�; i';t1:F'
Ili
LESS, PRE. -PAW) -US
TOTAL .6'1} 1tl1'$ff .e EWE 01.)!? i OW
�9,�h31:,1a<1i
,n'f
RECEIPT
D&ES � (,j� �
BY � �F /4I
DATE FINALED
INSPECTOR'
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
Ir BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab tirade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
Z 9
Compressor
Insulation
6
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath_
Drywall - Int. Lath
_3-9 61.4-
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 -- Z _ g
Utility Notice (Perm)VD-9-0-9"Y 46 '
3B
ROGER SNELLENBERGER DEVELOPMENT PURCHASE ORDER #
78615 NAPLES DRIVE 2250
LA QUINTA, CA 92253 , {
(760)772-0222
(760) 772-0257. FAX ,
TO: Apex Interior Source f , October 29, 1999
79-553 Country Club Drive PROJECT: :Bella Vista
Bermuda Dunes, CA 92201 • �, { r
Fax: s 760/360-3167
Attention: • Denise
Lot & Phase: Lot 6, Phase 5 Ship to: 78557 Torino Drive
Date Required ASAP La Quinta, CA
Requested by: Rita Homeowner: Gremski
Desian Center
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
j
?""' ,•'i
Z.
r
.
TOTAL
r
$2,173.00
apectai Lonamonsimstrucnons: . AI:KNUVVLtUUt ANU Kt I UKN '
Roger Snellenber er Development Apex Interior Source
J �� . • By:
cc: De enter
F .
BELLA VISTA
RELEASE .OF RESPONSIBILITYP .
FLOORING
I,1VIr. Gremski,ypurchaser' of Lot 6,' Phase 5, 'at Bella Vista Homes, hereby
acknowledge that by not purchasing my flooring through Roger
Sneilenberger Development Design Center:
1.: The flooring allowance twill be credited in escrow is $1,490.00.
2. Traditional Building, Inc js 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, 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, Inc. has no responsibility to buyer as to any-
paint,
nypaint, 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: ;
Date: Desi Center.
4 ,
`0'r r. rii_9 M T �;•� , �+•�. T. - I 1 h. 1 I In i F rS'
1 �� 9 k! Fri WE',;I',ERX KS L•A'II01 .' Av' K , 16' 908,364/-_I
fi
'ERN"'INSULATION., S�U'LA T''ION., INCS
o
WES
4211 Latham Street, Riverside, CWHora{a 92601
(909) 6B6-9760
_ (909) 696-8786 Fa+t "
INSULATION'CERTIFICAYE '
THIS IS 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: B-ELLA VISTA -PHASE 5A TRACT #:28458-1
LOT#: 6
SITE ADDRESS:- : . ° 78557 T'ORIN0 DR., LA QUINTA, CA.
EXTERIOR WALLS: '
MANUFACTURER: JOHNS -MANVILLE THICKNESS: -3 518" R -VALUE;; R-13 .
CEILI GS i BLOW r.
MANUFACTURER: JOHNS" -MANVILLE THICKNESS: -13" R -VALUE: R-38
CEILINGS : BATTS BLOW
MANUFACTURER: GREENSTONE THICKNESS: ;0.3" R -VALUE: R-38
GENERAL CONTRACTOR ROGER SNELLEINBERGER
LICENSE NUMBER:
.�
TITLE: ..
DATE• t
,
INSULATION CONTRACTOR: WESTERN INSULATION, INC:
LICENSE NUMBER: 481278 �! t
TITLE: Production iiag r
y DATE: OCTOBER 29,1999
s