9903-249 (SFD)LICENSED CONTRACTOR DECLARATION
Itiiereby a';tim under0enalty of perjury.that I am licensed under provisions of
Chapter 9 (chmmencing with Section 7000) of Division 3 of the Business and
Profe;:sionals.Al�de:and my License is in full force and effect.
Licen `ems _ Lic. Class Exp. Date
498234
t
Date of ��•7 Signature of ContractoY • r ���
OWNER -BUILDER DECLARATION
Ihereby affirm under penalty of,perjury that I am, exempt from.the Contractor's
License Law for the following reason:
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
O. I am exempt:unde'r 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:
(`) 'l have and will maintain a certificate of consent to self -insure for workers'
compensation; as,proJided for by,,Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
` (y)�.1 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.
y-`t�T FUND Fr .6355 -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 soyas to become subject to the
workers' compensation, laws of California, anclo%ree that if I should become
subject -to the workers' compensation provisions of Sectio}t 3700,of the Labor
Code, l shall forthwith complywith,those•pro isions./f
Date: Of �an
' Applict '`, •, s ��'/V >
TZ
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.,
IMPORTANT Application is hereby made. to the Director of Building and Safety
?`for. `a permit subject • to the conditions and restrictions set forth on his
application.
' 1. Each person upon whose behalf this application is made & each person at
Whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold -'harmless the City of La Quinta,, its officers, agents and employees.
2; Any permit issued as a result of this application becomes null and void if
:work is. not commenced within 180 days from date of issuance of such
;permit;•or cessation of work for 180 days will subject permit to cancellation.
I. certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Sig ature . (Owner/Agent)- =Y_A / „ ' Date / % 4
BUILDING PERMIT PERM T#
DATE ` VALUATION LOT TRACT
A/ ",/ a ,�a€4:1io r` 4 i ;f8459-4
JOB SITE '
ADDRESS t, x,=573 TOWN • .OffiVF1
APN
609-070-03
OWNER
CONTRACTOR/DESIGNER/ENGINEER \
THE EXCHANGE (,"MOUP .
ROGER SWRAIE-NHERC'd•Eft &MSW. '
•78-61-5 NAPt.ES M
711615 NAMES DRIVE
LA QWMA CA 92253
1A CJTWA. qt 9,2253
(760)772-022.2• UM IM_
f
USE OF PERMIT
,NG
SINGLEFAMILY DY7.
r
1.OT 4..PLAN 5AR. SM .r✓ "UT.f OR414u'T MCLUDE BLOCK Wiu.s
OR POOL. PLAN t:HJXK .F07. R RL!*.I">I,1CM, 7 -Wo FOR:A9:£,iLTIPLE? ISSUANCE, 0F - -
SAME PLANTYPE. � 1
iimcT coNsTav& ioi i 2,400.00 31+
i'vl"c.E:4°US'A`f`1s� IFrO.Ui► S
Gti1rtACkEICt>I21�Gk'I' 449,00 -SP
.1,V,8T1VA'TVD COST OF CONS11WC-f ION
141,24,41.40
C014WrRQC r1G+'I<• FEE 1€11.400-4111-4)00 5785.50
P1,..AN014U'ICK.I -T,1;• 101-000-439-318 <$X6t.aS
MECHANICAL Fhfs 101 -OW -421-000 $60.00
ELECTRICAL FEE 101-000-420.000 S141.48
P1 OM13I NO tE 101 -OW -419-000 $140.75.
STRONt 10�f3`rION1, F'.'tCO .tOI.-O�t1-24fYU 0 �a ..12
Ot2A�'itN�+ t�l� fClt-SI{10��123-001'1 $2t3;�0
- . ,- -
f NFR"I'RUC'i`URE 14% 22-5-000-44:3,342 $3,130.21
AWF IN M13LIC PLACES - COL, : 201-f)#?ti-255"000 $103.12
1B-7�!:'A4. SON -S r�r�rCMON ANg79 PJ�rAN CM
sA�CTy:e�K�1
$4,4%s�''�1,1��rf5�i
�� t y;j i�
WFAL 1PURUff FECS WE NOW
u, Ss S. 16
_ A
RECEIPT, j /q ,.
DATE�j //)f�{��Fry"
s! i
BY 1� rid f
DATE FINALED
INSPECTOR
t-
l S t
tL
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING ' APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Fort- s &Footings
Slab r;rade
Ducts
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
0. K. to Wrap / Q
F.A.U.
Framing
Compressor
Insulation Z B
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath —Z
Drywall - Int. Lath_g� d
Final
Final '�'� - +E;r _46
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
I 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
Pool Cover
Sewer Connection
Encapsulation
Gas Piping • fj_
Gas Test
Appliances
Final
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. or
Smoke Detectors
Temp. Use of Power
Final 01
Utility Notice (Perm)
COMMENTS:
NOV-05-99 FRI, 10 : 49 WESTERN *INSULATION w F�{ N0. 9096868786
P. 05
l
WES11ERN INSULATION
t
_ 4212 Latham Street, Rivezvide, California 92601,
r
F (3091686.8760
t (909) 686-8786 Fax
• �
ti t
k 9ty ULATION CER" CATS,
THIS IS TO CERTIFY THAT INSULATION HAS BEEN INST,kLLED IN CONFORMANCE
WITH THE
CURRENT ENERGY REGULATION, CALIFORNIA'ADMINISTRATIVE CODE, TITLE 24, STATE OF
CALIFORNIA, IN THE. BUILDING LOCATED AT: a
TRACT/ PHASE: BELLA VISTA—PHASE 5A r TRACT #: 28458-1
'
LOT#: 4 ,
SITE ADDRESS:., 78573 TORINO DRIVE, LA QUINTA, CA.
EXTERIOR WALLS:
NOTE: OFFICES
'
MANUFACTURER: JOHNS44ANVILLE THICKNESS: 35/8 R-VALUE:
R=13
EILINGS : 6A7TS BLOW
MANUFACTURER, JOHNS-MANVILLE,, THICKNESS: 1;" R-VALUE:
R-38
CEIL_ INGS :. - BAITS BLOW
MANUFACTURER: CREENSTONE . THICKNESS: 103' R-VALUE:
R-38
•GENERAL CONTRACTOR:_~ -ROGER SNELLEN'3ERGER
LICENSE NUMBER:. ,
BY:c
TITLE:
DATE:
•INSULATION CONIRACtOR: WESTERN INSULATION,•INC.
LICENSE NU R: 481278 ,
BY. G
+
TITLE;.roductio Ma ager
DATE: NOVEMBER•5,1s399.
ROGER SNELLENBERGER DEVELOPMENT PURCHASE ORDER # Lr
78615 NAPLES DRIVE 2254'
LA QUINTA, CA 92253
(760)772-0222
(760) 772-0257 FAX
TO: Apex Interior Source 7. November 5, 1999•
79-553 Country Club Drive PROJECT: Bella Vista
Bermuda Dunes, CA 92201
Fax: 760/360-3166
1
Attention: Denise
Lot & Phase: Lot 4, Phase 5. Ship to: 78573. Torino Drive
Date Required ASAP La Quinta, CA •,
s Homeowner: Cathern
Requested by: Rita
Design Center .
Qnty Ord'd
Material / Work Required 31
Unit Price Total
1
Furnish the following upgraded window covering
'
Premier verticals w/soft flow valence
$1,926.97
$1,926.97
Berkley, Alabaster
1 1)Verticals
6) Horizontals
Horizontals with Privacy
TOTAL
t
$1,926.97
' v'/c�oVI.7I JY YM4 VII.l.
Roger Snellenberger Developme t u
CC: i n Cent r ,
M%,MIYUVVLCUbC Fi1VU RC 1 UMN
Apex Interior Source
By: