9903-247 (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.
LiOnse* " Lic. Class Exp. Date .
D te: 1^ L' 6 �� Signature of Contractor A/1 X
OWNER -BUILDER DECLARATION
I 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 & P.rofessionals 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 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.
FI-IND
(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 if4 should become
subject to the workers' compensation provisions of Section'3700 of the Labor
Code, Iksh'all,forthwi complywit.-thoseprovisions.
Dde:; `1�°i i � I° '� Applicanti� l.6r •1 C� (
V /... r
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the'Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a -permit subject to the conditions -and restrictions set forth on his
application
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& .hold harmless the City. of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
Correct. I agree to comply with all City, and State laws relating to. the building
construction, and hereby authorize rep esentatives of this City to enter upon
the above-mentioned prro'pperty'for'inspection'puurrp`oses.
,,Signature (Owner/Agent),ZIJZ 1
BUILDING PERMIT PERMIT#
"l3.$-.Ba17.
DATE VALUATION LOT ��I LOT, TRACT x:34^1
JOB SITE Y /_ ....gg�Qp,. - - - .
ADDRESS 17 q RI�+4�L'() �1 � rl.
Tv
APN/ fV�
bOc - > 70
OWNER
CONTRACTOR / DESIGNER / ENGINEER
rtlt7 tz��wet,�rtrr• (. nor f-fiD
1lll..,r(i
ti��nit'�r`r�''t f �S�t�rirtr3.r> � ����"
R.O.t..1.1 /Y.eSA1,. V1 Pay ..O,t R,i' f \, 1..-.
9615 UNKES upli
LA. 4; UIN t'A CA 9225.3
LA QUIN'1:t1, CA 92253
('760)7'i?.42722 19SR
USE OF PERMIT
LOT d, PLAN 2;1E';; 6145 -.PEkN ;l i i 0ES NC')1V :tN(::t V"-, ai:.O:l til. L i.S
t.ft K0L. PLAN 4"MAK'K VEE 109)11,103W 7Ylo f 0,R MU1.17t? E ISSIJ.FI CL.' 03^
5.016 PA. AN `i YPIL
I?Ci. (IJPATf0 1Q.00 3'F
t; EA3ias3WCAii1+F.5R.T 449.0ti SF1
c:Q?i i,R.UCf.lt_IE FUR 1.01-0{E0418.000 S`t86.aU
M1:avl. AN IC''A1a .I" PE 1131 k444421 -04I1 $40,00
f LEt"'i"tilG'AL 1"1slii 101•#i1M 420.009) $141,48
1111'tANl13tNO FEU 101-000-419-000 $140.75
^
KfR(YIJ(? Mn '.i�t;T f - int: I! Y 101.0 0-7,44-lJti€3 S1432
CJWY, r, 1-03 10116,00047MOO
E"Edi j'ASTRU:,"`jTi', R
.ART IN PUBLIC PLACES, -.# .041L 'i�l,t)!3U-:c1�5h11f►f) $.I.U�. is
`I''1:F3.1.Y"'1'.I,'M,C,t'iNS"r#tlICTIONAND K,rN iUC'I4fY*:F:
'tCti,'iSRIti.
1,8'SS PRE-11KID FECS
}t .00
' :VO AL PERM"., lilfl is iJ1. R No Y7
$4,5158.1.6
RECEIPT �/+���
DAT �j)rJr! (
BY ! , j
DATE FINALED
INSPECTOR'
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Form's & Footings
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
p
Final
Final
_ D—
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
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
Traditional Design Center
Purchase Contract
5 White- Sun Way
Rancho Mirage, CA 92270.
DATE CONTRACT...
(760) 674=1188 Fax (760) 674-1668
9/8/99 'C=BV02/5-02
Janet Peters
t;OP ,
37682 Mojave Sage
Palm Desert, CA 92211
(760) 772-580.0
- ;T
(760) 343-7440
PROJECT LOT/PH ASE
PLAN. C.Q.E. TERMS
BELLA VISTA 2/5
5 .10/19/99 Due on receipt
AREA DESCRIPTION QTY
r.
UNIT -RATE y AMOUNT ;
Kitchen Micro Model #JVM 1660 Black 1
ea 523:00 523.00
Kitchen Std Black Appliances
NC
Std Micro 1
-
ea. -251.00 -251.00
Per Diagram :: Floor Coverings ,' I
ea 364.00 364.00
Tile -Lucca 12x12 '
Entry Border -PLM -#00.
Grout -(H) #370 Antique White
arpet-Bayvie Cashmere Bisque
Per DiagramEupgraded,Pad-1/2"
6LB1
ea 955.00 955.00
Signature
Date
I have read, understood and signed the attached Condition of Sale
Total $1,591.00
Agreement
Qnty Ofd'd
Material /Work Required °Unit
ROGER SNELLENBERGER DEVELOPMENT
PURCHASE ORDER # ,
78615 NAPLES DRIVE 22531. -
LA QUINTA, CA 92253
't
(760)772-0222
Premier verticals w/soft flow valence
(760) 772-0257 FAX
$1,464.97
Berkley, Alabaster
TO: Apex Interior source
November 2, 1999
79-553 Country Club Drive
PROJECT: Bella Vista
Bermuda Dunes, CA 92201
Fax: 760/360-3167
6) Horizontals
Attention: Denise
Lot & Phase: Lot 2, Phase 5
Ship to: 78589 Torino Drive
Date Required ASAP
La Quinta, CA
Requested by: Rita
Homeowner: _ Peters
Design Center
TOTAL
$1,464.97
Qnty Ofd'd
Material /Work Required °Unit
Price Total
Furnish the following upgraded window covering:
Premier verticals w/soft flow valence
$1,464.97
$1,464.97
Berkley, Alabaster
11) Verticals `
6) Horizontals
Horizontals with Privacy .
TOTAL
$1,464.97
Special Conditionslinstructions:
Roger Snellenberger Development
Cc: De ' Center
/1lJI\N%JVVLCLlVC MIIL/ RC 1 VrR1V
Apex Interior Source
By:
' . •NOV-05-99 FRI-10:48 WESTERN INSULATION RX NO, 9096868786 R03 +
WES'T'ER"N INSULATION INCS
4211'Latham Street, Riverside, California 92501
(909) 686-8760
(909) 686-8786 Fax
INSULATION CERCATS
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: BELLA VISTA-PHASE, 5A TRACT #: 28458-1'-
•
LOT#: 2
-.SITE ADDRESS: 78589 TORINO DRIVE, LA QUINTA, CA.
F TERIOR WALLS•
NOTE: OFFICES"..
MANUFACTURER:' -JOHNS-MANVILLE THICKNESS: 3 5/8 R -VALUE; . R-13
CEILINGS: BATTS BLOW ,
MANUFACTURER: JOHNS -MANVILLE THICKNESS: 13' R -VALUE:, R-38
<•
CEILINGS_: BATTS LO
MANUFACTURER: ' GREENSTONE THICKNESS: 10.3" R -VALUE_: R-38
r, 1
biEI�AL C0NTRACT01 ROGER SNELLEN.BERGER
LICENSE NUMBER:
BY: M ;
TITLE E
DATE:
t't .
••INSULATION CONTRAC'[OR; WESTERN INSULATION, INC.
LICENSE NU ER: 481278 =
'-BY:
TITLE: ' ` a Production an er
DATE:, NOVEMBER 5,1999 T
, A