9903-246 (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.
'License #n Lic. Class Exp. Date
48k34 t 12/31M
D t.f `1 r 14;;' ✓! ,Signature of Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
(. ),.. 1:.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).
( `,), 1,. 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
Ihereby affirm under penalty of perjury one of the following declarations:
(..) I -have and will mairtain 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:
Cartier. 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 pro
rvisions of Section 3700 of the Labor
Code,. I shall forthwith comply with those provisions.
Die r, j^ ; . ( ! . Applicant —\ ,-� /.
Warning: Failure to secure Workers9Compensation 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.
,k 1�
Signature (Owner/Agent)' / f!'�f - Date jl,'2! Nq
l
PERMIT #
BUILDING PERMIT t
t
DATE VALUATION Mi1e�Y�lw�.41� LOT irl "Y TRACT
t�
JOB SITSAPN
ADDRESS ,r�_ $! '�O�{N f 1 --- P.
J
6-70
OWNER ”
CONTRACTOR / DESIGNER / ENGINEER
'11I.. E")KIC -11"N E ROUP
ROGER SIME LEIV �)EfUlEd:. & ASSOC.
78-615 NIVLES 1A
79615 .NAPLES .DIU E
LA QU1NTA CA 92?.53
LA Q1 i1"NTA CA 92253
(760)77M222 CaLff '1859
USE OF PERMIT
SI.NIsLE FAMILY. DWEL1.,l4Jf ,
WT:UCiE NOT MW.IFL%MLG[-`K 1;i iW.S OR
j.C11' 1, .iaLllfi3."i+}; $.f"J1 - P9
'�1�AC'1' t".rl�i '1'121.IiTS+:�:F� i.tt�'1,fiG 51^
i`�c✓12.L'„"fi:i`�ta'['.IC1 7fi.1'I#) S�
.
40.vt) SF
."i, T[ Al t°�3,�•; OF ,)NIS�r1..11UC".fdo1�
�. 108.4,13.43
Lyng y p, q SIMAKY
L*0XSTRUC,"1JQN !7HH 101-60041.8�3i)0 $671.00
G+O, a ly (433' 1".•ti; ,F. $,455,1 ?�1i,4
ivlIXII.AMCAIA Y. 101-91MI -121-000 *17.00
UEt"tU'1C.A.L 'Gl�;;i:; 101x000-420.000 $120,31
PLUMBING F1E 101-000-411-01;6 $11M.75
";'1'rioml Mf7f'p"N;,'►+1 R4:'fof7 1014-_9i .2414M
IC4ACJ1iyC+.Y7;C !J, ULt? �Y�'3 1{�'� 320.00
inti%9�. a 3 TtLfC'l ilio: NM 225,-Ot3lM43! -342
ART LN YUE LIC l3L.t <3-S - R SHL 701-000-255-000
.. OR-TMAL C,014ti"1"ktUC"1'{ON AND PLAN C HECX,
$4pM.49
LESS RRE-1` AID FEES
$0.00
TOTAL Sa1F1.ILCAlf FECA DUE dyO'i7
RECEIPT
DTE
DATE FINALE D
INSPECTOR
INSPECTION RECORD
OPERATION
DATE .
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS .
Set Basks
Underground Ducts
Forms & Footings ,�
-3O
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K 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
Ott
Drywall - Int. Lath
Q
Final
Final
POOLS - SPAS
BLOCKWALL
APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pi . 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
e
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
I et/7
Final
Utility Notice (Perm)
BELLA VISTA
RELEASE OF RESPONSIBILITY
FLOORING
I, Daniel and Carol Priest, purchaser of Lot 1, Phase.5 at Bella -Vista Homes;'''
hereby acknowledge that by not purchasing my flooring through the Roger
Snellenberger Development Design Center:
1. The flooring allowance I will be credited inescrow is $1;913.00.
2. Traditional Building Co., Inc. is 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 Co., 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 BuildingCo. Inca has no responsibility to buyer as to an
P Y Y Y �.
paint, 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. ' n
"Date: , •
Buyer: '
Date: [ k e7 'Design ter.
f
ROGER SNELLENBERGER DEVELOPMENT PURCHASE ORDER
78615 NAPLES DRIVE 2252
LA QUINTA, CA 92253
(760) 772-0222
(760)772-0257 FAX
TO: Apex Interior source November 2, 1999
79-553 Country Club Drive PROJECT: Bella Vista
Bermuda Dunes, CA. 92201
Fax: 760/360=3167
Attention: Denise.
Lot & Phase: Lot 1, Phase 5. Ship to: 78597 Torino Drive, I
Date Required ASAP -La Quinta, CA
Requested by: Rita Homeowner: Priest
Design Center
Qnty Ord'd
Material / Work Required
Unit Price Total
Furnish the following upgraded window covering:
.
1
Premier verticals throughout
$2,173.00
$2,173.00
Rio White
16) Verticals
4) Horizontals.
t
Horizontals with Privacy,
TOTAL
$2,173.00
Soecial Conditions/Instructions:
ACKNOWLEDGE AND
RFTIJRN
NOV-05-99 FRI. 10:48 WESTERN INSULATION Fi)?{ N0. '9096868786 P. 02
- WESTERi1T• INSULATICON
.INCo'
4,211 14tham Street, Riverside, California 92SC1
(909) 686.11760 F
(9m) 6116-9786 Tax �
INSULATION (F$ FICATE
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#:
SITE ADDRESS: 78597 TORINO DRIVE; LA.QUINTA, CA.- `
EXTERIOR WALLS:
. NOTE; .OFFICES
MANUFACTURER:` JOHNS -MANVILLE THICKNESS: 3 5!8 R. -VALUE: `R-)3
CEILINGS • . 6�) BLOW..
MANUFACTURER: JOHNS-A4ANVILLE• THICKNESS:: 1 R -VALUE: R-38
CEILINGS: BATTS BLOW
MANUFACTURER: GREENSTONE THICKNESS: - 10.3" T R -VALUE: R-38
GENERAL CONTRACTON,,-.` ROGER SNELLENBERGER
LICENSE NUMBER:
JI
BY: ,
TITLE: .^
DATE: ,
1 �lLAT1ON CONTRACTOR: WESTERN INSULATION, INC:
-."LICENSE NU ER:'481278�-�. r.
BY:
TITLE: 1producfioA Man ger r
..:DATE: NOVEMBER 5,1999
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