9907-118 (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 # Lic. Class Exp.. Date
478689 B OV,19/2(
Date�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:
( ) 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 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.
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 0OLDEN EA.ME Policy No. . NWC 547701400
(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 provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those.provisions.
Date:' r1 Applicant
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 propertyforfo/r inspection purposes.
Signature (Owrer/Agent)._ 1`J�"`�"^�'R-' "� Date_- 1,20
BUILDING PERMIT PERMITNy
DATE VALUATION qp��.���� e�99y �{ //�� LOT 9901`"*k TRACT
S"11,22.�.10 -5 y -w
JOB SITE ' APN
ADDRESS 80" MV& -:RA, 761-090-048
OWNER CONTRACTOR / DESIGNER / ENGINEER
SO'UTHE" Hmj S LLC R.C. F10BB8 dba SOUTHERN 1 1.8, LLC
14301 C11APMA13 AVB MS 100 55-960 PGABLVD
ORANGE CA 92886 LA Q111grA CA 92233
(714)633-7260 CRUZ 5487
USE OF PERMIT
81NG12 TAMMY DWE.T.1N'CT
SFD • LOT 5 PLAN 3C PERMIT DOES NOT INCLUDDS BLOCK WALL OR
POOL."W PIAN t`vHWK REDUCTION A.PP LlED FOR MUL7rIP1,i? SU8fAiTf.AU
CUSTOM CONS1UCT)ON 3,465.00 51'
PORCH/PATIO 536.00 SIS
GARAGE/CARPORT 723.00 SF
9SIMAW COM' OF COli SI.RWi9OR
PERMIT FRE 907J El+iiti.�Y
CONSTRUCTION ME
101--000-418.000
41,311.50
PLAN CHECK }SEL
101-000-439-318
$269.07
MECHANICAL FEE
101-000421.000
8118.00
ELECTRICAL FEE
101-000.420••000
$193.24
PLUIa OMO IEE
101.000.419.000
8143.00
STROAO MOTION FEE+ - RESID
101-0003-241-000
$3'9.12
ORADINCI FEE
101-000.422-000
$20.00
DEVELOPER IMPACT FEE
$1,90,7.00
ART IN PUBLIC PLACES - RESE 7071.000.255-000
$.828.06
SZ]I,3-TOJ"AT CU1:39'PtRUL`�TTOAT M13 PT AK CHECK
IMS VIM -PAID FIM5
TOTAL lPE1?X1T 1+'E ES DUE NOW
RECEIPT I DATE I BY I DATE FINALED I INSPECTOR
291122.3.103
56,:318.99
$0.00
34;3,18_99
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
f
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
Is
F.A.U.
Framing
Compressor
Insulation /
Vents
Fireplace Pt.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final I
Final
IPOOLS
BLOCKWALL APPROVA S
- 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
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
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
Utility Notice (Perm)
COMMENTS:
WESTERN ..'INSULATION, INC
4211 Latham Stmt, Riverside, California 92501
Tel. (909) 686-8760 Fax (909) 686.8786
INSULATION CERTIFICATE
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: #28603-2/ PHASE 4
LOT #: _ 5
SITE ADDRESS: 80-464 RIVIERA. LA QUINTA, CA-'-
EXTERIOR WALLS:
MANUFACTURER: JOHNS MANVILLE THICKNESS: 5.5 " R -VALUE: R-21
CEIUWC s: BATTS BLOW
MANUFACTURER GREENSTONE THICKNESS: 16 1/4 " R -VALUE: R-38
CEIUNGS: BATTS SLOW
MANUFACTURER JOHNS MANVILLE THICKNESS: 10.3 " R -VALUE: R-38
GMERAL. CONTRACTOR: R.C. HOBBS COMPANY
BY:
TITLE:
DATE:
INSULATION CONTRACTOR: WESTERN INSULATION, INC.
LICENSE NUMBER: 48.1278
BY:
AAA
TITLE cAPODCTIO ANAGER
r DATE MA CH 6, 2 01
C.
.414
t;
Certificate of Occupancy
City of La Quinta
Building and Safety Department
This Certificate issued pursuant to the requirements of Section 109 of the Uniform BuildingCode,
certifying that, at the time of issuance, this structure was in compliance with the various ordinances
of the City regulating building construction or use. For the following:
BUILDING ADDRESS:
Use Classification:. SINGLE FAMILY DWELLING
Occupancy Group: R-3 Type of Construction:
Owner of Building: SOUTHERN HILLS LLC
{
Building Official
80-464 RIVIERA
Bldg. Permit No.: 9907-118
VN Land Use Zone: RL
Address: 1430 E CHAPMAN AVE STE 100
City: ORANGE, CA., 92886
By: DANIEL P. CRAWFORD JR.
Date: 3/14/01
POST IN A CONSPICUOUS PLACE