9907-121 (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
4` 6689 B 02/29/.2(
Date - Signature of Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that Lam 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
( ) I, as owner of the property, am rexclusively 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:
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.
('4)-l—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:
CarrierCOLDEN EAOLi3 Policy No: NWC 547'701400
(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 revisions.
Date: g ° Applicant " `b
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 performetl under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
A 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 propertyforinspection purposes.
Signature (Owner/Agent) "� Dated
BUILDING PERMIT PERMTJt
DATE VALUATION LOT • t.aPt.�'' TRACT
JOB SITE
APN
ADDRESS
OWNER
CONTRACTOR / DESIGNER / EN INEER
S<iT.!'r.HF13N IM -2 LLC
A.C. IY013BS dila SOTT(`.I WW HU1,.3,11Z
1430 E 01"MxAN AVE ME 100
55.9610 PGA BIND
OI,.ANGE CA 92696
1.,AQUINTA CA 92253 � 4
(i14�fi33-'726Q CBL!f 5487
USE OF PERMIT
M N GLE FA34RX DWME UWO
51FD • Lam' 9 PLAN 3CR PERMIT DOES NOT INCLUDE BLOCK WALL OR
POOL.IS (e`o K AN CI° WX RFOUCTION APPLIED ICOR MULTIPLE SUBMITTAL
CUSTOM CONSTRUCTION 3,465,00 Sly
PORCIVPATIO 536.00 SF
GARAC3WARPORT '1'33.0(► SF a
EST1MK17.D COST 011' CONSI'R1Ii4'n,01t1
291122:3.10
PERIV FEE slaive 'ARY
CONSTRUCTION FRE 101.0.0-0-418-000 $1,311.50
PLAN CHECK FEE 101-000-439-316 $169.07
MECHANICAL FEE 101-000.421-000 $110.00
ELECTRICAL FLEE 101-000-420-000 '$193.71
PLUMBING I+`RE 101.000.4.19.000 $243.013
S'TRO)Q MOTION FEE - RI SID 101-000-241-000 $29.12
GRAI7I14C1 F&F, 101-000.423-000 $20.00
DEVELOPER IMPACT YEZ $1,907.00
ART IN PUiBLIC PLACES - R SIE 701-000-.255.000 $213.06
Siils-1O7:AL CONSTRIT '1109 Abm PI..ANC URK
fi
$d,31 >R.9lx
LESS PPE PAID Y
$0.00
TOTAL F I`r E EES DUE NOW
i
S4.44? VI x%
RECEIPT
DATE
BY
DFI D o
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms &Footings
Ducts
Slab Grade2rzReturn
Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing ZjCompressor
Insulation /
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Dlywall - Int. Lath
Z
Final
Final 3
BLOCKWALL APPROVALS
POOLS - 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 APP OVALS
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:
a �
VMTERN INSULATION, INC.
4211 Latham Stmet, Riverside, California 92501
TeL (909) 686.8760 Pax (909) 686-8786
INSULATION CERTIFICATE
THIS IS TO. CERTIFY. THAT INSULATION HAS BEEN INSTALLED IN CONFORMANCE WITH
THE CURRENT ENERGY REGULATION, CALIFORNIA ADMINISTRATIVE COCE, TITLE 24,
STATE OF CALIFORNIA, IN THE BUILDING LOCATED AT:.
TRACT / PHASE: #28603-2/ PHASE 4
LOT #: 8
SITE ADDRESS: 80-512 RIVIERA. LA QUINTA, CA
EXTERIOR 1MALLS•
MANUFACTURER: JOHNS MANVILLE THICKNESS: 5.5 " R -VALUE: R-21
LOE� INGS: BATTS
MANUFACTURER GREENSTONE THICKNESS: 16 1/4 " R -VALUE` R-38
CEILINGS: TTS BLOW
MANUFACTURER JOHNS MANVILLE THICKNESS: 10.3 R -VALUE: .R-38
GENERAL _CONTRACTOR: . R.C. HOBBS COMPANY
BY:
TITLE: "
DATE;
INSULATIONCONTRACT-OR: WESTERN INSULATION, INC.
LICENSE NUMBER: 481278
BY:
TITLE: PFMDUION NXNAGER
DATE MARCH 6, '200
TOTAL P.09.
Certificate of Occupancy
City of -La Quinta
Building and Safety Department
This Certificate issued pursuant to the requirements of Section 109 of the Uniform Building Code,
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:
80-512 RIVIERA
Use Classification:
SINGLE FAMILY DWELLING
Bldg. Permit No.: 9907-121
Occupancy Group:
R73 Type of Construction:
VN
Land Use Zone: RL
Owner of Building:
SOUTHERN HILLS LLC
Address:
1430 E CHAPMAN AVE STE 100 - -
City:
ORANGE, CA., 92886
By:
DANIEL P. CRAWFORD JR.
`.,.
Date:
3/8/01
Building Official
POST IN A CONSPICUOUS PLACE
I