SFD (9909-004)57108 Medinah
9909-004
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
701039 B f 01lSI(2C
ate a,5 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). , , % ...
O 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 lis issued.
( ) I have and will maintain workefs' 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 STAT'? FUNDPolicy No. ' 0 3-98.0003z3b
(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 agreethat if I should become
subject to the workers' compensation provisions' Section 3700 of the Labor
ode, I shall fortliwith comply with those provisions.
ate: _ Applicant ' f / " •- /% f%'
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.
Vignature (Owne'r/Agent)
r,):0-60 BUILDING PERMIT PERMIT#
"W
BATE VALUATION LOT TRACT
$9 28410-791
JOB SITE _.. ,--- ._.<- _
APN
ADDRESS
716-4800 17,
OWNER
CONTRACTOR/DESIGNER/ENGINEER
MCC OM.T.C-8E6KTO.P TLC
'I'RA>`i S WEST FIOUMUGINC
750'E ST M3140 '
78-401 F1WHWAY 111
Sm.'P woo CA 92101
Tai QUINtA. CA 92253 ,
(619)537-9191 CP.L4 •4972'
USE O yF PERMIT
T AY RST YT1 yqG
LE
SFC!. LOT 49, PLAN IC, PIiRMIT DOES NOT INCLL DE BLOCK WALL OR
POOL„ 'i9 REDUCTION ON PLAN t;HECK. FEE OR MULTIPLE ISSUIU-MCP .
OF SAME PLAN TYPE. '
CUSTOM CONSTRUCTION 2,203,00 S!°
!
PORCHIPATIO 408.00 .SF
GARAOE/CAR.PQFVF 3F
~-
.F:,S`TUW'17.7 COST OF CONSTRUCTION
100,133.70-
P i ' ]f PX SUAUAARY
CONSTRUCTION i+tiE 101 -000-418-000 S9S1.00
•,
PL." CHECK FEE 101-000-439-318 $193.24
' a "I T
MECRANICAL 7EE 101.000-421.000
ELECTR.[C.A, FEE 101-000.420-000 $145.93
PLUMBING FEL 101-000-419-000 $166.00
. ?
STI ONQ MOTION FEE - RESID 101-001,-24.1-000 $18.81
GRADING FEE 101-000.413.000 $20.00
;:"f
DEVEL OP'vP• IMPACT g'L Z $1,407.00
y11j
I
SL'TP-TC)EM, Cl3 !°R.T.i'C'WON.AND PLAN CHECK
LESS. PP,EnPAIDri ;
TOTAL 1:'MWT .PEES DXPA NOW
RECEIPT
DATE
13Y J /
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
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
Drywall - Int. Lath
/
Final
Final
POOLS -SPAS
BLOCKWALL
APPRO ALS
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
30
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:
r
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)
`i
The" BaftDe
C"t yy;hx% Lic 732542
ROOFING'AND CONSTRUCTION
Roofing n p g Pro osa l {
.
P. 0. Box 277 Thousand Palms, CA .92276
Phone (760) 343.3385 Fax (760).34.3-3696
BIDS TO : JOB NAME:
TRANS WEST HOUSING, INC P.G.A. WEST HOMES -
78-40;1-F HWY 111 P.G.A. WEST AUGUSTA PHASE 4
LA QUINTA, CA 92253 LOTS # 1.51.5:24,49 LA QUINTA, CA 92253
PHONTE 771.3363 FAX 771.9077 DATE 12-7-00 i
;r,
NoncF .
u her IAA MQCnpn!rs l Ion Law (Californw Code?of Civil Pruwdute. Soctton 1181 of Soo..), ON CWl!rtClor. st0contraClor !Ahorer, gunprerntnAr psrinn me helps to
mulc4a yuv plooerty out IS Mol pals for his wrirk nt sitppliAg• hag a right !o enforce a claim against your property. This rtwans Ihal. aRc, a uuurl heUtuln your I)tnperty
could he sora try a coup ofricor and R,c prceaitxJs or the a ke $g tiSed to SAIISy the IndenlP.dnesa This can happen P.Ven Il .you have pats your own contractor :n full !f tliv
` Iexorvartn: laoorar nit supplier remains Unpaid and If legal action Is nowsSary to Collin O un!urut IIK: tarns til Int5 rnnithn, tnP lirevAlhrg p6ny Snal! De enunec to iis
rcasorlat)le adurriyy INps plus An mala of gua Ana interest snail accrue an ail sums witch are due 90 days aflol b!llmp TitRK+ ';Ar ;11 15 Inn: arrum The UanDee Co.
Inc. is not tesponslble for delays WV$Ctt by weather• strike. material shortage ex delay In material supplied to the ob or say othu, uc!uy evyu I t a.ei e:anum the.
DAN]". Cr Inc IrAAI I;annry under this contract or. in negligence is limited solely to the amWrnl of this CoolrOtt .
-We ate fully covered by wflfA[r.Uss.0ulDenga1Ian and WbhgjIabltlty Insuranco. Carriers names and poli;;y,RVMjZgrV.uviiilopu,orl
[BRNEsi.
Any alteration or dev.a;tun trorri lhkc t, PL'Ovb sp6^.•drrsnone tnvntvmg Astra cont 61 mafarlal or tat»r wlll,oniy be executed upor, ar.lttun Oder; kv will ".Come.
A-) a,ua charge aver the sum mentioned in this Prdposat All ivjreentents Inu;l IIG Irtade irl wrttllrlg And Is nAw or• tree ao:*ss to Wilding lot.OreCl Oprinxl frpn OIr
PrIcort are Bassa on current costs of material and labor. Increases or decreases, will be renectCn at Ptlto of signing contra[[
Be!ore and or during ruofing ovitratlons and the completion of roofing, The DanDee Cc Inc, will not be responsible or QeMe for damage cattsed from
acre of God, such as earthquakes, thunderelorms, Mall or any other weather conditions btyond roofers control.
t1i
e •
L- C) 98L0£b£09L uLLMON LULC` b'9t,=50 00—L0-:DaQ
' 06/26/2000 13:30 9997360018 STEEL T PAGE 01
Installation Certificate: Residantial
Use of rhla tor" to •alwy tha.requlr.ot•tgo of do AdmietWa6e Leda to 09110nmlti bad* fafsnasdeii;tauiiM
all• AWN" • •••
An insuOation con!f tease is roquired In be posted d the bu0dinq ale glia to lM itWhtlos, diii% 0004 id110t tt
may be used to most those irquirerrtenb. Ar dppdittOhd bWbW iftal ii iWi t
the •ffiCenry and typo d the appUarice irusaredaawbo orbet2otth ftfilt d
Co, npUnm (CF -i R). This ooriftals (or Its oquivftWO be prepared and WPM by du a updttQ overall
resportalbilky tot the aapilanoe Installnbn.
1, the undsms mad, VaNy trial the equipment gzted In the wtogofy above my WgrAft ti is 1W ardwl k ataAad and
exceeds that the equipment meats or the roquirsivarta d ftAppiEtttotl E » b htrm VArwt(offAod flat
thoetuipmerdIssquivalenttoormore eMdenttltanth•3pWfiedan Come" d to
domon•trate cmmplianco with the Energy Effk*my Stand forrasidsrtlWbuiWkVL
HVAC SYSTEMS
Nat•: Hydmnic boilor irtlormaibn is entered herr, Other hydronfc or t•t►rrtU" hydrofnb ottuorne t Is rated Under
Water H•stinq Systems.
No.ating Uutp. CEC Candied Ardtlal Distribution fD d or fbatlnQ f and dead
Type (fumscs, Yanuf. Make i Elilatettcy Too and {farm
hast cuma. •t-) Mcdei Nunrbar fAPULr atl--t Le®tinn iL &'hWM Inwhl CAR
t'V4jA44 44 Sib•%c 4AL 3fl, d0ot
61 1t It k la .:. 7MoaeD
The buitd•vng design haat toss and design hems gain nets have beton detetmlMd U*a trnstlned in section Ui0(h) of
the Energy EtricieL61?"
two of ft Of tarfa wed for eQU*Msnt *Wrn@ and2 Yap oo ,=. -;- T"' Al (.:.:r8c. •
Brie HVAC 8ubontrsi+ptor (G. Neteo) or Gseataf ComVft f or O nwi
WATER HEATING SYSTEMS
Water Hasting CEC CartMbd Rated' Yank fKedU ttir
Sysum Typo Yanut. Yaks a Input(kw Capsotty ■n.. av,. .
(siW-ace ass. otn:-) Ybdit Numl d he Attltli rAaitene\ 11442 was
Fw .mau pas mor•ps (rated input e. 76,0W 801Mrj decub taiduroe and kaet "Mp Water f aawl, tial Fedor.
Frage '118401ar 1up• Qaa st'118401 h••tea (mud input;??& 0t) fll Nt4 Hitt Ratod input, PAoe% r Eibdaetgr and lou.
Fa buttantsr+eoua pas VMLW hostas. In Rand tnputAM Roomwfy EtddNW,
For tnstsntanWous ekwole wet" h••tars, M RAW input.
RAUCM A SHOWER HEADS
AJ f scoots and showorho oda ilnstaifod we flood III tho CommiNion'a Oifttiesory of OW04 d pgUel b WW Sftoesarltmda,
pursuant to iitlo 24, pan e. Subchapter 2, 3ectbn i i i.
3sonswrs
A"630 Jawq *1111
Wats
;=rig Subesawomis+r 4G. Hounst) w Geeema cAmo aw w Owow
CEC Cariffted
C"ling Equip.
Cornpreaacir Unit
Adis@'
Distribution D1r<r er
Type (air oond,
Uanuf. Yaks i
Ellfalen
Type am
heat unno, etc.)
Yodel Nurnber
.(Sawn
Lbeatlon
The buitd•vng design haat toss and design hems gain nets have beton detetmlMd U*a trnstlned in section Ui0(h) of
the Energy EtricieL61?"
two of ft Of tarfa wed for eQU*Msnt *Wrn@ and2 Yap oo ,=. -;- T"' Al (.:.:r8c. •
Brie HVAC 8ubontrsi+ptor (G. Neteo) or Gseataf ComVft f or O nwi
WATER HEATING SYSTEMS
Water Hasting CEC CartMbd Rated' Yank fKedU ttir
Sysum Typo Yanut. Yaks a Input(kw Capsotty ■n.. av,. .
(siW-ace ass. otn:-) Ybdit Numl d he Attltli rAaitene\ 11442 was
Fw .mau pas mor•ps (rated input e. 76,0W 801Mrj decub taiduroe and kaet "Mp Water f aawl, tial Fedor.
Frage '118401ar 1up• Qaa st'118401 h••tea (mud input;??& 0t) fll Nt4 Hitt Ratod input, PAoe% r Eibdaetgr and lou.
Fa buttantsr+eoua pas VMLW hostas. In Rand tnputAM Roomwfy EtddNW,
For tnstsntanWous ekwole wet" h••tars, M RAW input.
RAUCM A SHOWER HEADS
AJ f scoots and showorho oda ilnstaifod we flood III tho CommiNion'a Oifttiesory of OW04 d pgUel b WW Sftoesarltmda,
pursuant to iitlo 24, pan e. Subchapter 2, 3ectbn i i i.
3sonswrs
A"630 Jawq *1111
Wats
;=rig Subesawomis+r 4G. Hounst) w Geeema cAmo aw w Owow
DEC-01-2000 16:39 WESTERN INSULATION 909 686 8786 P.05%17
ET%N INSULATION, INC 81. • f
4211 Latham 3t nc. Riverside, Cal ifbmiEL 92361
TeL (909) 686.8760 Fax (909) W-8786
INSULATION CEIiTIC T
THIS IS TO CERTIFY THAT INSULATION HAS BEEN INSTALLED IN CONFORMANCE WITH
THE CURRENT ENERGY REG ULATION,'CALIFORNIA ADMINISTRATIVE CODE, TITLE'24,
STATE OF CALIFORNIA, IN THE BUILDING LOCATED AT:.
TRACT / PHASE: PGA WEST - AUGUSTA _
LOT # 49 SITE ADDRESS 57-108 MEDINAH LA QUINTA, CA
• ...:.................ry---. -------.---
EXTERIORWAlLS- '
MANUFACTURER: JOHNS MANV/LLE THICKNESS: 3 1/2 R-VALUE: R-15
CEILINGS: TTS BLOW
MANUFACTURER: JOHNS MANVILLE THICKNESS, 13" R- VALUE. R-38
-GEMBAL CONTRACTOR' TRANSWEST HOSING
BY:
TITLE:
DATE:
INSULATION CONTRACTOR: WESTERN INSULATION, INC,
- LICENSE NU MBE : 48 *278
BY:
TITLE: PRODUCTION NAGLR fN
DATE DECEMBER 1, 2000
Certificate of Occupancy .
City of LaQuinta
.'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 fol%wing:.
BUILDING ADDRESS: _ 57-108 MEDINAH
Use Classification: SINGLE FAMILY DWELLING . Bldg. Permit No.: 9909-004
Occupancy Group: R73 Type of Construction: VN Land Use Zone: RL
Owner.of Building: MCCOMIC-SEOKTOP LLC Address: 750 B ST STE 3140
City: SAN DIEGO, CA., 92101 ,
By: DANIEL P. CRAWFORD JR.
Date: 12/8/2000
Building Official
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