SFD (9909-016)57131 Medinah
9909-016
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 r Exp4Date
701039 B % - f,01//3)/2(
ate'"' /``'` 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 is issued.
( ) I have and will maintain workers' compensation insurance, as required by
Sed
on 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:
Carver STATE i±U2 D Policy No 039>984001236
(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,
1 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,Iof the Labor
Code, I shall forthwith comply with'those provisions: / r~
Date: Applicant rye • /, : ,
Yarriing: Failure to:secure Workers"Compensation coverage Iselawful••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,aits officers, agents and.employees.
2. Any permit issued as a result of this` applicatiorf 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 purppoos es.
ignature (Owner/Agen-r 1 ' Date'_
BUILDING PERMIT PERMIT#
DATE ' VALUATION LOT ' TRACT
$2.50,795.20 4 28416-2/3
JOB SITE
ADDRESS 57-I31113(hl
[AP
711fI- iSA^4Dt
OWNER
CONTRACTOR / DESIGNER / ENGINEER
MCCOMIC-I11 0KTTOP LLC
r
TRAM W&rfr HOU& NO 19C
,
750 B ST 3140
75.401 F19011W_AY 111
SAN D.T_, GO CA 92101
} A QL'11N 1A CA 922.53
(619)557.9191 CBLA 4r12 -
USE OF PERMIT
311kTC11;E. FAN/MY OVA .WC
SIV. LOT 4, PIAN X, PERMIT DOES NOT rNaLUUL. BLOCIC'WALL CIR
POOL. 711% REDUCTION ON PLAN CHECK filvlg OR MULTIPLE ISSURANCE
OF SAME PLAN TYPE,
CUSTOM CONSTRUCTION 3,013.00 3F
PORCH/PATIO 325.00 SF
OAR.AGE/CMAR-PORT 600.00 SF
1ES'tMAIED COST OF CONS'ETdi1C77ON-
250,795.20
CONSTRUCTIO14 FEE 101-000-418.000 $1,168.00
PLAN CHECZ ME 101-000-+439•-318 $239.50
MECHANICAL IEE 101-000-421-000 $124.00
XLEC." JUC4L FEE, 101-0004.20-000 $174.96
f ./ •`q
PLUMBING FEE 101»5100419-000 $192,50
a I RONO MOTION FEE - RESIN 101-000-241-000
Y '
ORADINO F'EE. 101.000-423.000 $20.06
€- q
ART IN PUBLIC PLACES - RESIL- 701-000-255-004 $126.90
f "V
DLVELOPER IMPACT _PTZE
•
t:r r
SUB -TOTAL CCiNSTALTMON AIM PLOT CMEX,
$3,5'78.02
LESS PRE -PAIL) FEES
`x'0.00
TOTAL PEST F. ;S DUE NOW
&-4,978.02
RECEIPTDATE
B /1`
DATE FINALED
INSPECTOR
.
/ ! ' ,.
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
17
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
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 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:
irCertificate of Occupancy ,
City of La Quinta
Building and Safety Department
aTM
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
ollowing.BUILDING ADDRESS: 57-131 MEDINAH
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 9909-016
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL
Owner of Building: MCCOMIC-SEOKTOP LLC Address: 750 B ST STE 3140
Building Official
City: SAN DIEGO, CA., 92101 -
By: DANIEL' -P. CRAWFORD JR.
Date: 2/14/01
POST IN A CONSPICUOUS PLACE