SFD (9909-006)57138 Medinah
9909-006
y LICENSED CONTRACTOR DECLARATION ^
Thereby 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' ; 01131/2.
Date Signature of Contractor-
' ' Y'OWNER-BUILDER DECLARATIOEW
I hereby affirm under• penaltypf perjurythat 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.
(') 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:
Carrier Policy No.
STATEFUPd'» 03,5.93-OOOI23b
(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: Applicant d
-ry • . /Vii, .i'1 ,-
Warning: Failure to secure. Workers' OompensatIon coverag_e_is-unlawful-and
Shall subject an employer to cri`min'al 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 inspect;purposes: • " I
Signature (Owner/Agent) f Dater
1vICC0M1C-.9'0KTOP U -C
750 B 4T SE 3140
.W.1 4 DDMO CA 92101
t r
PERMIT # .
^jOs TRACT
7?. 2841 LI.2l1
' APN
CONTRACTOR/DESIGNER/ENGINEER .
78.401 FMGI•TWAY 11 l ;
X.A C MNTA CA 9225 3 ; !
(619957;•9191 CDL# 4972 s
USE OF PERMIT 1
MNGLEE PA1(X_Y DWM.I ING
SFD- LOT 51, PLAN IBR; PFIRMIT 1 OFM NOT INCLUDE BLOC: 'WALL O1`
POOL. 75 RE -DUCTION ON PLAN CHECK ,f 17, OR MULTIPLE ISSUR.A1•iCk -
OF SAME M A14 TYPE.
C. U3TOM CONSTRUCTIOld
PORCHIPATIO
OARAQIVi CARPORT
Z203.00 3F
408.00 Sig 1
$66,00 5h` '
?bg"I: mXrm) cosy OF CommIJCTXCJ.I.V'
PEM!MrFRE St7llVAAR i
-a v
BUILDING PERMIT
DATE
VALUATION LOT
$953
gg.qp
$18811.W. 10 ,
JOB SITE
$19'
ADDRESS,
101-000-421-000
1vICC0M1C-.9'0KTOP U -C
750 B 4T SE 3140
.W.1 4 DDMO CA 92101
t r
PERMIT # .
^jOs TRACT
7?. 2841 LI.2l1
' APN
CONTRACTOR/DESIGNER/ENGINEER .
78.401 FMGI•TWAY 11 l ;
X.A C MNTA CA 9225 3 ; !
(619957;•9191 CDL# 4972 s
USE OF PERMIT 1
MNGLEE PA1(X_Y DWM.I ING
SFD- LOT 51, PLAN IBR; PFIRMIT 1 OFM NOT INCLUDE BLOC: 'WALL O1`
POOL. 75 RE -DUCTION ON PLAN CHECK ,f 17, OR MULTIPLE ISSUR.A1•iCk -
OF SAME M A14 TYPE.
C. U3TOM CONSTRUCTIOld
PORCHIPATIO
OARAQIVi CARPORT
Z203.00 3F
408.00 Sig 1
$66,00 5h` '
?bg"I: mXrm) cosy OF CommIJCTXCJ.I.V'
PEM!MrFRE St7llVAAR i
CONSTRUCTION FIDE
101.000.418.000
$953
PLAN CHECK FEE,
101-000439-318
$19'
MECHANICAL FEE
101-000-421-000
$6
EUCTRICAL YZI;
101-000-120-000
$1143.93
PLUMBMG PEE
101-'660-419.000
$16
STRONO MOTIO14 PEE - RESID
101-000-241-000
$13
ORADING "Y.
101-000-423.000
92
DEVELOPER IMPACT FEE
$1,9
.00
3.24
v.0n r # '
£
6.00'
.81 I
0.0.0
m.00
SUB-'1'CYI`..AL CONS'!' U(M, ON ANI7 FLAK CFWCK
LFM PRE-PALT> FEBS
RECEIPT I DATE
18i3 g.7Q ;
.. -I
r
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs ot
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 APPROVA S
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
ool Cover
ewer onnection
VEncapsulation
iping
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:
DEC-01-2000 16:40 WESTERN INSULATION 909 686 8786 P.07i17
WESTERN INSULATION, INC:
4211 1 Atha- Street, Rh=oidc, CaUbmia 926,01
TeL (" 666.8760 FU (909► OW-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: PGA WEST - AUGUSTA
LOT #
SITE ADDRESS ' 57-138 MEDINAH LA CUINTA, CA .
• E RIDR WALLS.:.. .. • • ,
MANUFACTURER: JOHNS MANVILLE, THICKNESS: 3 1/2 R-VALUE: R-15,
CEILINGS: BATTS BLOW
MANUFACTURER:, JO NS MANVILLE THICKNESS:, 13' R-.VALUE: R-38-
GENERAL CONTRACTOR.: TRANSWEST HOSING
BY:
TITLE:. ' • ,
DATE: v
INSULATION CONTIUCTOR: WESTERN INSULATION, INC.
LICENSE NUM 81278
BY: - -
TITLE: PRODUCTIANAGER
OPf
DATE DECEMBER 1, 2000
• a M1. .
• p
3
DanDe-e'
C"twny hx% tic 732542 ;
♦
ROOFING ANO CONSTRUCT/ON
If
}. A
r
Roofing- Proposal;
.
• P n Box 277 Thousand Palmv, CA 92276 ,
Phone (760) 343.3385 Fax (760) 343.3096, '
BIDS TO: ` JOB NAME,
TRANS WEST HOUSING, INC `P.G.A. WEST HOMES,
78-401-F HWY 111 P.G.A. WEST AUGUSTA PHASE 4'
LA QUINTA, CA 92253 y LOTS # 1.51.5,24,49 LA QUINTA, CA 92253
PHONE 771.3363 FAX 771.9077 DATE 12 -7 -00 -
0•HAGIN ROOF DORMER VENTS
THE DAN DEE COMPANY 11M. yAS INSTALLED THE ROOF DORMER VENN. CORRECJLY. A
PER ENGINEER$ SPECIR IONS. ,
} i
- NOnCr!-
11100- ma MacnANcsten Law (Califorfva Code cf Civf PfuWliUfe. SOCtlon 11@1 01 SOV. ), Any ooffivoClOf, suWSOntrectOr !ohOrer, sunpnar nrhar parson ti helpfi 10 "
m,u'c ' • :four p,00tfiv Out not 004 lot hit wOrK Ot RuppllaR• has a right !o anfoiCe a claim against your pro
pperty. Thta ??warts Itlal. user. a cuul:hounnp yout ptnperty
could be 10:0 ty,' 1 court ofrcor and u4 Pf xcvW% of the Wle used to tatlafy the IndebtAdnARs INS Can ri.j0 RVM it you haYf pall: your Own WAlfilclpf ,n 1pll !f olio•
S111k:04'.11L3cto: IAboref nr supplier remains unpaid and If legal action is nowitiary to com;(,t w unfurl t (lru tonne (d Ih,s Cruuran; the IuavAll•ng berry final? ISP enunec !0 its
ruaSVl Wt)le 011011e9 IAAS ph(R All (»Ms of R,dl And i ntefest arVll acchM an all surnt witch are due 30 duyv oAOc baing tit Itvi nr(rr of 15 T'a par arniim- The VanDte Co.
Inc. it not responsible I'M delays Wv*40 Sy wealhnr• FInke. malaria! annnage or delay in material supplied 10 thelob of to any WIV' uulHr turu•ul ,In ri:rdita the
IfAN)". ('.If Inc
"At ltAbdtty under this conlradl or rn negligence Is Ilmiled solely to Use atwval of thrs con(recl • - - f
L
We are fully covered by w6.duraas.emDen2a1lon and public Ilabl1Ity Insuranco. Carrion names and policy ft.Nml34r@,av#.ilgkflu_oil
faquessi•
Any alto,stfo + or Oev7U0„ 1,(jrn Inc N 7bovy epeGhfJAQne involvdng RYtra 11041 Of material or labor will only be eaaculad upolr 'M9lL•11 ca dory to, lE and will MC.OMA
a•) aalra cNr9a Oval me tum rrynl!Oned in this prupo of All Agfeemenls must Ira Ifrndll in wfdllrno AAd it ORtRO On free aoasf t0 building for lyrt'CI OAdinV from Wil
Inn.\c
DflCna are based on Current cote of mattrtal and labor. Increases or Otcrltafas, will be WIRCtOrl At time of signing contract '
OVort and or during Wolfingovere(Iona and the comp1e00n of roofing, The DanDee Cc Inc, will not be responsible or Mobile for damage caused from
acre of Ood, such AS earthpuellea, thundgralorma, hall or any other weather conditions beyond roofers control. -
- — ----_. DATE,
a
DA 1111: /cA
I III. 0ANl)t•.F=. (:0. INh.
ZO'd 991-0£b£094 uMO
L N w t•C't3'9t X60. 00-LO- aO
Certificate of Occupancy
City of, La Quinta.
.F.W .4
Building and Safety Department OF °
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: 0-138 MEDINAH A
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 9909-006
Occupancy Group: R-3 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: .11/18/2000
Building Official
POST IN A CONSPICUOUS PLACE
i
SWANSON & ASSOCIATES 3914 MURPHY CANYON RD.
SUITE NA130 SAN DIEGO, CA 92123 (619) 576-3260
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CITY OF LA QUINA
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