SFD (9909-015)57141 Medinah
9909-015
E; LICENSED CONTRACTOR DECLARATION
1,J?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 ExprDate
701039 B p1/3112(
atef-%'` Signature of Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that l 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
dction 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 STATE FUND Policy No. 033-98.0001236
(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 thai if I should become
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions. .I
Date: "e-2- 4'= ' 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 .representati es of this City to enter upon
the above-mentioned propertty,fd inspection p.uurp oses.
gnatu( /(Owner/Agent)
i Date S ,
11-0 0 BUILDING PERMIT PERMITp
;,- 4
DATE VALUATION LOT `011 TRACT
j p tt rye ryq; pq t r, -VI
A. pd.Wa tYJ S 28410
JOB SITE
ADDRESS _57_1t4 `
9u
APN
'736- 018
OWNER
CONTRACTOR / DESIGNER / ENGINEER
MCCOW-SEO1IC"TOP LLC
7 .k1"S WEST HOUSNO.WC
750B 0TMY 3140
78.4.01 FIR10,11WAY 1 1
SAN DW30 CA 92101
LA QUTt31:A CA 92253
(619)55 7'•,9191 C`EL41, 4972 .
USE OF PERMIT
;:OLE F'AMMY" DVM Z. N(3
SPD- LOT _N PLAN iii, PERMIT 00115 NOT INCLUDE BLOCK WALL OR
POOL 750,10 EDUCTION ON PLAN CHECK FEE` OR. MULTIPLE 1,11W RANCE
OF SAME PLAN TYPE. ,
CUSTOM CONSTRUCTION '4203,00 8.F
,
PORCH/PATIO 408,00 SP
CihRACEICARPORT 566.00 Sia
t
Lb'aTA"7l ED COW OF CO.i STRUCnOW
PER&= FM SIThOIhRY
# a•••
CONSTRUCTION 1,72. 101.000-418-000 (951,00
,. 3
•"
PLAN CHECK FEE 101.000.439-318 $193.24
t
MECHANICAL "M 101.000.4.21-0071 860.00
ELECTRICAL FEE 101-000-420-000 $145.92
PLUM1 IWO IMM. 101-000.419-000 3166.00
STRONG MOTION Fid•RF,SID 1*01-000-?AI-8700 $1I1.V1
GRADING .FEE 101.000-423-000 S29,ti0
DEVELOPER IMPACT FEE: $I,907.[ro
8,31M -TOTAL C099'f ttie'7'I01+1 A141) lPT_AW' CHEC.4K
V3,461.98
1 , S9 PRE -PAD) FIMS
$0.00
TOTAL PERWr FSS DUEN(aW
€6i.
RECEIPT
DATE
,BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
07
Ducts
Slab Grade
1
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
/ r'
F.A.U.
Framing
Insulation
AM
Compressor
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 I
I
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
p/
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:
Tlie DanDee
ckdwmy hx%, lis 732.542
ROOFING AND CONSTRUCTION
p
Roofin Pro ' osal
P.O. Box d77 Thnus ind Palms, (.A 92276
Phone (760).34.3-3385 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 LOTS # 1.51.5,24,49 LA QUINTA, CA 92253
PHONE 771.3363 FAX 771.9077 DATE 12-7-00 .
O-HAOIN ROOFDORAAER•VENT4
D .
THE DAN DEF COh9PA(1[y._ INC,. HAS HVSTALLED THE ROOF DORMER VENM CORRECTLY, AN
PER ENQINEEQS SPEC[FICATIONS. `
,
a "r • - ,
i
()•.Orr Ina MACnamics' Lion Caw (Californw Code of Civil Auwduro. Soct on 1 illi o E}, any conv"tctor, likolontraelof !arlOror. al,npllAr nrhpr parr,nn no halpe to
mplcva vuut q piny out to not pa d or ills work or auppliat, halt a right !o anfofca s claim against your properly. This nwans (hal. uHrr a I:uui: h0unnn your pml:rtty
Could be 50:0 by a court Officor and nIc prCCdt.:JY Of It* Solt used 10 sanity It* Intlebledness This Can nanpen P.ven It you have paic your Own C0111faCtr)t :n full !f dlc
silwbCtr.l 107 IAocref fit Supplier remains unpaid and If legal action Is no,ds3ary to coil -a w unfvut irw tarns of Ihl3 CnnlrAri. trip pfeyAtf'ng OAfty tnaL oe entlnec to its
Z31,11101yp 011001yy f".3 plus All I" MIA of still And Inlefest'snafl accrue an ail sums wrath are due 90 Jars o4u1 billing 01 itxt talr Al 15 % III--, A. runt• The Uanoee Co.
. is not responsible tot deleys roused t)y weather• slrlkr. melena! snnnAge at delay In materiel supplied to the;ob of to any Jth* 061y CVyQ-Id 1.,k rr::ViQ1 thf,
()Anil". Co Inc 10xAl IlAhelry under this COntMM Of In negligence is limited adely to Me amOvfit Vf this cootrael
We are fully covered by worXmens compensatlon and nu_t(Iablqty Insuran ca. Carriors names andpolit;y RYtL13s! evil@t,lr.on
MQWJL
Ary altetahon w uevabv+ frurn 1hr a abtiv($ Spee !Irslione 111.1ving ertra row Of material Or labor will Only ba executed upon ,r. ntcn cadrrs io• Se,nr. ,u a will "V0,1*an extra charge over trip turn mentioned in Mia OrL*oaal All agiremenis must im tnrde in wrelltlp And is nRSP.o on free aCCess to ouliding for WreCt Oaf j#Xj from lytr
Pnrfis are Used On Current COSTS Of material and labor. Increases or decreases, roll tie ritnectod at firm* or signing contract
Before and or durlrg ruvni g olittratlons and the completion of roofing, The DanDee Cc Inc, will not be responsible or I eMe fur damage CAusen from
acts of Ood, such as earthpwlres, thunderelorms, hall or any other weather conditions beyond rooien control.
_..- - __......._. - DATE;
I III•. IV%NI)FF (.'0. INI: ---"— .
0O'd.' 98L0£bE09L U LMON wLC+ VqT:6000-40
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DEC -01-2000 16:44 WESTERN INSULATION 909 686 8786' P.14/17-
STERN INSULATION, INC.
4211 Whim Stmt, ldvmide- California 92301
Tel. (904) 686-8760 fax 1909) 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: PGA WEST - AUGUSTA
LOT # g
SITE ADDRESS 57.141 MEDINAH LA QUINTA, CA
............. --;----------- -----------------------
EXTERIOR WALLS:
MANUFACTURER: -JOHNS MANVILLE THICKNESS: 3 1/2 " R-VALUE:.R-15
CEILINQ&:iT SLOW
MANUFACTURER: JOHNS M VILLE THICKNESS: AX' R- VALUEi R-3$
GENERAL._CONTRACTOR TRANSWEST HOSING
BY:
IfBA
TITLE:
DATE:
INSULATION CONTFIAOTOM WESTERN INSULATION, INC.
LICENSE NU R: 481278 -
BY: ,
TITLE: PRODUCTION kAWAGE r '
DATE DECEMBER 1, 2000
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Certificate.of Occupancy
City. of-L'a Quinta
,. omrw.
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: 57-141 MEDINAH
Use Classification: SINGLE'FAMILY DWELLING Bldg. Permit No.: 9909-015
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
a By: DANIEL P. CRAWFORD JR.
Date: 1/30/01
Building Official
y POST IN A CONSPICUOUS PLACE
Notice
The follow sketch and calculations represent a field fix for each of the
following addresses:
80-105 Cedar Crest
80-225 Cedar Crest
57-108 Medinah
57-138 Medinah
57-168 Medinah
.57-178 Medinah
57-198 Medinah
57 14I- Medinah`
Greg Butler
Building & Safety 4anager
City of La Quinta
2 I 00
L SWANSON & ASSOCIATES 3914 MURPHY CANYON RD. SUITE #A130 SAN.DIEGO, CA 92123 (619) 576-3260
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CITY OF LA QUINA \
BUILDING & SAFETY D T.*
APPROVED
FOR CONSTRUCTION
DATE -ft2t BY
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REVISIONS DESCRIPTION I DATE I DESCRIPTION - DATE ITEM NO.
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