SFD (9909-007)57148 Medinah
9909-007
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 ExpDate
7C}103 a 13 /j ti1i1/2(
U
ate' `,y' ' Signature of Contractors
_..
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).
() 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 STATE FUND Policy No. 035-W0001236
(This section need not be completed if the permit valuation is for $100.00 or less).
O 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 proyisions ! PSection 3700 of the Labor
C6de, I shall forthwith comply with those1`provisions. r
Y,tSate: Applicant—
Warning: Failure to secure Workers' Compensation coverage i's -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 fo'r inspe on purposes.
r) ; ter..
iSignature (Owner/Agent) d / Dated'
BUILDING PERMIT PERMIT#
'INATE VALUATION LOT ` 7 ffRACT
1217 .01 .12 284.10.2/1
JOB SITE
ADDRESS!7_14 NW.>N.0-1
APN
716-480-017
OWNER
CONTRACTOR/DESIGNER/ENGINEER
MCCOVU:C_SEf)KTOp LLC
.
T -*M V bT HOI.M' WI INC
?50 D ST ME 3140
78.401 F HlGHWAY IA I
S Ax I31Fm CA 92101
LA QUINTA CA 92253
(619)557»9191 C133X 49,72
USE OF PERMIT
:!!b1GL.E F.A2MY DWMLPF+M C3
S10- LOT 32, PLAN 2C, PERMIT DOLS NOT INCLUDE BLOCK WALL OR'
POOL. 751K. REDUCTION ON PLAIN CHECK FEF OR MUTAIPLE ISSURA?JCL
OF SAME PLAN TYPE,
CUSTOM CONSTRUCTION 2,313,00 SP
PORCH/PATTO 432.00 SF
CIARACi CARPORT 600.00 SF
..EGM"M'D C09f OF C0XhW[ UCM0N'
217, WIAO
PERWr FEE SUAM RY
1w
CONSTRUCTION FEE 101.000-41.$000 $1,05.2,50
PIAN CHICK FE -0; 101-000-439-318 $215.39
Z-' -
MECHANICAL FER 101.000.421.000 $98.50
EL IX TRICAL FU 101-000-420-000 $149.52
l ,3
PLUMBING PEZ 101-000-419.-0011 $178.00
_r;;
STRONG MOTION IWL - RBS16 101-000-241-000 '171.79
ORADINO FEE 101-000-4234000 $20.00
AR'f IN PUBLIC PLACES - RF31L 701-000-255-000 $44.66
DEVFLOPER IMPACT FLEE $1,407,00
SUB -TOTAL COLT 1'i UI2MO.N AND PT..A2a' C.HECE:
$3,697.36
_ LESS PR:I::4P,AID FEES
$0.00
4 TOTAI,1'F.i3 H FSS DUE NOW
$21,6197,2*
RECEIPT
DATE
BY ( `
< _ GrJ •
DATE FINALED
INSPECTOR
i
.1
INSPECTION RECORD
OPERATION j
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 a 10
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 APPROV LS
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
s 3 qr
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
OM
Encapsulation
Gas Piping
Gas Test
kml—
Appliances
v
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:
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The'DanDele
GoiVemy hx% tic 732542
ROOFING AND CONSTRUCTION
r
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Y.
Roofing Proposal
P. n Box 277 Thousand Palmi, CA 92276
Phone (760) 343-3385 Fax (760) 343-3096
BIDS TO : ,SOB 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, to 92253'
PHONE 77,1.3363 FAX 771.9077 DATE 12-7-00
a `
F
Nonce
'W001 1110 MNCngn!CS' l Iorl Law (California Code of Civil Ptuwdufo, Section 1101 of Soy. }, any cWpraClOr. SIdN onrracipr !ahorer, at+npugr nrngr,pii no helps 10
,1u cw VOW plooerly out is not Palo for nils work or eupplitts' hall a right !o enforce a claim against your propery. This moans Itlal. eflci.a,wurt h0urii+n your ponotrty
could be so:o by a Coup ofOcor and file procueds of the sale useo to sausty Ins lndeblP.Aness 1MA cAn nappen even n ynu have pale your own clinlrkirt . m full !f tliV
Surk:6Mf.IMn IAboref lir .Supplier remains unpaid and K legal action is news iar/ to cillo W unfLvut Irk; !Cans of Inis crinitrio. tnR prevAtl'Qg Dany ¢nal! tie enlrttec to its
uasr+nafJ a aRnn+Fv WS oh!s An (•ns09 of stilt nerd interest snall accrue an all sums which are due 90 days oftur uiling al ltgt mtr. ;it 15,% 116rarrum the UanCee Co.
Inc. is not reeDo^slbie for delays tatused yy weather, strike. materia! snnnage or decoy in material suppliedto the ob or to any olhu uviar.uuyce•+d its rM:r,t;oa the
DAN]". CO Inc INAl unbmry under this contractor in negligence is limited solely to the amount of this 00111rocl
We. are fully covered by worknu s—umpensi,ation and oubljrdhbility Insurance. Carriers names and polity RNmggr$ ev it@t,lr.ott
IAQNM
Any alleravon or Uev.appn item Inc' N at,+ovy spt-7ifir:rihons mvolving P.Ytra nolit of material or labor will only be executed upon 'M..Itun urdws to• 5:u inC. ,ria :will rWilr`,106.,
AM extra charge over mm m
e sum In this proposalre
All our mull lir made in wrdhing and is nAsed on free access to oulloin0 tor direct parta+y horn pq - -
Inn.A
P(Ir:A2 are based on Current costa of rnaterlal and labor. Increases or decrifases, will be, renectent at tittle or signing conlracL
Belore and or durir.g ruanng 000rations and the completion of roofing; The DanDee Co Inc, will not be responsible or liable fur damage aA+rsen !ram
acts of God, such as earthyuaMes, thunderslorms, hall or any other weather conditions beyond roofers control.
itis. DANOFF.("0. INC.
ZO'd '991-0£b£09L
t
upanc"Certificate of Occ
Quinta
La.Cit of V
y
fW 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: 57-148 MEDINAH
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 9909-007
Occupancy Group: R-3. Type of Construction: VN Land Use Zone: RL r
Owner of Building: MCCOMIC-SEOKTOP LLC Address:' .750 B ST:STE 3140
. City: SAN DIEGO, CA., 92101
By: DANIEL P.*CRAWFORD JR.-
Date:
R.Date: 12/20/2000
Building Official
POST IN A CONSPICUOUS PLACE