SFD (9909-009)57168 Medinah
9909-009
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. ✓ f0I/3I/:IC
Date 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). f
( ) I, as owner of'the property, am exclusively contracting with licensed
contractors to construct,the project (Sec. 7044, Business & Professionals
Code). E _ • ` . .
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 maintaimworkers' 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:
CarrierPolicy No. ,
S1'ATF 1,1314D ®35-98.0A01 t36
(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
ice..
ode, I shall forthwith comply with those,prowslons.
Date: 5. *- 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 4he conditions' and restrictions set forth on his
application. Y '
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 Ffor inspeec/tioonxpurposse's.
ignature (Owner/Agent) y '/ - -' 4`' Date
V
BUILDING PERMIT PERMIT#
DATE VALUATION '. LOT "...9 0 TRACT
8168,133.10 $4 28410-2/1
JOB SITE
ADDRESS
[AP ;
i.164W-01
OWNER
CONTRACTOR /DESIGNER/ ENGINEER
M..CCOMM-SEMMP LLC;
TRANS'WWI LIOtTSWO IWC N
750 B ST = 3140
.78-4.01 F'lUGr1WAaY 1.11
SAN DIEGO CA 92101
LA. QUINTA CA 922:53
(619)5$7»9191 I CBIS
USE OF PERMIT
MHOM rA'MMY T WEJJ WG
.
a
yFJ- LQT 54, PLAN I ll , PERMIT DOES NOT INCLUDE 8LOC:r. WALL O
POOL. 75% REDUCTION ON PLANCHECK HECK FEP OR MULL IPI.E ISSURA)ra
r
OF SAME PLA14 T'Y'PE,
CUSTOM CONSTRUCTION %2D3,00 SF
PORCHIPA'PIO 405.00 SR
. .
CJ.ARACYFJCARPORT 566,00 Sr:
- •.
'
ria
PMZWTb'EF.SUAOURY-
C:OMTRUCTION FEE . 101.000-418.004 $951<0t►
PLAN CHECK, FEE 101-000-4351-318 $193.24
MECHANICAL t+IE ' 1'01-000.421-000 - $60,40
ELECTRICAL FEE 101-000-420-000 $145.93
•.H
PLUMBINd FEB; 101.000.419.000 $166.00
STRONG MOTION PEP, - RESID 101-000-241-000, Mal
?'
GRADINO FEE 101-000-423-000 $20.00
_' . • = .
1?WELOPE'R. IMPACT FEE' $1,907.00
LUES -TOTAL CONMRUCTIONAND PJ.,AN• C'MC K
$3,451.98 ' r
I,E',N°'S PM -PAID WIS
$0.60,
1'OMAL PERM E5 DUE lYOW*a...-
RECEIPT
DATE
BY K
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 A
Combustion Air
Roof Deck XOD
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 APPROVAIS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Tgst
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) 14,
COMMENTS:
' 06%26,/2000 13:30 9997360012 ' STEEL'T PAGE 01
r A
frtstsllail®n Canlficate: Residential , - ,
, '-:,
tlw► ialaraas r'd' '
Use of tl'1Ir tam to aallasrr Itla,roquir'ue.eota slow AdROinit7tft11tii e 0o e ptaAlla t ,,r'. ; .. xf•, , ;• :n¢.; .
rule as
An lrtstagaalon c onMi ade W regWred to bo'pMW at the hl"49 Pfbf to til! 13MMOid16 10a fal
may be used to meet these mgtrkainerta. AN oXAN abOhlwr O lha at t0{i tttu
the o fidancy and type of the app(lance but" Bund bo orbetarltmgo Ildt sl9ta
CompUance (CF -IR). This Conktide (or !i0 ogUNW0M s1rWG bel propstad ww dpw bj1 vw
responsibility for the appliance (nslaffibn.
1, the undar%4mod, verity thea the equipment Oted in the cdago y ilboveriViONMilOO d +
the: the equipment meets or woods the rOglair6rf w to of dts AW' IW= OWM O N& 10 IN"V*VW ft
the equipment Ls equivalard to or mom atltdeM Owthe og*rltlt9'PO4W anft COMWO d C4MPlwMwAffAed tO
demonstrata compliance whh the Energy EHlpianry Stardatds for rosidontielbuNinpaa
HVAC SYSTEMS
Now Hydmnic boner (rt{ormadion is ontered hen. Othav tlydrottic or ao"dWed hydmida equomert Is acted under
Water Heuting systems.
Heating t*qulp. CEC Canilsad Acitral Dtstr{ trilon Oudw r4 Load inapt
T:ijiai t 'hDUmoM) ddeNwlber (AAFU Make emu assn ' _ iE IY#t1Y41 dl l
oa ►r 1. k u ="a2aZ1
CEC Certllted
Cccling IiEqulp'. Carrtp►sauor Unit AaaRtsai DUoibutlan QliBr w
hype (sir =a hd YaRLd Yaks & Ellidloi l i pe'at w ,, ,
nraat pu=' stc.) •Madel Numb sr' f1 R1 . n,. %i11W
►*t it t o c ti: jjV ft • c 4.CJ Oe
tt...
The twitding design heat bss and design heat gain rowhave Mart deterntlnsd taas>hfq a rA--dOela in flectiDd 18o(h) of
t>,e:Enww Flf=0 Surd d are two of the arkeria ussd for squOrneert etdn@ WW
` 'r • °° —mac:- 17 w►I `3r
+ Date HVAGSubMusWiCe.Name'OtOOAWCore O=mawW
WATER HEATING SYSTEMS
Water Muting CEC-Cankfied Bated'
System Type Yanut. Yalu & Inpwtp
(siorsaa a■s. ota) U&dsl Numbee &f Btu]
1. Fonsm" Oss slorege (raved kVwl s 76,000•itOlMr), dsobb tsdlofanoe av+d Md POMP WOW MAIV%' id &OV feaW
Fw Isrgikou storsas twswr.heetsta (ritaad Input s71l = tdIW *list Fwd frg A lRA0o11ef EllbOn9y Ortel t iaa.
Fw tnawhuneeus gas Witaf hUtnta, W RYad,lnp n sed Reouwry t:Ifkdortei►.
Fa instsnwwwo vw Me vmtw hectare, no Rawl UVA.
FAU.CM & SHOWER HEADS ,
,:11U !sheets and shpworhoada inatsnod We Tatted In No COMMUion's DINOWtlaf;CONOd FWrift e*8hOwvh8*.
putsualrat.to Title 2A, Pan 6. S`UbChapter 2. sec dcal11.
3ipnrarurs Deep Prw►tung ilriprrs dor 1G. O rosj w t rr..Y G IIa wa ad Cwrwsr
no-load Jawq'as7
_ t `
DEC-01-2000 16:42 WESTERN 1 NSULA T I ISI 909-69G. 27@6,- , F s 0'
VESTERN INSULATION' INC.,j E
4211 Latham Street, Riverside, CitWbrnia 92501
Tei. (909) 686-8760 Fax (909) 686.8786
INSULATION LATION CERTIFICA'TF
THIS IS TO CERTIFY THAT INSULATION HAS BEEN INSTALLED IN CONFORMANCE WITH '
THE CURRENT ENERGY REGULATION, CALIFOhNIA ADMINISTRATIVE CODE, TITLE 2,1, .
STATE OF CALIFORNIA, IN THE BUILDING LOCATED AT:,,
TRACT i PHASE: Y PGA WEST - AUGUSTA
LOT # 64
SITE ADDRESS '57-188 M_EDINAH GA QUINT_ A, CA
EXTERIOR WALLS
MANUFACTURER: JOHNS MANVILLE THICKNESS: 31i2'" R-VALUE: R-15
CEILINGS: ATT SLOW
MANUFACTURER: JOH MANVILLE THICKNESS:' 03" R- VALUE: R-38
GENERAL CONTRACTOR: ,TRANSWES7 HOSING
•. 6Y:
TITLE: .
DATE:
INSULATION CONTRACTOR: WESTERN INSULATION, INC:
LICENSE NUM :481278
BY. ` .t
' TITLE:' PRODUCTION ANAGER
DATE DECEMBER 1, 2000 ,
The BanRee Roofing P'ro o'sal
.
p
dials bx% ' L/C 732542 P.0 Bo.v 277 Thousand Palms, CA .92275
ROOFING AND CONSTRUCTION Phone'(76011 343-3,385 fax (760) 343-3096
-BIDS TO : JOB NAME: r ,
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 -
NOTICE
uNoer ins Mechanics' Ilan Law (Cariforn-a Code of Civil Pluuuduro. SWI011 1181 olyup. ),any 1!rpC10r, St t><anrr tCIOr !ehorer, aunplinr other person ne helps to
iP,uvv vuur pwoerty'Gut is not po,0 for his work nr auppties• has a right !o enforce a claim against your property. This reams thal. and a cuurt neartno your 1100 rty
could be sold by a court pfficor and the piccuuth, or the sate used to satisfy Ine lndebtennp.9s t hta can nappen even n you nave pate your own contractor ;n full Y thu
Stj.Wrtntiactor iaborer or supplier remains unpaid and Iflegal action is nocessary to tonrxt u+ unfulct Un; ttslur. tit Ini5 cnntrecl. trip. p(evan ng party shalt oe enuttec to its
iva*onatilP allorngy rp.Pg plus art.r,nm% or sun elm interest snail accrue an all sums wn+ch are due 10 days anal. biking al mt,: rani ;if 18 t<, pnr arrurr The•usn0ee!Co.
Inc. is not responsible for delays ciwsed by weathr. r• s1rGP, material shortage or delay In materiel supplied to ihe;ob or to eny.ott u' ,Jule+y uuvc++d tri r: :;ti a, Ihe.
I)Ann" Go Inc totatuahnity under this contract or in negligence is limited solely to the am w+ it ul this 80-11roct
We are fully covered by worAM U-11Pmpgllg1.U;iblIItY Insurance. Carriers names and poliGY nyrnimm nvisil@t,le ori
I R„ear
Any alteration or ucv.abun Grim Inc tr Wjtovg gpf pl!CrSugng involving extra coat of material or tat»r will only oe executed upor, M-ttcn ulur rs it), .0 ir..rra will IMC.OMte
an extra charge'o,,er the sum mentioned In this prctposnl All aKyrbentenl.s haul Im rnadP. in wrlttlrny and le oas" on free access to ouilaing ror direct 4xioux] frorn lir,
PrIERe are Used on current costs of maternal and labor. Increases. or decreases_, will be rt:nettert of little or signing contract.
Be!ore and or during ruonng overations ens the completion of roofing, The. DanDee Co Inc, will not be responsible or Qat>re for damage caused from
f acts of God, such as earthquakes, thundartslorma, hall or any Other weather conditions beyond roofers control.
DATE,
_ • f
7-00
I til. I)r1Nl)F.F•. ('.'0. INC. -
y
ZO-d 98L0£ £09L ut.LMON-utLC d9L:60.00-L0-OaO
r i
.. . '' , r^
Certificate of Occu'pancy..
city of La.: Quanta -
iK fw 4
Building and Safety Department
.This Certificate issued.pursuant to the requirements of Section 709 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: 57-168 MEDINAH
Use' Classification:. SINGLE FAMILY DWELLING Bldg. Permit No.: 9909-069
Occupancy Group: R-3 S Type of Construction: VN Land Use Zone: RL
Owner of Building: MCCOMIC,SEOKTOP LLC Address: 750 B ST STEt3140 `
City. SAN DIEGO, CA., 92101
b By: DANIEL P. CRAWFORD JR.
l Date: 12/28/2000
- Building Official
L
POST IN A CONSPICUOUS PLACE