SFD (9909-011)57188 Medinah
9909-011
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
7010.39 - ' B ."' i 01/31/2(
bate - 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).
( ) 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
Se(/ion 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:
Cartier STAT FU14D Policy No. 035-93.0091236
(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 ofeSection 3700 of the Labor
Code, I shall forthwith comply with Ithose provisio s.
Date: Applicant—Z ri -0. — -
;3 / ✓' lei
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 I 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 forinspectionspurposeS.
Sig )
nature (Owner/Agent). = / ° ~ Dates ='
6 d BUILDING PERMIT PERMIT#
%ATE VALUATION LOT nj 99W4D1A TRACT
0217, .4U 5 28410.2/1
JOB SITE
APN
ADDRESS 37-A;h-3 IN ftfA9
rs
71.64W-017
OWNER
CONTRACTOR / DESIGNER / ENGINEER
MCCOMIC-9EOXI'MP LLC
TRANS WEST HOUSING MC
750.13 5"T '1i 3140
73^401 FIRGHTWAY i 3
SAN DIEGO CA 92101
LA QXMITA. CA 92253,
(619)557-9191 CT37A 4972
USE OF PERMIT
S•! OLE FAWLY M'tlELI N0
5.FD- LOT 56, PLAN 2A, PLRMIT DOES -JO T INGLUDZ BLOCK WALL OR.
POOL, 75WREDUCTIUM ON PL,&N CHECK PER OR. MULTIPIA', I901TR.ANCE
OF SAME jPLAN TYP9.
CUSTOM C014STRUCTION 2,572.00 SF
PORCH/PATIO 43100 SP
0ARAGE/CARPOR1 600,00SW
- I:STi'1 l 0-1) COrRr OF C0:P7f`a19E2t2'C'IX0N
217,11 4,40
PERMT FER SU.MM4W
CONST.RUCT1C44 FEE . 101.000-418.000 $1,052,59
PL01 CHECK FEE, 101.000-439-318 $215.39
MECHANICAL FKF 101.000.421-000 $98.50
ELECTRICAL FEE 101-000-420-000 $159.52
PLUMBINO SEE 101.000.419.000 1170.00
STRONG MOTION FEE, JR&,9ID 101-000-241-000 $21.19
; rr,:-77
;AADINO FEF. 101.000-42:1.000 $20,00
ART IN PUBLIC PLACZS - M' 11: 701.-000-255-000 $44.66
i t i., t
t
'DEVELOPER IMPACT FEF $.1,907.0D
ffU13-T0T.AI: CQNM..UCI'10X AND PI—AW CIVCY
$:3,697.36
I ESS PRE -PAM FITZ
U.C10
7'O'.E'AAL PERWRT FEES U13E NOW
".,69736
RECEIPT
DATE
BYt %/
DATE FINALED
INSPECTOR
A
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms &Footings (p
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
Insulation
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
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 16141ff 17Encapsulation
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:
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'"rhe',DanDe Roofing ProP9 ' 'I
( y hKe. LIC 732542
P.O. !/o>` 277 Thousand Palmas, . CA .92276
'ROOFING AND CONSTRUCTION ; Phone (760) 343-3385 Fax (760) 343-3096
BROOKFIELD HOMES
12865 POINTE DEL MAR, SUITE_#200
DFL MAR, CA 92014
PHONE# 858--481-8500 FAX# 564-8317
'Unflpf MR. MP.1
irpptrive Yo'={ f
could be Sold
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JDB—NAME .
HERITAGE COLLECTION
LA QUINTA, CA
BID# DATE 8122/00
1)A.II: t .
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DATr•.
ItROPOSAL VA1.iu FOR 1) Y!:
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ILL IHM WO_L r..IQ2 = TO 00 Z 2,-C7rnV•
.,.Certificate of Occupancy
City of La. Quinhi J
5
Building and SafetyDiepartinent 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: -
t Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 9909-011
Occupancy Group: R-3 Type of Construction: VN - Land Use Zdne: RL
Owner of Building: MCCOMIC-SEOKTOP LLC Address: 750.6 ST STE 3140
City: SAN DIEGO, CA., 92101
1--a By: DANIEL P. CRAWFORD JR.
Date: 1/16/01
Building Official
57-188 MEDINAH
POST IN A CONSPICUOUS PLACE
1 -
I
upancy,
Cert►fcatoof Occ
a.
L 1,
City of La Quinta
BuildingSafetyDepartmentand oF1ti
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: 57-188 MEDINAH
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 9909-011
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: 1/16/01.
Building Official
POST IN A CONSPICUOUS PLACE