SFD (9909-013)57218 Medinah
9909-013
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
Pr8fessionals Code, and my"License is in f - ull force and effect.
License # Lic. Class Exp. Date
701039 13
Signature of Cor
ate e- itrBcto
OWNER -BUILDER DECLARATION %
I hereby affirm under p6alty of perjury that I am exempt from the Contractor's
License Law for the following reason: -
(') 1, 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).
1, as owner of ,the, pr6perty,' am exclusively contracting with licensed
contractors to construct the project (Sec., *1 7044,' Business & Professionals
Code). 4
O I am'exemptun6r Section B&P.C. for this reason
Date, SignatA of Owner
WORKER'$. COMPENSATION DECLARATION
I herebyaffirmunder penal.ty,of perjury one of the following declarations:
I have andwill maintain a certificate of consent to self -insure for workers'
compensation, as provided for by 96ction 3760 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
SO, i-ob 3700,of-the Labor Code, for the performance of the work for which this
6rmit is issued. My workers' compensation. insurance
rance carrier &. policy no. are:
Carver' -Policy No.
STATIE FUNP,
(This section need not be completed if the permit'valuation is for $100.00 or'les7s).
-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 thit if I should become
Subject to the workers' compensation provisions of,S6ction 3700 of the Labor
Code. I shall forthwith comply with thosb- provisions. -
Date: L =%; : 6, Applicant—Z - Z -
Warning: Failure to secure Work q"romp6nsation coverage is u' ^nGwful 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 applicati6 - n 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 will
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, andState laws relating to the building
I I I
'construction, and hereby 'authorize represen . tativ . es:of this City to enter upon
the above-mentioned property for inspectionrurpoies_'
Signature (Owneir/Agent)Date
-7
BUILDING PERMITPERMIT #'
?ATE VALUATION LOT 9909 013 TRACT -
28410 -2/1 --
JOB SITE "A
ADDRESSV" r iXon
APN
-iz
716 48"17
OWNER
CONTRACTOR DESIGNER ENGINEER
mccolac_Wolcmp I i1c.
TRANS Wn HOU113RIG RJC
750 D STM 3140
7 8-4 01 F J.-U011WAY 131
SA14 DIE GO CA. 92101
1-4, Q.WrA CA 92253
(619)557.9191 CB14 402
USE OF PERMIT
SW(3.Ll_p PAW Y DW17J1.WG
$PD. LOT 53, PLAN 211P, PERMIT DOES NOT INCLUDE BLOCK WALL OR.:
POOL, 75% REDUCTION ON PLAN CHECK FD,'OR MULTIPLE ISSUPLANCK
OF ",&ME MAN TYPE
CUSTOM CONSTRUCTION Z"2.00 SF
POPICHIPATIO 432.00 SF
GARAWCARPORT 600.00 SF
tort
Esm"rkm con OF coi%T.S-TRUC-1101
.
PERMIT Fn GUADAARY
ZR
CONSTRUCTION FEE .101-000-418-000 $1,052,50
rn
PLAN CHECK FFE 101-000-439-318 $215.39
MECHANICAL FEE 101-000-421-000 $93.50'
ELECTRICAL FEE 101-000-420-000
PLUMBINO FEE 101.000-419-000 311"P3,00
STRONO MOTION FEE = RESID 101-000-241-000 $21.79
OkADING FF E 101.000-423-000 rA100
ART IN PUBLIC PLACES - RESIE 701-000-255-000 $44.66
DEVELOPER IMPACT FEE $1,907.00
3U.B-T(r1AL CONTSTIRLUCTION AND PLAINT C!1WZY,
1X.S.3 PRE -PAM Fb=
$0.0.0
TOTAJ.. 11F&Wr M S Dtw-.N OW
",69,736
RECEIPT
DATE B Y . ]DATE
FINALED
INSPECTOR
/
CAI
INSPECTION RECORD
OPERATION
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
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 d
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
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
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
L -E
o auk,
U -
P.O. Box 1504
LA QUINTA, CALIFORNIA 92247=1504 BUILDING .&.SAFETY DEPARTMENT
OF .78-495 CALLE TAMPICO (760) 77.7-7012
LA QUINTA, CALIFORNIA 92253: FAX (760) 7.77-7011
April 7, 2009
Mr. Greq Conway ;
4825 54 h Avenue South
Seattle, WA 98118
Dear Mr. Conway:
The purpose of this letter is to confirm that:
1. The Building & Safety Department is the issuer of official addresses within.the
City of La Quinta.
2. Tract 28410-2, within the development commonly known as "PGA West," was
addressed by this department in October 1997.
3. The correct address for Lot 58, MB 271/063 Tract 28410-2 isr57218 Medinah',
La Quinta, California (APN:.762-110-025)..
The original building permit for the single family dwelling (permit #9909-013, issued
5/9/2000) was assigned an incorrect address of. 57208 Medinah. A copy of that permit
was transmitted to the Riverside County Assessor's office at the time of issuance,
precipitating the -current confusion. All subsequent permits have been assigned to the
correct address.
have included a copy of the Assessor map page that includes your, property,
highlighted to show your property and its correct address. Please feel free to present this
letter to the Assessor's office or any other entity as necessary to resolve this.
Anyone with additional questions is welcome to contact me directly for confirmation by
telephone at.760-777-7015, or by e-mail at gbutlbr(cDla-quinta.orq
Your truly,
1
Greg Butler
Building & Safety Manager.
Enclosure
is
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DEC -01-2000 16:45 WESTERN INSULATIIOI - 909 686 8786. P.16/17
. W T%R11T INSULATION,, TION, INC.,,..,
4211 wba,s :Btaeet, Riverside. California 92501 ti '
Tel. (9" 686.8760 Fax (909) 686-8-P86
- T
MERATIQN CERTIFICATE-. ;f
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 A+ '
-SITE ADDRESS - - • - - ..:. - _ 57-3V MEDINAH LA QUINTA, CA - - • - - - - - _ - -- - -,
_ __ {
< EmRIOR iAdALLS:
MANUFACTURER: JOHNS MANVILLE THICKNESS:. 3 112.g R -VALUE:. R-15 <
CEILINGS: BATT SLOW
MANUFACTURER: JOA S MANVILLE THICKNESS: 13" R- VALUE: R•38
ragNERAL CONTRACTOR: TRANSWEST HOSING'
BY: _ t'
TITLE:
DATE:
INSULATION CONTRACTOR: WESTERN INSULATION, INC,
LICENSE NUMBER: 481278 `
BY:
TITLE: PRODUCTION M NAGER It
DATE DECEMBER 1. 2000 i
lite Da*nDee Roo ng Proposal
- Il l b1(!. L!C 732542
P. 0. Box 277 Thousand Pa/mc, CA 91276
ROOFING AND CONSTRUCTION Phone.(760) 343.3365 Fax (M) 343-3096-,
BIDS TO: JOB NAME:
TRANS WEST HOUSING, INC P.G.A. WEST HOMES
78-401-F HWY 111 P.G.A. WESTAUGUSTA 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
Nonce
u •.ap.r Ina MaChames" UPI Law (Califorma Cade of Civil Ro.Utrfo. SOCS)on t isjai .sob. Tey Coil!gtclor. Siordohffoctor'!,I hofef,"aUntla A r nthaf person Ile helps to
,mu+ev ' your Dluoerly out IS not paid for 1119 wOrtc Or auppliax, haR A right to enforce a claim against your property. This nwans fhal. one, ii cuut( neatu,n your lxnrt.rty
could De sora by a court officer and tic pr(,vwJS Of the 311lt! u9ed IO S811SJy the IndettleMAP.aa 1 h19 C.An Miri oven it you nave pate your Own crnuactnr :n full rf ulc
uxnrvaC1A: fADOrar Ot supptler remains unpaid and If legal action is nocos5ary to c011,VI w WIVrr Ilw tt•.IInS Of Ih15 MilltAf:f• trip.. pfevA1l"ng oarty Snai! oe enunec to 119
rvu5kmotsp Taornr,y f"..y plea An mala of gun And. Interest snail accrue an all sums wr•,rch are due 90 days afl01 bdlrns ill Ra,: min of 15 %Ila: a:•r•;im The VanOte Co.
Inc. is nor resporn7lb!e for delays closed by weather• a1nRr', material shortage ra detayfn material supplied to ihe;ob of to any otf+u' ou!uy e,,yo•+ 11t9 r :afiC:1 the
DAM)".. Cn Inc. (nfA1 uAhatry under this cantrect or to negligence is limited solely to (he ama,nl of this COnlroct '
We are fully covered by WQ.r)Ur.Jas..c.omDsnsa1Icln and oMblland As bi1.41labillty insurance. Carriers names and polioy RN'ggrg nveilfpkfla on
. rJigl esL - .
Any elter at on of oev.atwl+ F, urn Inc• ;f alnrve lions Involving olrtra rrnu Of material or tabor Will only DOIxecutad upon 'M.1tt•nur ucrs io. 51+1ne .frd will bAC.i1Me
ao as!ra crvrge over the sum mentioned to this proposal All iivieentenl5 mull 11e ntnrle irr wrdllnl9 Arid rs OASed OC free access to oultding for drrecl par•1nxJ ffprrl v1r
III,l.A1
arlf:naare nosed on current costs of material and labor. Increases or decreases, wilt t>o renectea at time or signing contract
Before and or during ruunng Ovitratlons and the completion of roofing, The DanDee Co Inc, will not be responsible or 11AMe rur damayr. caused from
acts of Ood; ouch as earthquakes, thunderstorms, hall or any other weather conditions beyond roofers control.'
DATE
of
I fII'.
l)/1, if
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ZO-d 98L0£b£09L 'uLLMON wLC b'9t=60 00=L"0—Ma0
XC.ertificateof Occupancy
City Quinta
of La
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: 57-2f,8 MEDINAH
Use Classification: SINGLE FAMILY DWELLING
Occupancy Group: R73 Type of Construction: VN
Owner of Building: MCC OMIC-SEOKTOP LLC
"'res-, /A -w
Building Official
Bldg. Permit No.: 9909-013
Land Use Zone: RL
Address: 750 B ST STE 3140
City: SAN DIEGO, CA., 92101
By: DANIEL P. CRAWFORD JR.
Date: 1/23/01
POST KA CONSPICUOUS PLACE