SFD (9909-095)57228 Medinah
9909-095
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#01039 Ne. Class Exp: D16101,20
Die° 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 prope'rty,'.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:
-f 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
perf rmance of the work for which this permit is issued.
I have and will maintain workers' compensation . insurance, as required by
Sec 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:
Carrier ..., li
Pocy -
No..
1 A'r s FUND
Oi:5.9t3-@001 6. .
(This section need not be completed if the permit valuation is for $100.00 or1ess).
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 provision's of Section -3700 of the Labor
Cod 'I shralljfor hwith comply With those provl"sions.
DTe: t '? + . Applicant L .= c Ji. r , . . c R►
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 3.706
of the Labor Code, interest and, attorney's fees.
IMPORTANTApplication 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 for inspection purposes
Si ature (Owner/Agent)• I -'1 "''c" " -Q yDate
BUILDING ERMIT PERMIT §; - • .
VALUATIONb ' '' LOT, TRACT/d -
V41 ;DATE
JOB SITEADDRESSJ i i YQ A — — „..
APN
7,164W417
17
r.
'
OWNER.
CONTRACTOR/DESIGNER/,ENGINEER
MCfWOMIC-SEORI1'OP LLC
TltANI S WEST HOUST.NG INC
7,54 B ST S'T'E 3140
8401 F HIGHWAY 8.11
SAN DIEGO CA -2101
LA QUIWA
CA
9225.1
(61.1)557-9:191.
CBL#
:1972
USE OF PERMIT '
MIGLE FAil+T1LY'DWl:,, LING
Zsvv- L(3'f- ."." ITA N i4:, .@' @ 91'i' 33S}.iVuk-1.i`i4 LJ rSt.E4f. .MW WAIX UK.
P?00L. M6.RFOCIC; ION ONPLA%l'OHECKFEE O3t:E1Yi1[ITLE TSSMANCH
OF SAME, PLAN TYPE_
CUSTC: M C;ONSTRUMO'N Z1201008F
PORCHIPI IO 403.80 Sf'
0ARAGFiCARP011t'' .Ot3 AF
ify . I1 ATED CYST OF (:011q.14 .'R'4.f ".MN
1^11./0
MXMIYTF1I'=014.FES 4ffii.-Ctfl f. 8-i?'UU $J51.0
w,
t4.A.14CHECK .FEXT
"
-10
WMC 1 AL t z ot3 »42.Ia11Q49 $%t.ear
.
EI.;.t0`. IC AL FW, 101. t t30-42{9.4?00
v11;
PL -UNI Y4iFSE 1[;):At3(7vu!19-fIGil $166.00
v
"
7:k .C ' dC'r O'klraP# 1~f:L 188Sdt ,1,01-000-241-040
Csftr4WNG FELT 10140-423- 0a0
tyP.393
Alm{•f'
I.TSEr 4sr ty. LIC"'IyS AC.E S RE.31V 701000455-WO4701000455-WO']. 'i
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opaid
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SGIk a l ai. C OWCRUC`D'4ON AN.ia.l'?1.AN CRECEw
RECEIPT'
DATEBY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms 8 Footings
Ducts
Slab Grade
1
Return Air
Steel
Combustion Air
Roof Deck
/
Exhaust Fans
_
O.K. to Wrap
_
F.A.U.
Framing
$ _ E,pTZACompressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
_lll!
Final
Final
/%
POOLS - SPAS
BLOCKWALL APPROVALS
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
/ y
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
_ jQ, D44A 7
Final
COMMENTS:
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)
,06/12/2000 07:03 9097360018
Installation. Cartificate:'.. Residential
STEEL T PAGE 01
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FA ucm HEADS
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pursuant to rdle 24, Part 6, Subchapter L 3@Ww I It.
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JUL-06-2000 12:53 WESTERN I14SULRTION -909 686 8796 P.05/08
iwYEST R11T Iwage
mmULATYON,, INC
4211 Latham Street, Mvereide, California 92501 y
TeL (909) 686.8760 Fax (909) 688.8786
INSULATION CERTIFICATE
THIS !S 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: PCA WEST -TRACT #28410-2
LOT t 59 f"
SITE ADDRESS: 57.228 MEDINAH, LA QU'INTA, CA
EXTERIOR WALLS:
MANUFACTURER: Johns -Manville THICKNESS: 316 " R -VALUE: R-15
CE! BATTS. BLOW
MANUFACTURER: !oh HICKNESS: 13" ' R -VALUE: R-38
f.
.......... .............. . . . ' - ........... ` - ......... . - . -
GENERAL CONTMUOR_'. TRANS WEST HOUSING, INC.
LICENSE NUMBER:
BY:
_t
TITLE:
DATE:
INS 091151TRACTOR: WESTERN INSULATION, INC.
E
;JULY
R:4 1278
MANAGER
2000
Ma.r-16-00 Q7:52A TOM WHITE
The' DanDee
Cal>inp[a>ty Inca. L is 732542
ROOFING AND CONSTRUCTION
P.O1
Roof i ng Prop osai
P.O. Box- 277 Thot mwd Palms, CA 92276
Phone (760) 343-3385 Fax (760) 343-3096
BIDS TO: JOB NAME;
TRANS WEST HOUSING, INC. RG.A. WEST HOMES
78-401-F HWY 111'. P,G,A. WEST (PHASE 2-B)
LA QUINTA, CA 92253 LA QUINTA. CA 92253
PHONE 771-3363 FAX 771-9077 DATE 2.15-00
QHAGIN ROOF DORMER V (yj
t
Tl"i"A&PEE COMPAAIY INC. HAS. INSTAL49QME.ROOF,.,QORMER..VENT$CORRECTLY, A
PER NGINEERS SPECIFICATIONS.
NOTICE
'Undot Itoc Machanier. I ion law (Coldurma Code of Civil Pmr.Rnvre scution 1161 at saq I Any conttaetor, subnnntraptor. Iabui r. supplier other pk fS01 he helps to
Improve ynur otuovty but is not paid try his work or supplies, hiss a right to emorcc* cairn against your pfr)polly. This motirm tont, ttnor a court nearing your pmp;rty
Ml lid bt7 sold by 8 CAIJn ohlCAf At NJ Il+v voC4Gds of the Ate I+t'An to salrsfy the Indat71IRrtnRift I his can happen even A ynu huvl: paid your avn nnnt;nr tri In NII If the
Subeomrarlor. Innnf@r or supplier rerralna ur.pald and ;t lopal action is 1`19001111111611,'Y In G)uuct or 411111 ae the tArnos of this coniract, rhA prAvndntp party shell be entitled td W
reasonable otivney fees plus as cnRla of suE and inturesl shall amore aft oil suras. which are nus 1D days>atter billing at the roto at 10 ti per .inmun Tho Dan Dee Co.
Inc, is not reaponalble Ink, nAlayu c:uusud by weather, 61110. Mlefoll Shr.'rtage or delay In matArtul supplied to the Ioh or lu :troy other delay heyntvl du control The
DanDae Co Inc' Iniac lilihdtty under this contract or In nepllrrr nt c; Is limited coley to the amount of this contract
We are fully,rovemd by workmen's pompwasadon and puble Ilap►flty Insurance. Carpiartf names and policy numbers ovellable on
r'eAM lile
Any altoratlnn of duviouork from Ina a annvA RW.Iluadtuas involving a►t.'A e0041 tautelialorlaborwdl only Ir, crccuted upon written vrdc,s for same and will tw;t;urrK
kin uxtre charge CIVAt IIIA Alton mf!nhoned In this prnpnr<ai All afjtI.-ytndnis mast be rK1nA to wr0ir7g a'td IS hafted Ml five access to hulid,nq Ino di,(xA loading from oltr
rruoMA
Prices am hneod on currant costs of matarlal and labor. Increases ne docreasas, will he rMlnrtod at time of signing cnntract
Ookwv and or during roofing nlwtrstlons ants the completion of rooting. The Dsnonn Co Inc, will not be reapnnwible or liable for damnytrcaussd from
arta of God, such as earthquakes, thkenderstormt, hall or any other weather eoneitlonr beyond roofers control.
I )A F
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I'll . f ANIIICL' CO. INC.
JAN -19-00 WED 12:39 2 -FAX N0, 4550212
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This Certificate issued-pursuan to Jthe .requirements of Section,109 .of .the Uniform Bui/ding Code,
certifying that, at the time of issuance, this structure was in compliance „with the various ordinances
r of the City regulating bui/ding° const[,tc_tion or use.: Forthe fo/%iing:
BUILDING ADDRESS:, ;. '' ,57-228 MEDINAH` ,
Use Classification: SINGLE•FAMILYS,'DWELLING Bldg. Permit No.: 9909-095
Occupancy G4roup: R-3 .lype - ofC onstruction: '
VN, 'Land 'Use;Zone: RL
Owner of Building: MCCOMIC-SEOKT4P LLC Address:', •750° B ST STE 3140
City: 'SAN DIEGO, CA.; 92101
--N,{
By: DANIEL P. CRAWFORD JR.
Date: 7/21/2000-
nuiming UrTiciai ' a
.POST IN A CONSPICUOUS PLACE `
S