SFD (9909-097)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.
(a License 70103 .Class p Exp9.. D 01`3)12(V
Dart Signature of Contractor
OWNER -BUILDER DECLARATION "
I hereby affirm under penalty of perjury,that.l 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 isnot 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:
(,) 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
peor ance 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:
CarrierPolicy No.
9't ATEFUND
dt'35 g?3-�100:t f► . '
(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 provisions of Section 3700 of the Labor
Code I shall forthwith comply with�t hose provirions
at Applicant
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000; in
addition.to the cost of compensation,'damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is'hereby made to the Director of Building and Safety
for a permit subject .to the conditions ' and restrictions set forth. on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose .benef.it work is performed under or pursuant to
any per issued as a result of this applicaton agrees.to', & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and 'employees.
2. Any permit issued• as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance .of such
permit, or cessation of work for 180 days will. subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply-with.all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes..
pature (Owner/Agent) f—'—+�--� Date c.
• BUILDING,PERMITPERMIT#..,,7`-0, •
DATE v9
pVALUATION�5� LOT: TRACT`a't�-d
JOB SITE "%-��.940 EA1 J1X.ION
APN 716-480-•017
ADDRESS
OWNER k ' Y"
CONTRACTOR / DESIGNER / ENGINEER
MCCOMIC-SE0KIMP L11C
JRANS NVFST H01JSn'.4G INC
WAY 111
&AN DIE.W, C)!k 91,101
Uk QUINT A C:d''9. 9.2253
(,619)557-9191 CBL# 41972
USE OF PERMIT
S1NQL,F.-R"1JLY DIVE L3eING
�4' AJ• .t.C)' ' fid, 3";l..el1V :_ d�tcti .tsf:K1Mi61 �� 7 EV(.a' " q.�A.i1➢.)� >' r,;lt,,.t .NxS.fa S,..h:
N)OL. 75% f1'DiX" ION L I PLAN tMCK.1H"E OR, M. U1.7,1711P F 98SURANr7F.
Or, SAW 11-ANTYpF.
CUSTOM C())NZ-J7 ''UC;''t'€0N 3.013,00 SF
si2�if`its 3`.(3t3 SP
GARA,C3! f;;ARPOF.7' 600.W SF
MWATE D COST OF CONSTRUCTION.
2.1%,795,20
OERMIT FE SU1414119ARY
CONSIRWrItrJ:N` )£1,9. t -43 ? �l:,.l �:dt(i
•�r ,'?`
PLAN C',63J-CK'FEr. 101-000.439-318$"3 .50
(b9 C` r^.i�i'br."[aE ; ti:f -13 f!•• R. -i $124M
EXBC:# R l(: AL. M. t0l-000-4.20-OW $174,96
PLU14;1,�1�'Os risF.' .� • €t�).-�A•-�)Y�•�tif141 &.1.<3,�..54
a � ~��
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AD.l 1\�.LY •�Sl•YV � I�•.J is � °'S\L�D.6Q✓. �L7L`VViI`:L`TA•�6J'N.�' F.la .7/!.7
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1, rh
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I�TsV111 .CZP4 i :.IA�T'EVC:i .mss
-'K ONSTRUPIMN AND PLAN CHECK
` XSS P.RC-MAID RES
$0,00
TOTAL PERMIT FEES DUE NOW
r1
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
• OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Stab Grade
Ducts
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
_
_
F.A.U.
Framing
�p
Compressor
InsulationUD
_
Vents
Fireplace P.L.
14Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
17_
Final
BLOCKWALL APPROVALS
Final
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final I
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
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)
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JUL-06-2000 1254 WESTERN INSULATION 909 686 8786 P.07%08
maim
ww E10T� lNS ATI '. IN Y r
4211 Latham Street, Riverside, California 92501
TeL (909) 666-8760 Fox (909) 686.8786
INSULATION CERTIFICATE
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 -TRACT #28410-2
LOT #:. 61
SITE ADDRESS: 79-940 MERION, LA QUINTA, CA
EXTERIM WALLSa
MANUFACTURER: Johns-Manvi HICKNESS: 3'A " R -VALUE: R-15
CE 1 G : BAT'f5 SLOW
MANUFACTURER: Johns -Manville THICKNESS: 13" R -VALUE: R-38
NERAL LOIN R: TRANS WEST HOUSING, INC,
LICENSE NUMBER:
TITLE:
DATE:
k
(Certificate of Occupancy
City of La Quinta
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:
Use Classification: SINGLE FAMILY DWELLING
Occupancy Group: R-3 . Type of Construction
Owner of Building: MCCOMIC-SEOKTOP LLC
Tom,
Building Official
79-940 MERIO.N
Bldg. Permit No.: 9909-097
VN Land Use Zone: RL
Address: 750 B ST STE 3140
City: SAN DIEGO, CA., 92101
By: DANIEL P. CRAWFORD JR.
Date: 8/14/2000
POST IN A CONSPICUOUS PLACE