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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 13 ,/,% 01/312(
Date <_' ' - Signature of Contractor f J '_ ✓� r 421'_ t'Y
f
OWNER -BUILDER DECL ATION
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).
( ) 1, 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
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:
Carrier STATE PLI14D Policy No. 033-98.0001236
(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 thhatif I should become
subject to the workers' compensation provisions of=Section 3700 of the Labor
Code, I shall forthwith comply with those provisio'ns.-I
Date: Applicant �,�- r• ! y'-,
- �i4
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 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 inspecti6n purposes.
Signature (Owner/Agent).Dates
•�-%�� BUILDING PERMIT PERMIT#
DATE VALUATION LOT'S j TRACT
5188,133.70 Ff3 28410-2/1
JOB SITE
APN
ADDRESS W225 C
716490-01.5
OWNER
CONTRACTOR/DESIGNER/ENGINEER
MCC.0, rIIC-;31+:0Y1T0P LLC.
7?".9 WM IiOT3SIRG we
750 L ST SM, 3140
78-401 F DIC111WA.Y 111
SA9 DIEGO CA 92101
LA Qt71,A TA CA 92253
(619)557-9191 CXL3=t 4W2
USE OF PERMIT
ISINGIZriAM Y1 -1 Ct. fCi
SFD• LOT 3, PLAN ID, PERMIT DOES NOT rNCLUDE BLOCK WALL OR
POOL 75% „kL7 UCTION ON P1,04 CHECK FEE OR .MULTIPLE ISS1URANC:E
OF SAME PLAN TYP
CUSTOM CONSTRUCTION 2,203,00 SP
PORCH/P.A,TIG 408.00 51f
GARAGE/CARPORT 566,00 SF
RST11�3.'t`i�:ll COT Off' CON�'iit17CTIOX
` ` ,108,133.70
yy'�7� q� yam• .�
F.�7-i.JYHi) $r.[1�t S0..1ADAARY
j ..
CONSTRUCTION VEL 101-000.418-000 $951,00
r `
.PLAN CHECK FEE 101-000-439-318 $193.24
MECHANICAL FEE 101-000.421-000 $60.00
..a
ELWTRIC.AL FSE 101-000-420-000 $145.93
-
PLUMBING ME 1.018000-419.000 $166.00
STRONG MOTION P'EF. - RFSID 101-000-241-000 $18.81-
ORADINO FEE 101-000-423.000 $20,00
DE'1: W P Z X IMPACT FEZ $1,907.00
SM -TOTAL *v.0.WMRXTCT10X AND PLAN CHECK
$3,461.98
7.,1133 1; Y,41AW I+' = 3
$1100
TOTAL P—ER32T 17AS ME MW
I
RECEIPT
DATE
X/ ,1
DATE FINALED
INSPECTOR
I. f/1 4iG/
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICACAPPROVALS
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
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 3 0
BLOCKWALL APPROVA S
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 TV
Gas Test / Qj
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:
'. 06/26/2000 13:30 9097360018
Installation Certificate: Residentlal
STEEL T
PAGE 01
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AUG -02-2000 08:41 WESTERN INSLiLATION 909 686 8786 P.01/02
WESTERN INSULATION9INC.
4211 Latham afteet, Ihvtrgide, Califonzin 92501
Tei. (909) 686.8760 Fax (909) 686-8786
INSULATION CARTIF.1
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 1 PHASE: PGA WEST - TRACT #28410.2
LOT #: 6
SITE ADDRESS: 80-345 CEDAR CREST, LA QUINTA, CA
EXTERIOR WALLS:
MANUFACTURER: , Johns -Manville THICKNESS: 3'A " R -VALUE: R-15
C ILING -BATTS BLOW
MANUFACTURER: Johns -Manville THICKNESS: 13" R -VALUE: R-38
GEN EBAL CONTRACTOR:. TRANS WEST HOUSING, INC.
LICENSE NUMBER:
BY:
TITLE:
DATE:
WESTERN INSULATION, INC.
BY:
TITLE: CE MANAGER
JULY 6, 2000
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: 80-225 CEDAR CREST
Use Classification:
Occupancy Group:
SINGLE FAMILY DWELLING Bldg. Permit No.: 9909-003
R-3 Type of Construction: VN
Owner of Building: MCCOMIC-SEOKTOP LLC
Land Use Zone: RL
Address: 750 B ST STE 3140
City: SAN DIEGO, CA., 92101
By: DANIEL P. CRAWFORD JR.
Date: '3/1/01
Building Official
I POST IN A CONSPICUOUS PLACE