9907-141 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed undgr 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
478689 B 02)29iNi
/ate-' _'ignature of Contractor ►L''����
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.
(XJ 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 Policy No.
C?I..tl-s;r(1: AGLU N'X(:
(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 of Section 3700 of the Labor
Code, I shall forth ith.comply with those p ovisio s.
Date: 1Q, 12- Applicant? .� 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 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
thee above-mentioned property for inspection purposes.
�ySignature (Owner/Agentp i� Date 1 -'�•»
BUILDING PERMIT PERMIT#
DATE 1011 j/1"VALUATION 4;2%..�i{'irYf t LOT4WTRACT I29W4
JOB SITE C� c�y� �SST�i�7�n�
ADDRESS �,7�..{,ojlfylu�ary►1[�RY7
A
tori
/�S�-�1L-VN
OWNER
CONTRACTOR/DESIGNER/ENGINEER
1:.C.14013"S dba &.�::11fl1:,.;:^: HILLS, 111C
14301x' CILAPINIAN AVF SIT-, 10D
55.960 PGA BLVD
0 AWilK CA 929116
LA QUINTA C A 1)1125:3
(7f 4jF33-7'1&P (7BT10 5-4117
USE OF PERMIT
S-NG1 . VA IL Y WELLING
SFO - LOT 7 PLAN 2A PI3�X11' IXJR,u NOT 1irh:: UDE BLOCK WA3.f, OR
P 0QL.'lhws PLAN CHECK Ri ll.)LIC,710N AP'PLIFU FOR NWL1AV1.E SubMirr!
CUSTOM COIN i.1°tdUM01ri :3,02x1 M W
41;0RCithirtTIO 320.00 S1'
k3AXA01Y0ARP'01CI' 865.04) 5F
>'filr RNfiT HT,SUMMARY
r_V'N31R.1lC,")'10N FEE I01 -WO -41K-000 $1.1d9s )
PLAN :IFF 14 r•*71J! 301 -()()f) -4;V4-' 1R
ATEC11AN1CAL 11X 101-000.421-000 S I l t.5t3
6L.1:(J`FkJl0AL FT -1 1G1-(1!)(3 .121?titki 11W),50
1�1.(IM}S13dt�1rtilti 1[fi-l)(Nt-4t�7-O�D 'Stt«.St3
� :. ,
V•rttOr,sf3 MOTION Full' 6s
w .....
ORAMNIG 114,13 1131 •rxx�••#'�_a•Otl[t 6:�►.Ut►
�_� f r,:3
ART IN PUBLIC PLACES - TW.iiv 701-000-,2,.`5-CtEh717
1.>k'V�-i.tr4�i:`tt iM1�r'6.0 y F'f•:k: �:.�►E17.(!iJ
�' � -„ • .
t,
-JR-IT)TAL CONS'T"ELI.ICiION ANT) Pi AN CHECK
S4,"153 74;
;.E:SS PRE -11A ID FEES
TOTAL 11CAMIIT FEKS MIK NOW
$4,253.76
RECEIPT
DATEBY
DA E IN E
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings �1/
//
Ducts
Slab Grade��
_ _
ReturnAir
Steel 6RS
Combustion Air
Roof Deck
r oe
fo'lllh-g
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
_
Compressor
Insulation p
Vents
_
Fireplace .L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
2
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
/f'/Q
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
41
Gas Test
07j
Appliances
Final
�--�
COMMENTS:
r
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)
Emerald Roofing, Inc.
78-670 HIGHWAY 111, STE.174
LA QUINTA , CA 92253
Lie# 770940
(760)347-9869
NAIL I ADDRESS
MONTECITO AT PGA WEST
THE R.C. HOBBS COMPANY
55487 SOUTHERN HILLS
LA QUINTA CA 92253
PROPOSAL
DATE PROPOSAL#
6/11'00 1122
JOB ADDRESS
LOTS 1-11 ==O'HAGIN VENTS
DESCRI MON
TOTAL
TO WHOM IT MAY CONCERN;
0.00
EMERALD ROOFING HAS INSTALLED AT MONTECITO HOMES AT PGA
NEST ,THE WHAGIN VENTS AT THE FOLLOWING ADDRESSES BELOW:
LOT # PLAN # ADDRESS
# OF O'HAGIN VENTS
1 2 -AR 55-142 SOUTHERN BILLS
17
2 3 -BR 55-164 SOUTHERN EnI S
16
3 3 -CR 55-186 SOUTHERN HILLS
16
-4 2 -CR 55-208 BIG SPRINGS LOOP
17
5 2-A 55-230 BIG SPRINGS LOOP
17
6 3-C 55-252 BIG SPRINGS LOOP
16
177 -"""2=A -x"`"55=274 BIG SPRINGS LOOP._
_
w ~ 17)
8 --VC----&54-9611164 DiGSLOOP
17
9 2-A 55-318 BIG SPRINGS LOOP
17
10 3-A 55-340 SOUTHERN HILLS
16
11 3-C 55.362 SOUTHERN HILLS
16
John .tones, President
TOTAL $0.00
TILE ABOVE PRICES, SPECIFICATIONS AND CONDITIONS ARE SATISFACTORY AND
ARE HEREBY ACCEPTER YOU ARE AUTHORIZED TO DO THE WORK AS SPECIFIED
PAYMENT WILL BE MADE AS OUTLINED ABOVE
SIGNATURE
ZOPn 8uT3oog pisaamg 6L96 LV£ 09L %Vd VS:90 0009/ZO/90
7UN-02-2000
WESTERN INSULATION 909 686 8786 P.06i19
WESTERN INSULATION, INC.
4211 Latham stmct, Itivelside, California 91501
TeL (909) 686-8760 Fax (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 I PHASE: MONTECITO - TRACT # 29004
LOT# 7
SITE ADDRESS: 55-274 BIG SPRINGS LOOP
------------------------------------------------------------------
EXTERIOR WAiLLS•
MANUFACTURER: Johns-Menville THICKNESS: 5 1/2' R -VALUE: R-21
CEILINGS: BATTS BLOW
MANUFACTURER: Johns -Manville THICKNESS: 13" R -VALUE: R-38
CEILINGS: BATTS 613L�ow:!D
MANUFACTURER: Greenstone THICKNESS: 10.3" R -VALUE: R-38
----------------------------------------------------------------
GENERAL CONTRACTORz- CENTURY AMERICAN DEVELOPMENT
LICENSE NUMBER:
BY:
TITLE:
DATE:
INSULATION CONTR CTOR: WESTERN INSULATION, INC.
LICENSE NUMBER: 481278
BY: &-, &jzj'-3�
TITLE: PRO CTION ANA
DATE JUW2,2000
Ce r1ificate.. Of C '�' �➢C
City -of La,Quinta
.r VMgAflU
Building and Safety Departm6 nt OFT�`�'
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: 55-274 BIG SPRING
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 9907-141
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL
Owner of Building: SOUTHERN HILLS LLC Address: 1,-30 E CHAPMAN AVE STE 100
City: ORANGE, CA., 92886
By: DANIEL P. CRAWFORD JR.
Date: 7/19/2000
Building Official
POST IN A CONSPICUOUS PLACE
I l