9907-140 (SFD)LICENSED CONTRACTOR DECLARATION
! I hereby affirm under penalty of perjury that I am licensed under provisions of
d"FF_ Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
04 W Professionals Code, and my License is in full force and effect.
O =) M License # Lic. Class Exp. Date
6/Date { Signature of Contractor
Copy
OWNER -BUILDER DECLARATION w
WW I hereby affirm under penalty of perjury that I am exempt from the Contractor's
to License Law for the following reason:
Z_ ( ) 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).
co () I am exempt under Section B&P.C. for this reason
Ln
N Date Signature of Owner
p N
0)
d Q WORKER'S COMPENSATION DECLARATION
o Z I hereby affirm under penalty of perjury one of the following declarations:
Lo H p () 1 have and will maintain a certificate of consent to self -insure for workers'
X W �= compensation, as provided for by Section 3700 of the Labor Code, for the
O J Q performance of the work for which this permit is issued.
C0 Q ( �`_nI have and will maintain workers' compensation insurance, as required by
O 0 Q Section 3700 of the Labor Code, for the performance of the work for which this
LO
a 0 Z permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
J (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, sh.111 fo_t•t2hwith comply with..toose rovis(o',n_s
Date: v`' I .. Applicant !"i� (•--,~-
�/ 1
/Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as'provided for in Section -3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to. the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
• application.
1. Each person upon whose behalf this application is made & each.person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a.result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of' this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
• correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter.upon
the above-mentioned prcperty;�r inspection purposes. `
VSignature (Owner/Agent) Date
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PERMIT #
BUILDING PERMIT
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DATE t.onx igA#VALUATION ➢ i}Nl1w'7�i i° 1tI LOT TRACTJOB
SITE ]
ADDRESS °��faLOrl.u��
APN •��1^I�}?�
OWNER
CONTRACTOR / DESIGNER / ENGINEER
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RECEIPT
DATE
BY
D! I%AT
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms 8 Footings
/
Ducts
Slab Grade
d
Return Air
Steel
Combustion Air
Roof Deck
/
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation 3
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. L th
j �$
Final oa
BLOCKWALL APPROVALS
Final
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
i 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
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)
COMMENTS:
Emerald Roofing, Inc.
_. 78-670 MGHWAY 111, STE.174
LA QUINTA , CA 92253
L' ic# 770940
(760)347-9869
INAM /ADDRESS
MONTECITO AT PGA WEST
THE R.C. •HOBBS COMPANY
55-487 SOUTHERN HILLS
LA QUINTA CA 92253
..-W
PROPOSAL 1,
DATE
PROPOSAL#
611'00
1122
JOB ADDRESS
LOTS 1-11 ==O'HAGIN VENTS
THE ABOVE PRICES, SPECIFICATIONS AND CONDITIONS ARE SATISFACTORY AND
ARE HEREBY ACCEPTED. YOU ARE AUTHORIZED TO DO THE WORK AS SPECIFIED.
PAYMENT WILL BE MADE AS OUTLINED ABOVE
SIGNATURE
i
I
fDESCRIPTION
TOTAL
To WHOM IT MAY CONCERN;
0.00
EMERALD ROOFING HAS INSTALLED AT MONTECITO HOMES AT PGA
WEST ,THE O'HAGIN VENTS AT THE FOLLOWING ADDRESSES BELOW:
LOT # PLAN # ADDRESS
# OF O'HAGIN VENTS
1 2 -AR 55-142 SOUTHERN HILLS
17
2 3 -BR 55-164 SOUTHERN HELLS
16.-
31 3 -CR 55-186 SOUTHERN HILLS
16
{ 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
7 2-A 55-274 BIG SPRINGS LOOP-
17
8 2-C 55-296 BIG SPRINGS LOOP
17
9 2-A 55-318 BIG SPRINGS LOOP
17
10 3-A 55-340 SOUTHERN Hill S
16
11 3-C 55-362 SOUTHERN HELLS
16
I
t
John Jones; President
TOTAL $0.00
THE ABOVE PRICES, SPECIFICATIONS AND CONDITIONS ARE SATISFACTORY AND
ARE HEREBY ACCEPTED. YOU ARE AUTHORIZED TO DO THE WORK AS SPECIFIED.
PAYMENT WILL BE MADE AS OUTLINED ABOVE
SIGNATURE
i
I
JUN -02-2000 10:56 WESTERN INSULATION. 909 686 8786 P.05i19
1
WESTERN INSUlLATIONt INC.
4211 Latium Street, Riversidc. California 9250 i
TeL (909) 686-8760 Fax (909) 686-8786
iNSULATTON CERTIFICATE
THIS IS TO CERTIFY THAT INSULATION HAS BEEN INSTALLED IN CONFORMANCE WITH
THE CURRENT ENERGY REGULATION, CALIFORNIA ADMINISTRATIVE CODE, TITLE 24,
STATE OF CAUFORNIA, IN THE BUILDING LOCATED AT:
TRACT / PHASE: MONTECITO - TRACT # 29004
LOT# B
SITE ADDRESS: 65-296 BIG SPRINGS LOOP
------------------------------------------------------------------
EXTE IOR WALLS:
MANUFACTURER: Johns -Manville THICKNESS: 5 1/2" R -VALUE: R-21
CEILINGS: <ED
BLOW
MANUFACTURER: Johns -Manville THICKNESS. 13" R -VALUE: R-36
CEIUNG : BATTS BLOW
MANUFACTURER: Greensrone THICKNESS: 10.3" R -VALUE: R-38
GEi1 ERAL CONTRACTOR: CENTURY AMERICAN DEVELOPMENT
LICENSE NUMBER:
BY:
TITLE:
DATE:
INSULATION CONTRACTOR: WESTERN INSULATION, INC.
LICENSE NUM5ER: 481278
e
f/_
of
Occupancy
pity 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 followhig:
BUILDING
ADDRESS: 55-296
BIG SPRINGS
Use Classification:
SINGLE FAMILY DWELLING
Bldg. Permit No.: 9907-140
Occupancy Group:
R-3 Type 'of Construction:
VN
Land Use Zone: RL
Owner of Building:
SOUTHERN HILLS ,LLC
Address:
1430 E CHAPMAN AVE STE 100
City:
ORANGE, CA., 92886
By:
DANIEL P. CRAWFORD JR.
Date:
7/17/2000
Building Official
POST IN A CONSPICUOUS PLACE