9907-133 (SFD)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
4
A-86��a 8t%/�1'SN
.Date 2 y Signature of Contractor—
OWNER-BUILDER
ontractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I 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 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 otconsent 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:
CarrierPolicy No.
f; OI DEN es'a �61U MVC.: 5177a 11. VW
(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 forthwith comply with lt o e provisions.
Date: i 2 • `l- t) Applicani
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. l
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.
�Slgnature (Owner/Agent-)- �,
Ui,.�-�f' Date?. ? v
t
PERMIT #
BUILDING PERMITt--J -
DATE 1j VALUATION S2,3901—j4 ) 0(i LOT t� TRACT 7219776 .
JOB SITE` "� r +��y;���y g+�•i�a.� APN e
ADDRESS CJS-Li�i� wSilYJ+l�t�'iAAit)✓�7' l�i.G� I�iEi
OWNER CONTRACTOR / DESIGNER / ENGINEER
i30v3 i 1"iir��1 ['i i. f_o l.r1..� �. .i?i.C,. Eir`;ii)wT Uis.'i u1,.iU ;,ZaA:s\iv l°I Li..t.:�, LLC
1430 :E CWXPIMAN AVE, SlE 100 3.5-960 I'Cp.+i. BlAr�
O1Zt NCIrE CA. 928M LA QU1grA CA 92253
(714)633-7260 i'BL# 5457
USE OF PERMIT
S).N43LE FAMILY- DWEL NG
SPO - LOT 2_8 PLAN f A ITAGRii'ilT DOO NOT iNC'.t. RDE BLOCA: WALL OR
F001...
CLT S T OXI C014S'TRUC 1110N 2,786.00 Sr.
P0RCFVPATT4D 3:SilM S1±
(JAXA00CA.RPORT 930.00 SF
a ED C��lr O CONNS 8.Rt./r'1. TI.t+NT
�{ 7��y �[r�j* q, y� y�q {� ` yi.S"€'.II�,rl'A,
.Rp�v.1:�1� f 0' E, E STEM IVIA i Y
L"ONS'1RUCI'IONFEE
10 1 -000-4 EK -000
$1.139.50
f=r.a�c3•tF�;ti �1?r
1('t1_!i!!{t�4�k�-;:1R
!F433.R?
NM IIANTICAL FIEL"
101 -0004? 1-000
�T(D5.b0
L"LE,'MICAL FEE
106-000-42.0-M
$1'73.440
PLUMBING FEE
1161.000-419-000
5.1.86.50
S`rRoN(i wynoN FWr - Rf SID
101-1 0-241-()00
. u
GR.A .;\C FUE
1Q1-()00-:1;3 Ofl0
$N.00
DEW10PER iNIPAC'T' FIX $1, 7.00
AIZT 1N PUnic PLACES - RESfO 601-000-255-00U $347.95
LESS PP,£'.TIX- ;.717EFS
2137'11 I,7M
$0.00
TOTAL 'aivIT FEF.S 1DIU!~;Ni3AA' 1 54,817.09
DATE FINALED
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Dp
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
F.A.U.
Framing!j
Compressor
Insulation 4
Vents
Fireplace P.E.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drjwall - Int. Lath
Final
FinalD
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
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
Gas Test
d
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring t
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
OCT -19-2000 12:12 WESTERN INSULATION 909.686 8786 P.02i16
11� I1ITSUL 'TION * INC,
wESTEIS
4211 Latham Street, .Rh'-*Slde, Calif"'21a 92501
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 REGUL
BUILDING LOCATIED AMINISTRATIVE CODE; TITLE 24 '
STATE OF CALIFORNIA, IN T
TRACT / PHASE- MONTECITO COLLECTION- 28776 PHASE 3A
. LOT # ��8'r,.,�
SITE ADDRESS - - - - - - - -.55-010 SOUTHERN HILLS, LA .aUINTA, CA - _ - - - - - - -
EXTERIO WAILS: ,
MANUFACTURER: GRE ENSTONE ' THICKNESS; 10.3'.. R -VALUE: R-38
• CEIL NGS: BATTS BL
MANUFACTURER: JOHNS MANVILLE THICKNESS: 13" R -VALUE: R-38 .
CEILINGS ATTS BLOW .
• MANUFACTURER: JOHNS MANVILLE THICKNESS:' 5.5" R -VALUE: R-21
t
- - -
GENERAL CONT R CT R: ' R. C. -HOBBS CO.
LICENSE NUMBER:
BY:
,
TITLE:
DATE: w
~ .
I SULATION C® T CT : WESTERN INSULATION, INC.
LICENSE NUMBER: 48127 y
TITLE: OFFICE MANAGER
DATE OCTOBER 19, 2000 .
•
EMERALD ROOFING,
INC..'
.
78-670,1-1IGHWAY 111, STE, 174
LA QUINTA, CA 92253•
License No. 770940
(760)347-9869
October 26, 2000
v
MONTECITO AT PGA' WEST
' -THE R.C. HOBBS COMPANY
55-487 SOUTHERN HILLS
LA QUINTA, CA.92253
TO WHOM IT MAY CONCERN;
{
/.
-
EMERALD ROOFING HAS INSTALLED 0lHAGIN VENTS AT MONTECITO HOMES
AT PGA
WEST. BELOW ARE THE ADDRESS AND NUMBER OF VENTS INSTALLED.
PHASE 3-A TRACT# 28776
LOT# PLAN#
'
ADDRESS
# OF VENTS
17 3_C _
54-768 SOUTHERN HILLS,
16
18 .3-A
54-790 SOUTHERN HILLS
16
19 ' 3-C
'
54-812. SOUTHERN HILLS
16
20 2-A
54=834 SOUTHERN HILLS
17 �I
21 2-B'.
54-856.SOUTHERN HILLS
-
17',
22 2-0
54-878 SOUTHERN HILLS
17 ;
23 2-A
24
54-900 SOUTHERN HILLS
17
- . 3 -CR
54-922 SOUTHERN HILLS 16
PHASE.3-B TRACT# 28776
,
LOT# PLAN# iADDRESS.
25.
# OF VENTS
3 -AR
54944 SOUTHERN HILLS.
16
26' 2-C
54-966 SOUTHERN HILLS
17 4
27' 2-A
54-988 SOUTHERN HILLS -
17
28 -1,-A
.55-010 SOUTHERN HILLS
`. i17
29 1-B
55-032 SOUTHERN HILLS
17 .
- 30 1 -CR
55-054 SOUTHERN HILLS
17
31 1 -AR .55-076
SOUTHERN HILLS
", 17
THANK YOU,
JOHN JONES
PRESIDENT
4
t
r
-
,
T*Certificate'dfOccdp�'an'cy'_a�
Cit o,a uanta_.
nd SafetyDepartment. ZF:B.uldin � a
�o>~
This Certificate. issued pursuant 'to the requirements of Section 709 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: 55-010+SOUTHERN HILLS
Use Classification: . SINGLE FAMILY DWELLING * Bldg. Permit No.: 9901-133
Occupancy Group: R-3 Type of Construction: VN Land -Use Zone:. RL, ,
Owner of Buildirig: SOUTHERN HILLS LLC . Address: 1430 E CHAPMAN AVE STE 100 -
t City: ORANGE, CA., 92886
--� By: DANIEL P. CRAWFORD JR.
Date: 1/30/01
Building Official
r POST IN A CONSPICUOUS PLACE