9901-127 (SFD)rrl � - ` 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
Date Signature of Contractor
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 thIis reason
Date Z!, - Signatureof,.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 Policy,No. ;
GOs:.MIN ..EACs.. NWU 97�a:t�tor
(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 those, provisions.
Date: Applicant
Warning: Failure to 'secure Workers' Compensation coverage is unlawful and
_shall subject an employer to criminal *pen alties 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'inspection purposes.
Signature (Owner/Agent) i Date
PERMIT #
BUILDING PERMIT
�..�
DATE VALUATION $2}�!-oto-2!! LOT TRACT
O i
JOB SITE :7SS-.���5�
ADDRESS
APN ^9.✓ -M
OWNER
CONTRACTOR/DESIGNER/ENGINEER
<<�f,.-r't.�v�r1 ;��,r , �,1,r �
�� c�. ist-���;.►.s �t�a �c:��������r rvt:z_;r.s, �;:,�:� •
1430 E U-. A1'MA.N A VE Sia i00
55-060 PGA. BLVE)
t•7RANG11" CA 9?896
'LA (ALAN T'.,A 0k 92253
(7141)633.7260 _ C13.L!0 5487.
USE OF PERMIT
S.KG1,r- PAM 1.,; DWriLT ING
LCAT 3, PLAN 3A -al;[)- FLRI 11 l' 3��f.�.i;:S NOT flIN4�1,C1DZI B'Uo' js "WALLS OR
P00.0. t'LAV (aHBCi .:t•'1X ROOI OW) 7SIuPOltA41U T191Ji tSSVANCL, O
SAW, PLAN r3.'3 PE. �
c"u,)a vJvc cvrv:, T.«uC ., i��t4s,:� 72,6k ar
PORCHIPXf M 119.00 5F
ii.Atb At is%CAldN+3R'I" 700,00 8
E&•ieiY'.fgi.C'LTED C0.5-oS OF 4...Ol.IS Bl UCIL 011V
2AvrJriPl
PERMIT IrET SUMMARY
C'ONS:i h[itw'f ON FEE' 1(31-100-418-000 St,273.00
1'ti.nN CttKX Fsin✓• 1101-0W-439-31.8
iViFXrt4t1VYlCAEM 1% 101-000-412-1-000 1'•n�R=RAr'.C)1n)%
-. ; G
-
'
EU «i:,r L H38 ill Ali-�S2C1 t7�f13 �183.J2
LtJis9is.I'1✓t E 101-000419-000 S20.75
Y}2C9tJCi1a11r1Ti<?N'k ,-RFS'! 1Oi'0� t11-()00 °s:rf:06
GN -Ur 114 I"LIE 110:1.0004 3-000 _ $20.00.
- -
110-RA31TRUt;.t UIU FTIE 2.25-000w443-342 KOWA)()
A..M." N PUBLIC !°.LAC S - £t:ESW 701-000-255-000 n151.57
flL-1�iF�la �)NCjet1ft !(3jVAND, PI A"\yyC��C".���'i•!iCK
• 1ri'. ti,J' .ia4�%.-f'�t�i�.i ��: C:�
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,4•���ti�_, .Ir 6:!&6i�:9.� 8. ,T. �.�.C.'.7 6,7 Y.7 ++;+ �LV V'VY
+I?�ti*�'':1�u7�I
RECEIPT
DATE
BY
J.DATE FINALED
INSPECTOR
I
INSPECTI N RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DAT
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade2
Return Air
Steel
Combustion Air
oof Deck
Exhaust Fans
rap
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
BLOCKWALL APPROVArS
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
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:
Oct -29-99 09:50A
The DanDee Roofing ,P Pro osal
Conch lay bw. L is 732542 P.O. Box 277 Thousand Palms; CA .92276
ROOF/NG ANO CONSTRUCT/ON Phone (760) 343-3385 Fax (760) 343-3096
BIDS TO : JOB NAME:
THE R.C. HOBBS COMPANY MONTECITO COLLECTION,
55-960 PGA BLVD. PHASE# 1,
LA QUINTA, CA 92253 LA QUINTA, CA 92253
PHONED 564-1551 FAX* 564-5091 DATE 10-28-99
THE. DAN DEE COMPANY INC: HAS SUPPLIED, AND INSTALLED
THE FOLLOWING AMOUNT OF O-HAGIN ROOF VENTS.
1QT9 0 CI VENTS
3 16
r
---------------- `--------------------------------------------------------------------------------------
NOTICE
'Tinder the MeclwOuti' lien I.aw it:alifomta Code or Civil ProceAure Section 1161 el Stag ), any :upsmitnor 5rrhranrravor. latorer 5u1RIAm tfter peroon not to-1p.i 10
imp vc yryur pr.4r11y but is n -ped ru; hr wOrk.asr AuFFisa, f' -as : right iv enfwue- a s;Wni r gains, your property. This Teams that, atter a mw nearing your property
rrwtlA be sold try a c4,urt ufGcer ano the proceeds of the sale used to unary the indebtedness. This ;-in happen wan if you have pard sour own con4:lracr Lor ruA If trw.
Sut-:wuracior, lanotte or supplier remains Unpiti0 anA it ligal action is n&oe awry to coffers or entnrrx The terns of this contract. tilt, IM eva itivi lhifly shall t* r:nntlea w As
reasonable acorn" tees plus all costs Lot suit and interest shall accrue an All RUMS; which are due 30 days after billing' of the rat, at i d % per annum The DanDee Co.
Inc. is not reswiwele k6 oeibys caused by wcathr r. gtnkv, material shortage or delay nt malenal suprdrrd In the lob or to any other delay Wyotia its contmi rw-.
DanDee Cu Inc, total liaurlrl, unser this contract or in naglisR-vrce is limited coley to the amount of this c:ontraeA
We are fully ralrered by wgrftmen•s cofntaensation and,public liability insurance. Carders names and ooligy numbers available on
roqugt.
any alteration or deviation hunt the a bbryve. specifications involving extra oast of material or l.thnr will only be executed upon wtittut uideN kA, sbr'i&-. arts will bm:ome
an •-rra dgn)e uvvi Ine. sum ntentinnad in this piorwsaL All agreements muar he made in wdtNng anu is uasud Lori riot acress to Wilding (nr difect loading hone v.a
liuChS
Prcos are based on current costs of material and labor. Increases or decreastas, -111 ho raflactad at time of signing eontmet.
Before and or during roofing operations and the completion of roofing, The DanDes Co Inc. wig not be responsible at liable for damage caused from
acts of God. such as eanthquaaes, thunderstorms, hall or any orhtw weather conditions beyond roofers cOn"I.
t
Till' DANDEL CO.
I
l)A 1 I•. ....
DATE ID l
PROPOSAL VALID FOR :SO
I)AY
OOT-19-99.TUE � 9:39.,AM WESTERN INSULA'T'ION' FAX NO`. 161'96$66425.. F 4'
WESTERN INSULATION �!Nc. ;
4211 Latham Street,'Rlvereide, California 92501 '
(909) 686-8760 .
`(909) 686-8786 Fax
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
CAUrORryNIA, IN TI IC BUILDING LOCATED AT:
TRACT/ PHASE: MONTECITO-MODELS TRACT #: 28805 u
LOT#: 4
SITE ADDRESS: 55-491 SOUTHERN' HILLS, LA QUINTA, CA. ,
EXTERIOR WALLS: '
MANUFACTURER:. "JOHNS-MANVILLE THICKNESS: 5 1/2"' .R-VALUE: ;R-21
Iti
CELLINGS : `BATTSy} BLOW s
MANUFACTURER: GREENSTONE THICKNESS. 10:3" R-VALUE: R-38
CEILINGS: BA TS-,BLOW
MANUFACTURER: JOHNSMANVILLE• THICKNESS:.' ,13. R-VALUE: R=38
GENERAL CONTRACTOR: CENTURY.HOMES
LICENSE NUMBER:
BY:
' TITLE: .d
€ DATE:
INSULATION CONTRACTOR: WESTERN INSULATION, INC "
LICENSE NUMBER: 481278
BY:
+ TITLE:' Prod uctio Ma ager '
` DATE: OCTOBE 19;1999' _
i
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of1La Uinta
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Budiding-ond.Scifety.D�qpartMent 'OF41
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 conipGance with the various ordinances
of the City regulating bui/ding construction or use. For the. following:
BUILDING ADDRESS: 55-491 SOUTHERN'HILLS
Use Classification: SINGLE FAMILY DWELLING •~Bldg. Permit No.: 9901-127
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: 2/7/2000 ,
Building Official
}, ..POST.IN A CONSPICUOUS PLACE ,