9907-126 (SFD)LICENSED CONTRACTOR DECLARATION
1 -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
478689, $ 02I29120t
tDate Signature of Contractor -
;. OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I amexempt 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). '
O 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.
( y) 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.
GOT.00NrA?J_L CS610
(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
CAB, I shall forthwith comply with .th,-6se provisions..
•l5ate:y Applicant
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
1, 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,,age nts 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 1804ays 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 in§pection purposes.
Signature (Owner/Agent) K— Date
6. PERMIT#
BUILDING PERMIT
DATE / + VALUATION 1$2.x9,6,74.,90 LOT23 a. TRACT r,8776
JOB SI SS````rrrffffRT tI�,Ir:�r, �' j
APN 769-910-013
OWNER- —. _ . r . -- - - --- - _ _ _—
CONTRACTOR/'DESIGNER/ENGINEER—-
SOU111HE.;i;<d 13TULS LLC
IRC. HOBBS dba S'101 TrHEPN HI, .,S, LLC
1430 E CHAPMAN AVE ST'E 100
55 -960 PGA, L33.VD
ORANGE CA 92886
L to QUIN•r.A, CA. 92253 .
(714;!633-7260 CRIN 5497
USE OF PERMIT
CW� iLP .h''.thMILY Diid iRDING
S!%D -LOT ,21 TILAX 2B :P01W"TDOE S NOT INCLUDE BLOCK WALL OR
lyUi ,C..15"/0 4�d AN' C;`F1 :i I, Jtirll'i rG'i1U f APPLLE0 FOR M(3 :PJPLE SUBN117•1'AL
CL;STONNICONSTRUCa1ON 3.073.00 SF
POItt::HIPATIO 320.00 8F
GARAW- CARPDXf 8t0.Si0 '
.'EST NIA 1' IED C09f € rt i;O NS',1 H UC:`'e ::CJI`:
259,674,50
CONSTRUCTION 101.001.1-418-0W $F.199.50
$244.37
AIE04,V,0CAL FPC- .101"000.421-000 $1,t1•St)
OMECTt21CAL.FOis 101'-000-420-000 �I1si.33
PLUMBING 14X 101 -OW -419-000 $SKSO
a 1' rhtet>'ngc� rlCypf ? - 0 1IS r0 1.01.-00()-24:1-OI10 97
GRADTING PET 101-0 -4.23-000
IDUVE. 0PEIt IWA:Cc HE
ART IN PU LIC .PLAC HS - RESID 70.1-000-25.5-0013 $399.19
ISIUB. GON111 ?' LICI'I'l;ON AND PLAN CHECK
$4275.16
LESS PRE -PAID TEES
$4.W
T'01?'&L Pt1,,RMWT I EFS )1DUF Now
x,275.36
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
Compressor
Insulation q
Vents
Fireplace .L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
_
Exterior Lath
Drywall - Int. Lath
Final
Final/t
'5
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
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
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Vottage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G. F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
OCT -19-2000,'12:14 WESTERN INSULATION 909 686 8786 P.10i16
r I11TYJ�LATION ITC.
WESTSKN ,
4211 Latham Street, Riverside, California 92501
TeL'(909) 686-8760 Fax (909) 686-8786. r
J, a
�IN IiLATI®N CER I ICATE
t
THIS IS TO .CERTIFY THAT INSULATION HAS BEEWINSTALLED IN CONFORMANCE WITHi
THE CURRENT ENERGY REGULATION, CALIFORNIA'ADMINISTRATIVE CODE,' TITLE 24,
STATE OF CALIFORNIA; IN THE BUILDING LOCATED AT;
TRACT /PHASE: MONTECITO COLLECTION- 28776 PHASE 3A
LOT #`
'
;,QUINTA
SITE ADDRESS I 5�4�-856 SOUTHERN HILLS,LLA; CA
" -------------------------------- -- ,----,
-------=----- --- -
EXTERIOR WALLS:;
4; MANUFACTURER: 'GREENSTONE THICKNESS: 10.3" R -VALUE: R=38,
LO
MANUFACTURER JOHNS•MANVILLE '=THICKNESS: 13".,. . 'R -VALUE: R-38,
;.
BATTS
BLOW.
'CEILING r
MANUFACTURER: 'JOHN$ -MANVILLE THICKNESS: 5',S" R -VALUE: R-21,:
-- - - -------"-- - - -- -- 7...----- -
GENERAL CONTRACTOR: R . C. HOBBS CO. r
LICENSE NUMBER:`r R ;i
,,.
TITLE:. ,
DATE':
'
INSULATION CONTRACTOR: WESTERN. INSULATION, INC.
LICENSE NUMBER: '481278 - h
TITLE: - OFFICE MANAGER
-
DATE " OCTOBER 19,',2000 - t .
EMERALD ROOFING,
INC,
78-670 HIGHWAY 111, STE. 174
LA QUINTA, CA 92253
License No. 770940
(760)347-9865
October 26, 2000
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 O'HAGIN VENTS AT MONTECITTO HOMES
AT PGA
WEST. BELOW ARE THE ADDRESS AND NUMBER OF VENTS INSTALLED.
PHASE 3-A TRACT# 26776
LOT# PLAN# -ADDRESS
17
# OF VENTS
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
21 2-B
54-856 SOUTHERN HILLS
17
22 2-C
54-878 SOUTHERN HILLS
17
23 2-A
54-900 SOUTHERN HILLS
17
24- 3 -CR
54-922 SOUTHERN HILLS
16
PHASE 3-B TRACT# 28776
LOT# PLAN#
25
ADDRESS
# OF VENTS
3 -AR
54-944 SOUTHERN HILLS
16
26 2-C
54=966 SOUTHERN HILLS
17
27 2-A
54-988 SOUTHERN HILLS
17 .
28 1-A
55 010 SOUTHERN HILLS
17
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
!Mq
Certificate ',of Occupancy
Tioliyl 4
OF�ti : - Building & Safety Department . r -
This Certificate is issued pursuant to the requirements of Section 109 -of the California ,Building
°Code, certifying that, at the time of issuance, this structure was in compliance' with the.
provisions of the Building Code and the various ordinances of the City regulating -building
construction and/or -use.'
BUILDING ADDRESS: 54-856 SOUTHERN HILLS.
Use classification: SINGLE FAMILY DWELLING Building Permit No.: 9907-126
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
r 'City, ST, ZIP: ORANGE, CA 92886
,By:' STEVE TRAXEL -
Date: APRIL 12, 2001 .
• Building Official
-POST IN A CONSPICUOUS PLACE
i
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