9907-125 (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
%i+e�z�
/ate 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 ' .
( ) 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 Secti6n_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.'
! t_701,t.
(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
work re' compensation laws of California, and agree that if I should become
subject to the workers' compensation provisions of Section 3700 of the
Labor
6e, shall fortrwith comply with-thdye�p�oosion � . :„:.
Mate: Applicant
Warning: Failure to secure Workers' Compensation coverageis 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 M
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
4: 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
correctell. 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 f inspection purposes.
1Signature (Owner/Agent): Date '
BUILDING PERMIT PERMIT# .
DATE r j VALUATION LOT TRACT
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JOB SITE'
ADDRESS �:" 11Y _6Li� ;S!4%
APN-A,V��Dµi.
OWNER
CONTRACTOR/DESIGNER/ENGINEER
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LA. QUI;N A CA 92253
USE OF PERMIT
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RECEIPT
DATE' .
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs 11 11
Underground Ducts
p
Forms 8 Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
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 I/ 0
BLOCKWALL APPROVA S
POOLS - SPAS
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 IFPlumbing
Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral APool
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=19-2000 12:14';� WESTERN, INSULATION 909,686 8786 P.:09i16
{
.v STERN_ -INSULA TIONt., INC,*
01 ] Lachem Street, Riverside, California 92501 ;
' Tel (909) 686-8760 Fax (909) 686-8786 '
'INSULATION CElkTIFIdTE
tail
THIS IS TO CERTIFY THAT'INSULATION,HAS. BEEN INSTALLED IN. CONFORMANCE WITH: f
THE CURRENT ENERGY REGULATION CALIFORNIA ADMINISTRATIVE CODE�T(TLE 24;
'STATE OF CALIFORNIA, IN ,THE BUILDING LOCATED
TRACT / PHASE: MONTECITO COLLECTION-.28776 PHASE_ 3A
LOT # . , 20
SITE ADDRESS 54-834 SOUTHERN HILLS, LA QUINTA, CA, +
_ _--————--——-----——--———-—— —
EXTE OR WALLS: ,— —,� -
MANUFACTURER: GREEN NE THICKNESS: 10.3"; R-VALUE: R 38.
CEfLINGS: ' BA 'S
w i
MANUFACTURER: • JF�iS MAN `IELLE ` THICKNESS: • '13" R—VALUE: R-38
CEILINGS:ATT • BLOVIiI ,
MANUFACTURER: JOH NVILLE THICKN S 5.5 R-VALUE:,R•21;� `
•..s GENERAL' O TRAC -OR: - - - - R : C. HOBBS- 0.
LICENSE NUMBER:. `
- .BY:
TITLEc -
DATE:
IJLATION L 061i'RACTi
• • ��$ n��P WESTERN INSULATION, INC. - •
LICENSE NUMBER: 461278 y
BYi c F'
TITLE: ' ?FFICE MANAGER, '
DATE . OCTOBER ,18, 2000
EMERALD ROOFING,
'
INC.
78-670 HIGHWAY 111, STE; 174
LA QUINTA, CA 92253
License No. 770940
(760)347-9869
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 MONTECITO HOMES
AT PGA
WEST. BELOW ARE THE ADDRESS AND NUMBER OF VENTS INSTALLED.
PHASE 3-A TRACT#26776
-
LOT#.. PLAN#
ADDRESS
# OF VENTS
17 3-C
54-768 SOUTHERN HILLS
16
18 3-A
54-790 SOUTHERN HILLS
•jS
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 XCR
54-922 SOUTHERN HILLS
16,
PHASE 3-B TRACT# 28776
LOT# PLAN#
•
25 3
ADDRESS
# OF VENTS
-AR
26
54-944 SOVTHERNFHILLS,
16 }
2-C
54-966 SOUTHERN HILLS
17
• 27 2-A =
54-988 SOUTHERN HILLS
17
28 . 1 A
55-010 SOUTHERN HILLS
'17
29 1-8
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
f '
PRESIDENT
Certificat.6-of Occ-upanc y . a,
t. -City of La Quinta .. F
" 5
- Building and Safety Department
�f p.F fit'►
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 constiuction or use. For the fol%wing:
BUILDING ADDRESS: 54-834 SOUTHERN' HILLS
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 9907-125
Occupancy Group: R-3• Type of -Construction: VN •Land Use Zone: RL
Owner of :Building: SOUTHERN -HILLS LLC Address: 1430 E CHAPMAN AVESTE.100 -
City: ORANGE, CA., 92886
By: DANIEL P. CRAWFORD JR.
�64"" Date: , 1/11/01
M
Building Official - -
POST IN A' CONSPICUOUS, PLACE'
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