9901-124 (SFD)LICENSED CONTRACTOR DECLARATION
I,hereby affirm under: penalty of perjury that l am licensed under provisions of
Chapter 9:(commencing with Section 7000) of Division 3 of the Business and
;=Profe'ssionals Code, an,d.my License is in full force and effect.
License # Lic. Class Exp. Date
�y
0 ,o7 .
Dated - i r 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 isnot 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).
(J,, Ilam ezempt,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:
have and�will mai ntain.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.
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 JS, issued. My workers"compensation ,insurance carrier & policy no. are:
Carrier' Policy No.
'C( t)L`d heACiX}3 NWC 517701400 .
(This,section.need not be completed if the'permit valuation is for $100.00 or less).
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 thos provlslons;, ' ��
ID re '7r C 7-1-6 Applicant j
•
Warning: Failure to secure Workers' Compensation coverage is unlawful and
Shall subject an employer. to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of.theLabor Code, interest and attorney's fees.
IMPORTANT. Application is hereby made to the Director, of Building and Safety
for.:a: permit subject -to the conditions and restrictions set forth on his
application.:
1. Each.person upon whose. behalf this application is made & each person at
-Whose request and for whose benefit work is performed under or pursuant to
:..any permit issued as a result of this ,applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta,-its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work .is not commenced within 180 days from date of .issuance .of such '
permit.,.or cessation of work for 180 -days will subject permit to cancellation.
\l certify that I have read this application and state that the above information is
kcorrect:'•I'agree to'comply with all City, and State laws relating to the building
construction, and hereby authorize representatives .of this City to enter upon
the above-mentioned.property for inspection purposes.
eZ
Signature ' (Owner/Agent) ��� Date •
PERMIT #
BUILDING PERMIT,�;,.:�a
DATE VALUATION y� LOTTRACT .y
S87rr0, ':
JOB SITE
ADDRESS St1'd�' lR l M�.4
APN 769-8164W
4":3i0
OWNER
CONTRACTOR/DESIGNER/ENGINEER
SOUT"1%Ei'.N H11 LS, LLC"
R.C. HOt3ES tI
dha SOtHER:N HILLSD LiyC
1410 E C14AP1\4AN AXT,' 81 100
5-960 PGA.BLVD
ORAINGE CA 92186
LA QUI.NTA. CA 92.253
(714)6311200 CB1, 5487
USE OF PERMIT
STtvCaC. FAMIJ WElA..t'NG
LOT 9, PLAN 302.5FD. PPMWO tDOF$ NOT I C71bw.87LO Z.'1 SVA I,.S OR
POOLS. PLAN CWCK M. R D'LTC_ D 75Vo FOR MLi1,11.PLE ISSUANCE OF
SjWE PLAN TYPE.
CUSTOM CONSTRUCTION 3,:372:04 SF
PORCnP hTlO 318.00 ,r'
OA)iAGW.ARPOR`C 700.005F
1MATED COST or CtDNS'f':itl)C VIONI
280,67A.20
PERMIT FEE SUMMARY
CONSTRUCTION r -EF i0L-0Af1�1,i8-OOt) S.t,2?3.fh�
PLAN C[EC''1% "FE -9 10.1 -OW -439-3 i.8 S26046
NIECRANTCAL :FEE 101�0W-411.000
1 LEC't`C2.IGAL FF S • .101-(3tyib-•420-000
PLUNBTMCI FEF; ' 1014060-419-000 $20.5.75
ST;p.oN't3 MJTION &lam.: REBID 101-000-241-000 $28.,tia
GRADMG' 101-000-423.000
lAiVRASTRUCTiTRE .F F.9 1:` .: Wt)-4.�1�442
ART M PTJEL,I.0 P..Lf1.CSS RI'sS)1: ` oi-t)EI(1-255-000 $151,57
SLII3-TOTAL.CONS'1`RMITON 41kNDfLjV4 CHECK
LESS PRE-FAID >+EFS
TOTAL PERMIT FEES DUE MONY
3II,55L90
N
RECEIPT �q
_!
DATE �,, ey
f r !
BY
DATE FINALED
INSPECTOR
.,•
11"01 � INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs I
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck z/
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace Pt.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
two
IT
Final
Fina 4#WM4
BL CKWALL APPROVALS
OOLS-SPAS
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
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.1.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
x~29-99 09 50A
The DanDee
CAMWasky bw. L is 732542
ROOF/NG ANO CONSTRUCT/ON
a
4s'
'P_01.
Roofing Proposal
P. 4. Box 277 Thotnane Palms, CA .92276
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
PHONE# 56.4-1551 FAX# 564-5091 DATE :10-28-99
THE DAN DEE COMPANY INC. HAS SUPPLIED, AND INSTALLED
THE FOLLOWING AMOUNT OF O-HAGIN ROOF VENTS.
-LOT# a OF VENTS
1 16 - •
2 17
3 . 16 ,
4 17
S 16
6 17 t
7 16
8 1S
.NOTICE
Under the Mechanics lien I.aw ICalifornia Code of Ctvd Prorxdure Section I I a I el Saq ). any oontracu',r, sahrnnrrauor. laborer. supphci olhcw person ne help.; to
impruve yrwr pmoery but is not paid for his Work nr supplies, has a right to erelorce. a tarot against your property. This muaris that, atter a mttr hearing your properly
mild be sold by a court uKcer and Ina proceeds of the sale used to sansty the indebtedness. This can havo6n even t you have paid your own conuactcr to full it lne
Sut^:untroctor, larwitj or supplier remains unp<ud,and ii legal action is necessary to collect or enforce The terns of this contract. the W evathng pany %hall he entitled to its
reasnnaae attomey fees plus all costs of suit and interest shall accrue an all sums• -which are due 30 days after brlluog at the rate at t d / per annum. The DanDee Co.
Inc, is not respons-ble for delays Caused by weather. wnke, maierial shortage or delay 4) material suprdwa to me jot, or to any other delay buyono its coniml rrte
DanDee Co Inc, total liability under MIS contract or in negligence rs limited solely to the amount of this contract
We are /ally eQvered by workman's compensation and,9ublic liability insurance. Carriers names and policy numbers available on
requs3L.
Any sheration or deviation hon the a above specifications involving extra cost of material or labor will only be e■ecuted,upun wtifhn urders fa' Satire, and will become
an extra dtarVe over Ute sum mentinned in this proposal. AD agreements must he made in writhing anti is bascid ort free access to building fpr direct loading from :out
Prices are based on current costs of material and labor. Increases or decreases, win he raflec[•d at time of signing contract.
Before and or during roofing operations and the completion of roofing, The DanDee Co Inc. will not be rvsponslble'or Ilable for damage caused from
acts of God, such as eanhquartes, thunderstorms, hall or any other weather eondidons beyond roofers control.
DA'1'I'
DATE .
THE DANDEE Co. — — pit( PO.C.AI. VALID FOR 1-d DAY's —
DEC-29-1999 '09:44 WESTERN INSULATION 4 909 686 8786 P.16i19
WESTERNINSULATION, INC.
4211 Latham Street; Riverside, CaWoraia 92501
(909) 686-8760 i
(909) 686-8786 Fax
INSULATION CEiRTIFICA°i'E
THIS IS TO CERTIFY THAT INSULATION HAS BEEN 'INSTALLED IN CONFORMANCE WITH THE
CURRENT ENERGY REGULATION, CALIFORNIA ADMINISTRATIVE.CODE, TITLE 24; STATE bF
CALIFORNIA, IN THE BUILDING LOCATED AT: `
TRACT/ PHASE: MONTECITO-PHASE 1 TRACT #:28776
LOT#: 9
SITE ADDRESS: 54-570 SOUTHERN HILLS, LA QUINTA, CA. ;
EXTERIOR WALLS: '
MANUFACTURER: ' JOHNS-MANVILLE THICKNESS: 5 1/2" . R-VALUE: R-21
CEI LiN ATtS. BLOW
MANUFACTURER: JOHNS-MANVILLE THICKNESS: 13" R-VALUE: R-38
CEILINGS • BATTS LOW
MANUFACTURER: GREENSTONE , THICKNESS: 10.3" R-VALUE: R-38 '
SE-NERAL CONTRACTOR: CENTURY AMERICAN DEVELOPMENT
LICENSE NUMBER:
BY: -
TITLE:
DATE:
INSW ATION CONTRACTOR:. WESTERN INSULATION, INC. ,
LICENSE NU ER: 481278
BY: -
TITLE: rodu n Manaj4r.
DATE: DECEMBER 29,1999 '
Ix" 0
.,I, t
C,
�4•`::;�_� �+Pr' ®. '�.'•i: ylYo ta
�� d
an�1eparreia
ff n
iling
t, .1 4'• 's
This Certificate issued pursuant4o. e`requirements of Section ,1&9-ol the Uniform Building Code,
V.; I -
certifying. that, at the time of issuand is structure was -in comp iance with the varibui'ordinances
tru lo W
-Forthe fal fii�r.
of the City regul�qting b construction or -use.
- A I . 4
4
BUILDING' ADDRE!
3S: 54-570 SOUTHERN HILLS
Use Classification: SINGLE FAMIUV115WELLING Bljg'.,Permit No.: .9901-124
. IL b nyd - U s`6`Zone: R L
Occupancy, Group: I ype.�of.Cons truction:VN '
S166 Add
1*4� JCCHAPMAN AVE STE 100
Owner of Building: SOUTHERN, Address:_ 0
City: ORANGE, CA., 92886
By: DANIEL P.-CRAWFORD JR.
Date: 7/20/2000
-Building' Official` 7- ----
-POST IN A CONSPICUOUS PLACE
b..