9901-116 (SFD)LICENSED CONTRACTOR DECLARATION
['hereby'affirm under penalty of perjury that I am licensed under provisions of
Qhppter9 (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
Vii. 29
00
Date 1!!�L •Signature of Contractor -
I
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that.1 am exempt.frorn the Contractor's
License LaW for the following reason: d
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 (Selc.'7044, Business & Professionals Code).
1, as owner,'of the property, am exclusively contracting with licensed
contractors 4o construct, the prbject (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 6nder1p;ndlt'l I thefollowing declarations:
y of perjury one0
(„) .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, forthe
performance of the work for which this permit is issued.
I have and will .maintain workers'. compensation insurance as required by
S'eltion 3760 of the Labor. Code, . foi the performance of the work for which this
permit is issued._• My. workers' 'compensatio6 insurance carrier & policy no. are:
Cartier.Policy No.
0- OLVEN AGLS, NWC 5477,0140
(This section . need not. be completed if the permit valuation is for $100.00 or less).
I certify that in the perf rmance,of the work for which this permit is issued,
1:§hall 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 thoseSI:
vision
Dater -`i Cl Applicant —
XWarning:Failur6 to secure Workers' Compensation coverage is unlawful and
shall subject an empl6yerto criminal penalties and civil fines.6p 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 pe . rmit 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 ai'a result of this applicaton agrees to, & shall, indemnify
khold 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. comme- nced within 180 days .from date of issuance of such
permit, or cessation of work for 180 days, will subject,permit to cancellation.
(Ceftify 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
ffie-'above-rrientionied property for inspection purposes.
Sig tune (Owner/Agent) Date
BUILDING PERMIT
DATE VALUATION $2go*,62.8,20 LOT
PERMIT!_.
TRACT '287'70
JOBSITEAPN
769-800-023
ADDRESS. , !;�*94 S&iHERN 141jusi
OWNER
CONTRACTOR/DESIGNER/ENGINEER
SOLRIMRN HILLS, LLC R.C. HOBBS dba SOLtrRERN HILLS, LLC
1430 E CHAP[ AN AVE., St6 100 55-960 PGA BLVD
ORANGE CA 92896 LA QUfNTA CA 92253
(714)633-7260 CBL# 5487
USE OF PERMIT
SINGLE FANILLY (WKILING
LOT 1, PLAN 3BR -SPD- PERMYr DOES NOT INC&IME BLWK WALLS (.-)R
POOL' s..Pf,AN amcm.-FEFR MMM 75"/o FOR MUTIPIX ISSUANCE OF
SAME PLAN TYPE.
CIUSTON4 CONSTRUCT.10N 3,372.00$1
PORCHtPATIO 31&00 SF
GARAGECARPORT 700.00 3F
ESTIMATE D COST ()tP CONST RUCtION
280,62tv)
PERMIT FEE SUMMARY
CONSTRUCTION: FIX,
101-000-418-000
$],-V3.00
PLAN CHECK FEE
101-000439318
2260.00
TVISCHANICAL FEE
101-000421-000
$124-00
hLECTRIC/q. FEE
10.1-000-420-000
$189,52
PLUIVIB [NO 1;I -,E
1.01-000-4194000
S205.75
STRONOMOTION FEE. -'RESW
101-000-241-000
SZ8.06
aRADING FEE
101-0110-423-000
$20,00
1AW-7 FEE,
225 004413-342
$("000o)
ARX:IN PUBLIC PLACn - RE5IC'701-000-255-000
SLT-TCFJ'dXICONSq.'R.LICIION-A.NDPL..t%.NCItE-C-K$8,551,90
USS Pkii-PAID FEES 1 $0.00
DATE
TOTAL PERMIT FEES DUE NOW I sa'5's.1.90
DATE FINALED IINSPECTOR
I- INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs Ala A
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
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
T"f of
S
Final
Final
BLOCKWALL APPROV LS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping i
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) 77
COMMENTS:
_ y 1
Oct: 1-99,09:50A
The Da'nDee
Comp' b>. L ic, 732542.
ROOF/NG AND CONSTRUCT/ON
P_O1
v +
Roofing Proposal -
P, p Box 277 Thousand PJhns, 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. ,
�_x OF.VENTS
.2 17
3 16
4 17
6
17
7 16
8 15
9 16
---- -------------------------------------------------------- ------------------------------- ------------------- ---------------- ------------
NOTICE
'Under the Mechanics' lien I,aw (California Code or Civil Pror enure Section t 161 el see ), any cuniravr+r, srthr. artzroctor. laborer. suplAef oth@r p6r3rn he hFtlpi to
Improve your pmrreny but is not paid rix his work or supplies, nas a right to cnfotce a daim against your property. This muaris that, after a gotur nearing your propeny
..mind be sold by a court rdreer and the proceeds of the sale used To saart_aty the indebtedness. Tnis can happen even d you have paid your own conliactor to full If mP
Sub,xi tractor, latwpr or Nupplier remains unpaid and it Ir -gal action is necessary to colleci or enform The terms of this contract. the pi evathrvi piny %hall he entitled to Its
reasonable attorney tees plus all costs at suit and interest'shall accrue an allsums, which are due 30 days after bdlog at me rate at id v/ per annum. The DanDee Co.
Inc. is not respon3-tile rot delays caused by weather. stoke, material shortage or delay in malenat guprdwd to me jot, or to any other delay t mio its contml rrw
DanDee Co Inc. total liability unser RHs contmet or in neglisiefice is limned solely to the amount of this conlraU
We are fully ,rgyered by wgrftmen's cofntleasation and,public liability insurance. Carriers names and polity numbers available on
request.
tiny alteration or deviation hum the a above specifications involing extra cost of material of lADnr will only be executed upon written urders tot' sanw-, sun will biome
an extra diarye over the sum maminned in this proposal. All agreements mtrar he made in wriut(ng anu is based ort free access to ►iiilding fnr direct loading from ver
truces.
Prices are based on current coats of material and labor- Increases or decreases. wt►I he reflected at time of signing contract.
Before'and or during rooting operations and the completion or roofln,% The DanDee Co Inc, will not be responsible or liable for damage caused from
acts of God, such as ea"quakss, thunderstorms, had oe any other weather condidons beyond roofers control.
DATE
DATE
Till: DANDEE CO. — PROPOSAL VALID FOR _Sd PAYS.
DEC-29-1999 09.42 WESTERN INSULATION 909 686 8786 P.08/19
Ll
WESTER-N .INSULATION • INCo
4211 Latham 8Veet, Rlvendde, CaHf mk 92501
(9.09) 686-8760
(909) 686-8786 Fax
;'MMULATIONCERTIFICATE`t
THIS IS TO CERTIFY THAT INSULATION HAS BEEN INSTALLED IN CONFORMANCE WITH THE
` CURRENT ENERGY :REGULATION; CALIFORNIA ADMINISTRATIVE CODE; TITLE 24, STATE OF
CALIFORNIA, IN THE BUILDING LOCATED AT: _
TRACT/PHASE:, . MONTECITO-PHASE,/- TRACT #:28776
LOT#: 1:
SITE ADDRESS: 54-394 SOUTHERN SHILLS, -LA QUINTA, CA.
{
EXIMOR WALLS:
MANUFACTURER: JOHNS-MANVILLE THICKNESS: ; 5 1/2" R-VALUE: R-21
l.
NGS : �ATrS BLOW "
MANUFACTURER: - JOHNS-MANVILLE THICKNESS: 13"' : R-VALUE: R-38
CEILING5 BATT'S BLOW ,
MANUFACTURER: GREENSTONE THICKNESS: 10.3" R=VALUE: .R-38
GENERAL CONTRACTOR: CE'RY'AMERICAN DEVELOPMENT
LICENSE NUMBER: .
BY:
TITLE:
DATE: t
INSULATION CONTRACTOR:,' WESTERN INSULATION,,INC. .}
LICENSE NUM ER: 481278•
BY:
TITLE: ' odu n, M ger
DATE: DECEMBER 29,1999`
rthncate
:of O:ccu a. c
art of*La�.�C�urnta
'
r uilding�:andSafety- Departnje'nt OFti°
This Certificate issued pursuant to the • requirements of Section:109 of the Uniform Building Code,
n 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, fol%wing:
BUILDING ADDRESS:-.-.- `` 54-394 SOUTHERN HILLS
Use Classification: -SINGLE FAMILY DWELLING Bldg. Permit No.: 9901-116
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
I By: DANIEL:.P.*CRAWFORD JR.
Date: 1/12/12000
Building Official
POST IN A CONSPICUOUS PLACE