9901-120 (SFD)LICENSED CONTRACTOR DECLARATION
�,Iher6by affirm under penalty of perjury that I am licensed under'piovisions of
Chapter 9 (commencing with Section 7000) of Division 3 of.the Business and
LLJ
Professionals Code, and my License is in full force and effect.
;
D , License # Lic. Class. Exp. Date
r
LO
'478689- .2429 .
111
rk,
_.0
Z r— Date, -,.2 L Signature of Contractor
ontractor
0
".OWNER -BUILDER DECLARATION
LL - W
J ii1-hereby affirm under penalty of perjury that I am exempt from the, Contractor -s
License Law for the following reason:
'Z. 1, as owner of the, property, or my employees with, wages as their sole
,77 -0 and the structure is not intended or offered for
gompensation, will do the work,
sale (Sec. .7044, Bus,iness &.Professionals Code).
J 1, as owner'of :the, property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code)..
I, am ex6m n
p�u 'der S'ec'tiori B&P.C. for this reason
LO
Date.
'Signature of Owner
ir
Of
Q
WORKER'S CO_ MPENS ATION DECLARATION
as z
I hereby aff irm'.u.ndee 'penalty,' ' 'of perjury one of the following declarations:
Lo
ill maintain a certificate of consent.to self insure for workers'
�'o 1 have and w
4 , ., , �� Compr'�- S�t� 'by Section '3700 of the Labor Code, for the
:X- , en i6n, as pr�ovided'for
Aij
performance of the work for which this permit is issued.
I have and will *maintain workers' compensation insurance, as required by
§�cti6`6 3700 of the Labor Code, for the performance of the work for which this
ulolic� n
permit is issued. My w6rkers' compensation insurance carrier & p o. are:
'z
Carrier i Policy No.
OLDEN EAOCE NWC 547,101400
(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,
'Shall not employ any person rson in I any manner so as to become subject to the
�Vork4�P1s"compe6sation laws of California, and agree that if I- should become
subject' to the workers' compensation provisions of Section 3700 of the Labor
Code, h comply with those provisions.
b
ate: Applicant
�J
Warning: Failure to'secure Workers' Compensation coverage is unlawful and
hall subject an erihployer 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 permitsubject to the, conditions and restrictions. set forth on his,
application.
A. Each,person upon whose, behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant t6
.'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
perpit, or, cessation of work for 180 days� will, subject permit to cancellation.
t I have read ,this application and state that the above information is
I certify that
correct. t. I agree to comply with all City, and State laws relating to the building
construction, and hereby abthoriz6 representatives of this'City to enter upon
the above- mentioned property for inspection purposes.
Signature '(Owner/Agent). D a t ej
�
PERMIT#
BUILDING PERMIT
DATE VALUATION $280,62$.20 LOT -5" TRACT
4,
JOBSITE- IrAPN
ADDRESS 34,482.4366THERN HILL$ -,i
70-900-027
OWNER
CONTRACTOR DESIGNER ENGINEER
SOUrRE-1W HILLS, LLC
R.C. HOBBS dba.SOIJrHERN HILLS, LLC
1.430 E CHAPMAN AVE., Ste 100
5j-960 PGA BLVD
CA 92986
LA QUINTA CA 92253
(714)633-7260 CBL# 497
USE OF PERMIT
81-NOLF-1 AMIL"Y [AV L111,10
LOT 5, PL.Qq _ABR -WD- PtWIT DOES NUP MCUUDE 13LOOKWALLS OR
1 C
POOLS. PLAN M."iCK FFE REDUCED 75% FOR MULTRI'LE 1.4SUAME OF
SANE PLAN "'PE.
I
CUSTOM CONXf RUC -110N 3,372.00 SF
PORCUPATIO 318:60 SP
GARAGWCARPORT 700.00 5F
1XI IMATE, D CXK%T OF CONSTRUCf 101%
2-80,628.20
PF-AhOTIIEEE 91MMARY
C0N,1.;TRUCrr10XFE9 101-000-418-000 $1,273.00
PLAN CHECK FU 101-000-439-318 $260.00
,tV1W7HAN71CAT, FFX $124.00
&EMUCALFEE 101-000-420-000 $189.52
PLUMBING FEE 101-000-.419-000 &205;75
SUONG MarlaNYEE - RESID 101-041}-241--000 M.06
GRAM NO FEE 101,_000_423-000
J1NFRATMUMPE.M08, 224W443-342 $6.000,00
ARTV PUr.41,1C PL A"ms - RESTE `70.1-000-:255-000 U51.57
SUB -TOTAL. CONSIRUCTION AIND PLAN CHECK
$8, 1"90
LESS P&E-PAIDFUS
TOTAL P ULM I T F EF -S D UF. NOW
RECEIPT
-7
DATE
JBYr
DATE FINALED
INSPECTOR.
72 �
4-1 J
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
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wali Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVAO
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.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
Oct2.9-99 09:50A `
nr.� iF
The-DanDee-
CkwWowky bw. Lis 732542
ROOF/NG AND CONSTRUCT/ON
BIDS TO:
THE R.C. HOBBS COMPANY
55-960 PGA BLVD.
LA QUINTA, CA 92253
PHONE# 564-1551 FAX# 564-5091
P_OP)
Roofing Proposal
P.O. Box 277 Thousand Palms, CA .92276
Phone (760) 343-3385 Fax (760) 343-3096
JOB NAME:
MONTECITO COLLECTION
PHASE# 1,
LA QUINTA, CA 92253
DATE 10-28-99
THE DAN DEE COMPANY INC. HAS SUPPLIED, AND INSTALLED -
THE FOLLOWING AMOUNT OF O-HAGIN ROOF VENTS.
-LOT# S OF VENTS
1 is
2 17
3 16
4 17
6 17
7 16
8 15
9 16
--------------------------7---------------------------------------------------------------------------------------------------------------
NOTICE
Under the Mechanics lien l.aw Walifomia Code or Civil Procedure Section 1161 el St:rj ), any comractnr, suhrani laborer. supVhci olhc`r pergnn nR halps io
improve your property but is not paid for his wark nr supplies, has a right to enforce a daim against your property. This moans that, atter a mitrT nearing your property
roulu be sold by a court officer and one proceeds of the sale used to sansy the indebtedness. This can happyn even d you have paid your own confiactoi rn full It the.
Subwrttractor. IatXYpe or supplier remains unpaid anti if Irgal action is necvasar'y to collect or enfnrrA the terms of this contrail. the plevarhnv party shall tm entified to its
reasnnabla aftorney fees ples all crests of suit and interest shall accri a an all Bums, which are Clue 30 days after billing at the rAip at 1 d v/ per annum. The DanDee Co,
Inc. is not responsible for delays Laused by weather, 3tnke. material shortage or delay 4) malenal supplied to the job or to any other delay tnryono its corttm, Trb:
DanDee Co Inc. total liauitity uruter mis eontran or in negligettt:e is limited safety to the amount of this contrrcA
We are fully c.Qlrered by workmen's compensation and.public Ilablllty insurance. Carriers names and�olicy numbers available on
request.
tiny alteration or deviation frail tnc a ctxyve specifications involving extra cost of material d lahor will only be executed upon writtt n uidtrs hit satire, soul will became
an extra diarge ovei Ute sum mantinned in this proposal. All agreements must he made in writhing anti is basad ori free access to building for direct loading from vin
truaB.
Prtcas are based on current costs of material and tabor. Increases or decreases, —III ho reflecrad at time of signing contract.
Before and or during roofing operations and the completion of roofing, The DanDee Co Inc, will not be responsible or liable for damage caused from
act* of God, such as earthquakes, thunderstorms, hall or any other weather conditions beyond roofers control:
DA'I'1•:
TI II( DANDFL CO
PRO ASAI. VALID FOR SI DAYN -
DEC -29-1999 09=43 WESTERN INSULATION 909 686 8786 P.12/19
WESTERN INSULATION' INC.
4211 LatUm 8tmet, Riverdde, California 92501
(909) 686-8760
(909( 686-8':86 Fan
INSULATION CER MICATE
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 1 TRACT #:28776
LOT#: 5
SITE DRESS:, 54=482: SOUTHERN7HIL"LS; -LA _QUINTA CA'`
EXTERIOR WALLS:
MANUFACTURER: JOHNS -MANVILLE THICKNESS:. 5 1/2" R -VALUE: R-21
CEILINGS : ATTS BLOW
MANUFACTURER: JOHNS -MANVILLE THICKNESS: 13" R VALUE: R=38
CEILINGS_; BATTS BLOW
MANUFACTURER: GREENSTONE THICKNESS: 10.3" R -VALUE: R-38
I
GENERAL CONTRACTOR:
LICENSE NUMBER:
BY:
TITLE:
DATE:
INSULATION CONTRACTOR:
LICENSE NUMBER: 481278
BY: oa_'�
TITLE: ProduiWon anag
DATE: DECEMBER 29,1999
CENTURY AMERICAN DEVELOPMENT
WESTERN INSULATION, INC.
JON TANDY R '
<q 37630 Medjool Ave`.
e Pi m �Vpjm ."Desert, CA 92211
l//./ n... d • O
Office
X760) 60) 772-71719293 E Cl• Pager ( (760) 776-3338
REGISTERED INSPECTOR'S WEEKLY REPORT `����,
TYPE OF '
INSPECTION [�
PERFORMED l
O REINFORCED CONCRETE �TRUCT. STEEL ASSEMBLY ❑
❑ POST TENSIONED CONCRETE ❑ASPHALT ❑OTHER
❑ REINFORCED MASONRY ❑ FIRE PROOFING
JOB LO A ^ �cx-)-(VAEX I 9 , `� I! L� ���� �,
P� 1, `
REPORT SEQUENCE N0.
TVRIJFTURE -`
PERMIT N0. _Er
DAV OF WEEK
MATERIAL ESCRIPTIO - Sp�
ARCHITECT `
INSR .:
N
HRS. CHARGED
•
7
LINSPECTION
R ENGINEE
ASSISTANTS
HRS. CHARGED
SUB
DATECONTRACTOR L CONTRACTOR. �C -L- `Iv C,
-4
E-k G'D UQ I IJ C- 0-4('u u '-Fo
, 14 - 0L X s /
1660'OeCTLO
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SHO (P Weca (P C®un (a
COPY SENT TO*CLIE
CmINUED ON NEXT PAGE ❑
PAGE OF
CERTIFICATION OF COMPLIANCE
I HEREBY CERTIFY THAT I HAVE INSPECTED.TO THE BEST OF MY
KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE
NOTED. I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED
PLANS.. SPECIFICATIONS, AND APPLICABLE SECTIONS OF THE
GOVERNING BUILDING LAWS. r
SIGNATURE OF REGI RED INSPECTOR -
DATE 6F REPORT REGISTER NUMBER
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This Certificate issued.pursuant ':to.;;the...requfipments of Section:" 09: of. the Uniform Building .Code,
certifying that, at the time ofissuance,'this structure was in compliance.with the various ordinances
of .the City.regu/ating building, construction. or-use. For the fo/%;wing:.
BUILDING-ADDRESS: 54-482 SOUTHERN'.H.ILLS
Use Classification: SIN GLE_FAMILY DWELLING Bldg;_. Permit No.: 9901-120.
Occupancy: Group: R-3 Type of;. Construction: VN Lan.d..Use Zone: RL
Owner of Building: SOUTHERN HILLS; -LLC Address: 14.30. E CHAPMAN AVE STE 100
City: ORANGE, CA., 92886
By: DANIEL P. CRAWFORD JR.