9901-117 (SFD)r. LICENSED CONTRACTOR DECLARATION
by affirm under,'penilty of perjury that I am licensed under provisions of
Chaptee,6 (commehcing with Section 7000) of Division 3 of the Business and-.
Professionals Code, and rriy License is in full force and effect.
Li'cen'se # Lic. Class Ezp. Date
478689B 2129100
bate �'-- c) Signature of Contractor
tk 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,"bwner 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, arnr excl.u'sivbly contracting with lice6sed
contractors tio'construct'the "project (Sec.'7044; Business & Professionals
(;ode).
I( I,am -exempt under Section B&P.C. for this reason
Date Sig-nat'ure of Owner
F11 WORKER'S COMPENSATION DECLARATION
!:hereby 'affirm under penalty of. 'perjury one o'f*.',the following declarations:
'I. -have and will maintain a'certificate of consent to self -insure for workers'
Compensation, as provided.'for by Section 3706'6f the Labor Code, for the
06&rmanbe of .the work for which this permit is issued...
'have and will' maintain,workers' compensation insurance, as required by
EA6ion of the Labor Code,, for the ' performance of the work'for which this
permit: is'issuec. My.workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
GOLDFN FAbI-
(ThisJ section need not completed if the permityaluation is for $1 00.00,or'
. less).
(t)' JI that in'the performance*of the work for which this permit is issued,
I*shA[l not employ any person in any mannersoas,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, l; shall forthWith comply with those provisions.
Dai6�6_ -'Tel -Applicant'
XWarning:'.Failuire to secure Workers'
orkers' Compensati . on coverage -is unlawful and
shall -subject an employer to criminal penalties and civil fines up to.$100,000, in
aclaitio dto the'. cost of compensdtidn", damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT ORTANT 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.
U, -
..J. Each person. port whose behalf this application is made & each person at
Whose. retIuest and for whose benefit work is performed under or, pursuant to
any *pe rmi t issued as a result of this applicaton agrees to, & shall, indemnify
& hold.harmless th6 City of -La Quinta, its officers, agents and employees'
2.i 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
*mit, or cessation of work for 180.days will subject permit to cancellation.
certify that -I have read this application and state that the above information is
corfect..l agree to comply with all City,.and State laws relating to the building
constr6ctio'n,and hereby authorize representatives of this City -to enter upon
'the,abbve-mentioned property for inspection purposes.
k e Date"
Signature (Owner/A0 nt)
BUILDING PERMIT PERMIT#-
DATE • VALUATION LOT C9:"71117,1 TRACT
4 $256.468.00 (02, 28776
JOB 'SITE '_
ADDRESS
APN
ate SOUTRFMN-ffl1X8
769- 00-024
OWNER CONTRACTOR/DESIGNER/ENGINEER
SOUTHERN HILLS, LLC R.C. HOBBS dba SOUTHERN HILLS, LLC
.1430 E CHAPMAN AVE'., Ste 100 45-5-960 PGA BLXD
ORANGE 0-A 92986 Lk QuLtrr-A CA 922-53
(714)633-7260 CBL# 5487
USE OF PERMIT
ROV/11 I V 122
LOT 2,PLAN 2CR -WD,P M -11T DOES NOT INCLUDE BLOCK. WALLS OR
POOLS. PLAN CHECK FEE REDtJCE,0 750,-bF0R1AULTf.PLV.S3UA.NCE OF
RANJEW AWTVPP
CUSTOM 0014STRUCTION 3,020.00 SF
PORCWPATIO 320,003F
GARACEfCARPORT 865.00 SF
ESTIMMO COST. OF CONSTRUCMN
256,468.00
IPE RA411f SEE SUMMARY
M,NNfRVCT1ON FEE 101-0N-418-000
PLAN QWXK FEE 101t000-439-318 $2142.44
NrlF04AKICAL FES .1011-000421,000
&EC 3TRICAL FEE 10.1 -00_42b=000 $180.50
PLUMBING FEE 1,01-000-419-000 $186.50
STELONOMOTION 'FEE. - RESID :101.000-211-000 $25,65
.
CRADING FFE 101-000-423-000 s20.00
WMASTRUCIU1EFHK 225-000-443-3421, $3,67417
ARTIN PUBLIC PLACES 4(11SW 701.-000-2554)00 1391.17
SUB40ra CONSIMUC710N AND PL -AN CHECK
$8,021.53
LE -PAI )"1 PRE DES
TOTAL 41ERMT FEES DUE NONNI
$8,021.53
[RECEIPT
DATE j rif
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.C.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath /
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final -
Utility Notice (Perm)
COMMENTS:
t
DEC729-1999 09:42 � WESTERN INSULATION, 909 686.8786 P;.09 19
WE,$T. RN INSULA'T'ION, :INCe
4211 Latham Street, &iverelde, Calif lob 92501
• (909) 686-8760
(909) 6864786 Fax
IN TION CER FICATE
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#: 2 !
SITE ADDRESS: .54-416 SOUTHERN HILLS, tA: QUINTA, CA:
EXTERIORWALLS: ,
MANUFACTURER: JOHNS -MANVILLE THICKNESS: 5 '/i" ; ' R -VALUE: R-21 ''
CEILINGS,
BLOW .
'MANUFACTURER: JOHNS -MANVILLE THICKNESS: 13" R -VALUE: R-38.
CEILINGS BATTS BLOW
MANUFACTURER: ` 'GREENSTONE •THICKNESS: 10.3" ' • R -VALUE: R-38 '
GENERAL CONTRACTOR: CENTURY AMERICAN DEVELOPMENT
LICENSENUMBER:
BY: ^
TITLE:
DATE:
INSULATION CONTRACTOR: WESTERN INSULATION, INC.
LICENSE NU ER: 481278 ' ;
BY:
f
TIRE: rodu on na e
DATE: DECEMBER 29,1999
129-99 09-50A
The DanD ee
('ontp�y b L icy 732542
ROOFING AND CONSTRUCT/ON
-/0
Roofing �p Pro osal
P.O. Boa- 277 Thocnat& 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# 564-1551 FAX# 564-5091 DATE 10=28-99
THE DAN DEE COMPANY INC. HAS SUPPLIED, AND INSTALLED '
THE ' FOLLOWING AMOUNT OF O-HAGIN ROOF VENTS.
z
-LOT# tt OF VENTS
1 16 •
17-
3 16
4 17
s 16
6 17
.7 16,
8 1S .
8 16
'Under the Mechanics lien I.aw (California Code or Gvd'Vrrr:edure Section 1161 cl sttq ). any :unvactrr, suhcantractor. laborer. suppltct other parer rte helps io
improve yrnlr pri,peny but is not paid for his warli er supplies, rias a right to enforce a daini against your property. This moans that, after a c purr nearing your properly
r:ornd be sold by a curt officer ane Ine proceeds of the sate used to %ansfy the indebtedness. This can happen avan rt you have paid your own conhactur In full If MP
Subwrttractor, law, -r or supplier remains unpaid and it legal action is necessary to collect or enhxce The terns of this centrad. the W evatbnsl pant Shall tw entitled to its
reasonable anornery fees pias all trouts of soil and interest shall accrue an all sums., Which are due 30 days atter billing at the rate at Id vi per annum. The DanDee Co.
Inc. is not re3Wns-ble for delays caused by weather. sinks• material shortage or delay qI material SUprdre d to the jco or to any other delay Wyono its contrnl Toe
DanDee Co Inc, total liability uruler Mm contract or in rit"Neme ivWnited solely to the amount of this ccmtrad
We are fully Ggvered by wgrkmen's compensation and,public liability insurance. Carriers names and faolicy numbers available on
requ"L
Any alteration or deviation from the a atxj oe specifications involving extra cost of matorial or labor will onlybe e*ecubid upon writtvii udders foi zwns8, mul will become
an a-tra diarye over the sum ntantinned in this proposal. Ail agreements mirar he made in wridting anu Is basud orl rree access to fntilding fnr direct loading froth vw
Prices are barred on currant costs or material and labor. Increases or decreases • Wm ho ron.«ad at tlme'ot signing contracr.
Before and or loving roofiriy operationsm
afid the coptetton of roofing, The Denbee Co Inc, will not be responaltyfa or liable for damage caused from
acts of God, such as eaMquakes, thunderstorms, hall or any other weather conditions beyond rooters control.
_ _ L)A'i'I{
R
Tl 1, DANDVE Co PKOPO 'W. VALID FO� PAY
s:w:wv.u:,N�.c.�u::rn.:kt•i�arr'�.-c�.I+3tf�fa�`et>•�:o:�i.'N.rC�.�st�o-�4'KTI�Y€?t>'i�•�+?i`��"-���l;F.SZc�3��a�.��t:7�fi "n— '°r`�tif �•.�h3t?'r��?
x<i d r�.•� . k
Cert�ficaOccupante.of _�. C
a
1 � • - - --_ - ,� o obi -. - .;�
Cit of La . unto y_
Building and. SaMtY-0fpartm
ent� ��OF
. or.
'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 comp/lance with the .various ordinances
- of ttie . City regulating building. construction or use. 'For the following:.-
BUILDING. ADDRESS: 54-416. SOUTHERN HILLS
-Use Classification:: SINGLE FAMILY DWELLING . :. Bldg. Permit No.:.,, 9901-.117
'Occupancy Group:; .R-3 -Type of Construction: -VN- ''. Land'Use•Zone: AL,
Owner'of Building: SOUTHERN HILLS, LLC :� Address: . 54-416 SOUTHERN HILLS
-�
City: , 1430-E CHAPMANAVii, STE .100' ;
• By: DANIEL,P. CRAW_F_ ORD JR. ,
Date. r� r
_ '- .Y �b� � •" - • Dat y � . ' • , ..
5/25/20.00 .
Building O ficial - , ` ,... • t,
` ' ' POST IN' A.CONSPIC000S PLACE^ c