9907-154 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I amlicensed 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 ryry .
rate ,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, 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 Section. 3700 of the. Labor Code, for the
performance of the work for which this permit is issued.
(� ff 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.
a ? l jI�£ .{v` ; t4WC s/1' 701400
(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
workers' compensation laws of California, and agree that if I should become
subject to the workers"compensation,provisio?s of Section 3700:of the Labor
Code, T hal fo M h comply wittf, > provision' 06
Dater fIApplicant ^' ��+�' �-
Warning: Failure'to secure Workers!, Com pensaton.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 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 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.
I certify 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
'the above-mentioned prop o Inspection purposes.
d �y
Signature (Owner/Agent) �!t "' "^ Dat).(),
PERMIT #
BUILDING PERMIT
DATE 1(p113{1"VALUATION S1 LOT TRACT
77
JOB SITE
ADDRESS ' fl `aTiP'iJ i7Pi ifaa "`AA►RtLK
AP
769161"09
� M.
OWNER
CONTRACTOR / DESIGNER / ENGINEER��Tr,yy����''
'O �"' P•�''31etJ.A r.��a �:oif.i�R:�i`it'�
Is".' "0 .r..1
A+�. +b.,,6ip1 Iil�t`�1f,�1I; IV TV 70055-160P^l
ABL
13RKN+,, E CA, 0886
.6A C,VIN 1'tA.
(,`.A,
9225.3
i^J91d163`I-'1`2tit}
13`O'Y 4:47
USE OF PERMIT
SM - LICOT 16 'A.UQ128 P0111VOT DOXiS NOT WMUDts .lBL4.-jCK WALL OR '.
K)"':iL, 750no PLA314 01U,%. %..TtTRX, Ur4(.)N A!'t?E,d4:ii.�Ff,)1t..iviU.i.7'3.i L1; SUS.fbtfl'g"M),., .
i � LiC1311°f1 � l� 3 ti:fJ�� SF
3F
.
Rico �'4Jr1 +p.i�•�iv�+S�.E'it�1RJc R'�,+1'�1
�.' y�.7��p.•�,y,�yA�'R3s�,ux,%.N`
q�.�y FEE
PRO
.�" gbk�',t R AI Yr�E Sillll•N-IK.P.ARA�
PLAIP4 C.xir:CK FEE S Oi-MO-439- 41;4 1,42A2.44
t1Ar10EMNJ `,rV.l+' E" $111.51)
N.WVRICA.L F'.F'S - w 1,1006-4204000 b',littf.s4
;
PY..A§'fk11B1N0 v}?1r 101 000-419-fftbf3
,
b 2a t!a
125 00
1�'J,Ch`.A!^'�O YTY�./rBION1 .)"3.�-l:+. '�;F�ESTY/ .1lf14VID-241.'4MXU •]25' 0 „$
tFi�F� i!:G 1.01- -423-000 $20.00
MU INT PURL IC" PLACUS -1€EUX _701-13I 2554 0t} 5341.17
aO
19EVEL0PE.:d:'4P AC:T 1F13Iv
,
s r
SUB 1KYr.A1, COwXi(:7T'i(?i•I ANP PL N C11FAAt1 14
g,:,,?E5v1 16
FUS
LESS 3".1" E-P.AID 3•li.L'S'
I0.��(�
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
a
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 G L
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
s
D vall - Int. Lath
001, Aj
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
A
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:
08/18/2000 10:47 FAX 780 347 9879 Emerald Rooflng,
!. Q01
•r c..
® ng, IIke- _
PROPOSAL.
7"70 MGHWAY 111, STE. 1.74.
Lp.� Q®JiT�I'I'A , CA 92253
GATE ! PROMAL w
(760)347-9069
S✓t6J*00 } _ _' 11415
-
r—NAME /7oiQ8,�
MONTECTTO
J08 ADSs '
AT PGA WEST
THE ILC. II® .coM.� r
i 1.0'I310.1� l0°HAGIIri YE�I'I'3J
I
i 55-W SOUTHERN ffILLS
!
LA QUINTA CA 9253bIcscpmIOfq
i TOTAL
---- -
�TO WHOM IT MAY
—�
°
EMERALD ROOFING- VIAS INSTALLED O'®AGIN VENTS AT MONTECIOT
HOMES AT PGA• WES'T.BELOW ARK THE ADDRESS AND NU."BER OF 9iE10_TS
INSTALLED.
II!
!
LOT At + PLANp A®®RESS q OF VENT's
1Q 2•ALa 34.614 SOUTHRRN HILLS - 17,
f
11 2-11 - 34.636 SOUTHERN HOLM 17
12 2-C 34.659 SOUTHERN H UA S 17
1$ 1-A 34.00 SOUTHERN RMLS 17
14 i•B 54-702 SOUTHERN TOLLS 17
' r �
1
113
'''-C -4-72 SOtJT]3=NHMLS 17I
t l
116
_ -2-9 $4.746 SOUTHERN IIIL.i.S 17
---_ ......
doh® Jom% ]President --; :
i
•
TOTAL $0.00
----- __.L�_.—.._
nm move PRICE. @ C19dCATiOPllll AND CQY�ri i0lV8 Hilt "TIDiAC MV APIA
._............... _��
ARE WMEBY ACCVYMD. VOL ARE AUi'HORIM T1O DO THZ WMX -AS SPECIFIED.
'
PAYMIT WILL BE bUDE ASOUTLUMDABiOM
JUN-02-2000 10:58 WESTERN INSULATION 909 686.•8786
P.13i19
'WEST---- tN INSULATI Nq INC.
- 4211 TAM= Since[, Riverside, caiffornia 92501
Tel. (909) 686-8760 Fax (909) 686-8786
AIT BJI,ATION CER110ICATE `
THIS 15 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 = TRACT #.29776
. LOT# Z16
SOUTHERN HILLS
SITE ADDRESS:-_--.- ----------------------._
--
----54-748
EXTE IOR ALLS'
• f'
MANUFACTURER: Johns-Manville THICKNESS: 5 1/2' R-VALUE: R-21 .
CEIL_ Nl GS• ,' ; .BATTS BLOW
MANUFACTURER: Johns-Manville THICKNESS: -13q R-VALUE: R-38"
'
CEILINGS: BATTS BLOW
MANUFACTURER:.Greensione THICKNES 1,0.3" R-VALUE: R-38,'
_.---•------------------------------- ------------•
TOR:"CENTURYAMERICAN DEVELOPMENT,
GENERAL' OCA NTRAC_
LICENSE NUMBER:
BY: _
TITLE:
DATE:
INSULATION CONTRACTOR: WESTERN INSULATION, INC.
LICENSE NUMBER: 481278
y -Z
TITLE: PROD TI N MANAG
DATE JUN 2;2000 ,
,
Ce'dificate,ofOcc'upant
"CitY of. LaQuin b.. 4
Building,qnd.,Safety,,Departnieot oF-°�' ,
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 bui/ding construction or use. For the following:
BUILDING ADDRESS: °+ 54-746 SOUTHERN' HILLS '
tR.
Use Classification:_ SINGLE.FAMILY DWELLING, Bldg.- Permit No.: • 9907-154
Occupancy Group: R-3 Type of Construction:,, VN Land Use Zone:-' RL
O.wvher of Building: SOUTHERN HILLS LLC Address: '1430 E-CHAPMAN AVE STE 100`
{ s City: ORANGE, CA., 92886
• By: DANIEL P. CRAWFORD' JR:
Date: 11/7/200,0
Building Official
POST IN A CONSPICUOUS PLACE.