9907-127 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed 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
4786-69, 02/29420(
vl)ate j^ 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). r .
( ) 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&RC: 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..
( ) 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.
001DUN.EAGLE XWC 547701400
(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"rcompensation 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 those, provisions.
,pate: ! r; ► Applicant-
Warning:
pplicant 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 the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director. of Building and Safety
fora 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 property for inspection purposes.
S!g ture (Owner/Agent)` ^""`r Date
BUILDING PERMIT PERMIT�3_��'
DATE VALUATION $2.% 41��{�i LOT --�j�' TRACT '1` 76
rr
!! 92
�'" SOUT.H�.F_1NL ld)i..a11 JOB
ADDRESS
APN Tel-' H�.14-014
\
OWNER %
CONTRACTOR / DESIGNER / ENGINEER
Si: LQ11ARD-1 KILLS LLC
R' .C. HOE BSS riga SOU':i HF.I N fULLS, LLC
1430.% CHAPivli0l AVE SM .100
55-960 PCTA BLVID
MANGE t;.,•'l 92986
LA QIIfNT°A (A 92253
C114)633-7260 CBL # 5487
USE OF PERMIT
SNOLE !°t9.MI:trY MVPL1.UING
SM - Lar Z2 Pi AN 6C PMAO.T DOLS NOT INCLUG►F,.1BLOM WALL Oil - .
l�Ut7L. '
CUSTOINI CO NS7RUMAOiJ 3,073.30 Sr-
:POIi(:I-tNIAT1O 320.00 SF
CfA.ftAt,f0t;t\RP0fC1' 810.00 8
EST 1A INTE, D COS T OP CONS'I"I:iJff:101N
259,674.50
P1. RAUT FEIv SUMMARY
(:ONSTRUC:TI N:FEE 101-000A18-000 51:;'199.50
d'LA?d r +~CK. FFF 1131(j0(1439- 318 $244:37
MEi:13f1NICAL I LILT 101-M-421,000 0 111.50
ELECMU CAL FEE 101-000-420-400 S181.33
PLOM31NO FEE 101-000-419-0W $186.51
C'q`I2 tiX(3 M(T [ (C31V F F _ 12F-5Tl. 1014100-241-0 521%,97
GRADING Ffr13 101-000-423-004 $20.00
i)tirVtsLOPEM iMPAC rE.E $1,907.00
APCIAN PU91AC.WLACk.S-.ICSit 701 -OW -255-000 x399.19
SUP T'f_7°f NL, CON;;iRI-I<,i'IC)v AND PLAN CfffCK
LESS PRE -PAID .FEES
$0.00
TOTAL PERAM FE&S DUE NOW
r1
RECEIPT
DATE
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
I
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
/
Compressor
Insulation
Vents
Fireplace .L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wali Firewall
Exterior Lath
Z
D II - 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 Pibg. 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 44
Utility Notice (Perm)
COMMENTS:
. Certificate of Occu anc= T
City of La Qdinta
�• � " .,tib
Building and Safety. -Department,
This Certificate issued pursuant tothe 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 building construction or use. For the following: .
t BUILDING: ADDRESS: 54-878 SOUTHERN HILLS _
Use Classification: SINGLE FAMILY DWELLING Bldg, Permit No.: 9907-127',,
Occupancy Group: R=3 Type of Construction: VN. Land Use Zone.: RL � r
-Owner -of 'Building:' SOUTHERN HILLS LLC.,Address: 1430E CHAPMAN AVE STE 100
t
City: ORANGE, CA., 92886
By: DANIEL P. CRAWFORD JR.
Date: 6/15/01
Building Official
POST IN A CONSPICUOUS PLACE
1
•OCT -19-2000 ' 12:14- WESTERN INSULATION.! -909 686 8786-. 'P..11/16
WEST ' INSU, LATiow, arc.
4211 Latham street, Riverside, CaLfornia 92501. e
' 47e1. (909) 686.8760. Fax (909) 686-8786
9 I1ITSULATI0, :CERTIFICATE
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: ,p
a TRACT / PHASE MONTECITO COLLECTION- 28776 PHASE 3A
LOT # .: 22w
�;
SITE ADDRESS 54,878 SOUTHERN HILLS, 'LA QUINTA, CA
—————----———-
EXTERIOR WALLS:
MANUFACTURER: ' GREENSTONE THICKNESS: 10.3" R-VALUE:'R-38
CEILINGS' BATTS BLO
MANUFACTURER: JOHNS -MANVILLE THICKNESS:' 1'3!''R—VALUE': R08
a !
CO Sc BATTS BLOW T
MANUFACTURER: •JOHNS ANVILLE, . THICKNESS: 5.5" R—.VALUE: R=21
GENERAL CONTRACTORt-_ R . C.'HOBBS CO -i.
LICENSE NUMBER:
BY: `
TITLE:
DATE: „
INSULATION ZONTRACTO_R: WESTERN INSULATION, INC.
LICENSE NUMBER:'481278
BY:
TITLE: OFFICE MANAGER
DATE OCTOBER 19, 2000
EMERALD ROOFING, INC. -
78-670 HIGHWAY 111, STE,
174
LA QUINT*, CA 92253
°
Llcense.N`o.770940
r
(760)34.7-986$
µ
October 26, 2000,
MONTECITO AT PGA WEST
THE R.C. HOBBS COMPANY
"
55-487 SOUTHERN HILLS
LA QUINTA, CA 92253
"
TO WHOM IT MAY CONCERN;
-
- EMERALD ROOFING HAS INSTALLED O'HAGIN VENTS AT MONTECITO HOMES "AT PGA
WEST. BELOW ARE. THE ADDRESS AND NUMBER OF VENTS INSTALLED.
PHASE 3-A TRACT#26776
LOT# PLAN#
17
ADDRESS
# OF VENTS
3-C
'
54-768 SOUTHERN HILLS
16 F
.18 3-A
54-790, SOUTHERN HILLS
16,
. 19 3-C
20
54-812 SOUTHERN HILLS
16
2-A
64-834 SOUTHERN HILLS
17
21 2-B
22 ''
54-856 SOUTHERN HILLS
.17 F
2-C;
54-878 SOUTHERN HILLS
17 '
23 2-A
24
54-900 SOUTHERN HILLS
'17
3 -CR
54=922 SOUTHERN HILLS`
16
PHASE 3-13 TRACT# 29776
LOT# PLAN.#
25
ADDRESS..
# OF VENTS
3 -AR
54-944, SOUTHERN HILLS
16
26 2-C
.
54-966 SOUTHERN HILLS
17
27 2-A
28
54-988 SOUTHERN HILLS
17 E
1-A
55-016 SOUTHERN HILLS
17
' 29 1-B
55-032 SOUTHERN HILLS
17
30 1 -CR
55-054 SOUTHERN HILLS`
17
31 1 -AR
55-076 SOUTHERN HILLS
17
..
THANK YOU,
JOHN JONES
'
PRESIDENT
01
v
Y